Unfolding A Man
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Even now, living with what we would consider severe disability must be a miracle to him. Can you imagine how hard the rehab must have been?
My heart aches for what he and his family went through. and then I think about kids here who we are told are suicidally depressed from the last year.
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The joy on his wife's face...wow.
That said.
I've seen several patients with ankylosing spondylitis. None, of course, were as severe as this poor mans. A former colleague of mine had it - it made life difficult for him. He couldn't turn his neck or flex/extend his neck. When he needed prostate surgery, managing the airway was a problem. The last time I saw Don, he was in his early 60s, and just becoming symptomatic. This poor man's disease was obviously much, much, more aggressive. Wow.
The surgeon's comment: "He didn't bleed too much."
I've always hated, HATED, big-ass spine surgery. There is frequently a lot of bleeding from raw, exposed bone. There's really no way of controlling it, other than to hurry the hell up and get it closed so that pressure of surrounding tissues stops it. One of my former colleagues (the lady who died of kidney cancer, if you recall) gave anesthesia for some of these big spine cases - Harrington rod insertions for kyphoscoliosis, and they were always a nightmare. There are so many considerations, beyond just keeping the patient asleep. You have to keep ahead of the blood loss, you have to keep the anesthesia just deep enough so that the guys monitoring spinal cord function can detect if the surgeon is causing a problem.
Before the advent of sophisticated neural monitoring in the mid 1980s, we would do a "wake up test." The surgeon would get everything in position, hoping that he didn't affect the blood flow to the spinal cord, or compromise the cord itself. Then, we would lighten the anesthesia to the point where the patient could respond to a verbal command ("Wiggle your toes!"). If the patient would, we'd deepen them again, so the surgeon could finish the procedure.
It was real balls-out anesthesia. DIdn't like these cases at all, and I tried to avoid them.
Did I mention, I hated these cases? I'd rather do an open heart on the sickest patient in the hospital than one of these.
Kudos to the people that did this one, and to all others who embark on this treacherous, scary path.
Hated these cases.
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That made me cry.
@George-K interesting stories. That is a "world" that I know about nothing.
