The brain surgery under bombardments!

According to Epic and Resistance Group of Fars News Agency (Tavana Club), during the Sacred Defense Era, different classes of society with different skills and expertise would defend the lands of the Islamic Republic of Iran. In fact they played significant role for the defense of their country.

Each person stood up against the enemy with the scientific or practical ability that he/she had. In this regard, the medical society, specially different fields according to the ethical and humanitarian charter that that had been sworn in, they helped the war veterans with all of the materialistic facilities that they had outside of the battlefields and they struggled so much to ease their pains; in a way that doing difficult surgeries is something great under that tough moments with the minimized level of facilities. The book ‘Wandering in strange land’ is a book which reviews the memories of physicians of the medical society dating back to the Sacred Defense Era. The following memory is one of the memories which have been selected from this book.

***

I have brought 12 injured patients. This one was G.S.SH and he had provided unilateral mediria, Phenytoin and two ringers and a blood bag. I have made a hole in front of his ear too. Has he got mannitol? No, Mr. Doctor! Thank you, you can take care of the rest injured patients. It was the final sentence that Dr. Saleh said to Zareh. After that he looked at me and he said: "Zareh is one of the good technicians for us. You should try to learn what is good from him, of course if we survive from these bombardments.”

A very heavy military operation took place last night 14 kilometers away from our desert hospital. It was close to the noon that the siege of our forces was broken and many of the injured patients were being delivered to another place. Zareh had taken the injured patients to the hospital by six ambulances. Our colleagues had put them on the beds so immediately and they were trying to examine and treat them. Zareh himself had considered the health condition of this patient who was so critical and he had done so many good initial health cares for him. He was only 24 years old and he had come to the battlefields voluntarily. I was also the resident of the third year of Surgical Neurology. I had come to the war zone only a few days before and still had not got used to with the situation and by each sound and noises, my heart would be trembling and a very strange weakness would cover me.

Each time that I would see the war veterans that they would fight against the enemy under the most difficult situation including the bombardments and rocket attacks, I would feel shy about myself. During the first days I had been frightened so much and sometimes my feet would shake uncontrollably, but now after this short period of time I was getting used to the situation gradually, but still my fears had not wiped out completely. When I got off the ambulance, I observed that the blade was still in his hand. At this time he shaved the head of the patient so quickly and he had connected some pipes to his lungs through his mouth.

Dr. Salehi, himself helped that they put the injured patient on the stretcher and take him to the surgery room. The desert hospital was under a soil hill close to the frontiers. It was a hospital that had the ability of doing relatively surgeries so good up to the Subspecialty surgeries. After the experience of American in the war of Vietnam and Korea, this time we Iranian were able to new experiences. But our experiences were different. In this way that after Triage, the hsoptial that had a bad situation and at the same place in the frontiers, the medical health cares would be done and those injured patients who would survive, they would be sent to Ahvaz and other provinces of Iran in order to continuer their treatments. By this work, the level of casualty and deaths would be decreased so much.

After delivery of the injured patients to the hospital, Zareh got out so immediately in order to arrange the work of delivering the injured patients to Ahvaz by helicopters. There were two other injured patients that one of them needed amputation and the other had a body full of quivers that had been most in his stomach and the other cooperators were taking out the quivers and bullets from his stomach.

The light of the surgery room got on. We washed our hands and we came to the injured patient in order to do the surgery on him. Dr. Zareh drew a very big question mark on the forehead of the patient. This big mark question would be started from the front side of his ears and it would go to the backside of his head and then it would be stretched up to his forehead. Usually the surgeons specify the place where they want to do the surgery on.

We started clearing the head of the patient by Betadine. Many cuts could be seen on his head. His left eye had been a bit bruised too and his pupil was dilated too. I asked this question from Doctor Saleh: "Wasn’t it better if the patient had received mannitol?” without saying any words, he nodded it meant that no! When the patient’s health condition was bad, he would think about his condition so deeply in order to do the surgery so nicely. During those moments he would talk so little and you would not dare to ask questions from him and none of us dared to ask a question for twice.

Since during this time I had used to his behavior, I never repeated my questions and before mentioning any words, I would give any tools or facilities that he needed to him. I had heard that in the hospitals of Tehran that he would work in the past, ten persons would be there to help him in order to do the surgeries. Also some sentimental nurses would help in the surgery room.

But now I as a giant man was helping him and Zareh who had a thin short and fat body. Also Zareh could help us if he had free time.

The anesthesiologist had connected him to the device. The doctor put the surgery knife on the places where he had drawn and he started the surgery. We did not have access to CT scan. He did not have the time of getting CT scan. The health condition of the patient was so bad and we did not have any opportunity except doing the surgery for him. I told myself, I will get my reply after opening this mark question.

Dr. Saleh was cutting off and he would put the meat layers away one after another and I could stop the blooding by pressing and I would give to him by the other hand.

It was the turn of the first hole. He put the drill tip on the ear; close the place when Zareh had made a whole with a nail. When it got close to the brain, he started taking out a layer of the bone. At this time, the blood clots started getting out. Since I was there, I directed the blood towards the device through the pipe. The anesthesiologist was so careful about the blood pressure of the patient. If this part of the surgery would be done so well, the rest of the surgery was easier.

I was trying to make the device to suck the blood clots through a pipe. Suddenly an explosion voice was heard so badly and after a few minutes a very big shaking moved all of us. I really controlled myself so much in order to prevent replacement of the pipe that had been connected to the brain of the patient in order not to let him die. The patient was really lucky that I did not do any additional movement. The lights of the surgery room started to turn on and off and they were gradually getting off. This situation continued for a few minutes. It was the habit of the Iraqis that they would open fire on the rear side of the war each time that they would be defeated by the Iranian forces so badly. In fact they wanted to retaliate by this work and all of us knew this issue so well that the explosions would be continued for a long time and that we must be careful more. Doctor Saleh widened each of the holes with a small spoon. During the surgery, each time that he would lean up due to tiredness uncontrollably, his head would hit the lights of the surgery room and each of us would say utter a formula of praise for constructor of the surgery room who had made the ceiling in a low height. Although the doctor was doing the work so deeply, but he would smile each time that he would hear we were uttering the formula of praise and he would say: "you shake the spirit of the ancestors and grandparents of the constructor of this hospital in the grave each time that you utter the formula of praise.”

During this time I had been interested to him so much. He was a rich man and he had a good wealth, but despite of this issue, he had come to the battlefields and his golden hands would do something that was really unexpected and educational for me. His wife and children had gone to foreign countries after the bombardments which took place against Tehran city and he preferred to come to the battlefields rather than going to foreign countries.

Now the skull of the patient had been full of holes the same as Swiss cheeses. He asked me to give the saw and I gave it to him so quickly. After that he used a device and took it into the two holes and then he put the saw behind it and he started sawing it. He did this work for each of the two holes that were close to each other in order to make a window into the brain. When he wanted to cut off the final hole, he said: "You must be so careful that the bone not the jump out and I put my hand on the bone, the saw was moving so close to my fingers in a way that I thought it will cut my fingers, but the doctor did it so carefully and skillfully that no wound was created on my fingers. Zareh who had worn uniform came there and he helped us.

Now it was the time of opening the window. This work was done cautiously too. Before that he separated the brain membrane so slowly and gently by the device, so that when we wanted to remove it not to tear suddenly. When he removed the bone, what appeared was the same as liver. The blood was clotted and by pressure on brain and all the connected parts led to pressure on the downside part and they had influenced the eyes nerves and they had led to the paralysis and dilated pupil in the same side.

The increased pressure of brain from one side and the localized pressure on the blood vessels provider based on the brain movement towards downside was a move like a fork created for the whole brain. By this action, this pressure was removed and the work of Zareh was penetrating the front side of the ear at the beginning of facing this injured patient with the reduction of the same pressure that as doctor Saleh would say, this work had been done so good and scientific.

Dr. Saleh asked: "Why didn’t you give mannitol? Zareh responded: "Because his pressure could be hardly measured. The injured patient due to much blooding, it had lost much blood and Zareh was able to stop blooding by wrapping a band. Giving mannitol which is done in order to do decline the brain pressure can lead to the bad health condition of the public situation of the patient due to decrease of blood pressure.

Rehabilitation regarding the consciousness disorder of the patient in addition of causing blowing to the head of the patient and the decrease of blood pressure could be resulted from the respiratory disorders due to blooding from the mouth and nose and also due to the damages to the lungs, brain and nervous system due to the use of poisonous gases by the enemy against the forces that had been surrounded. On the other side the blast wave was also effective in disrupting the consciousness. Also it was possible that dilated pupil comes from a simple nerve paralysis of the eye muscles which would not function properly. There was no CT scan in order to prove something.

A part of the liver (the blood clot) was removed by hand. The rest of the blood clot was suctioned by using a device with a curved bar. Bleeding vessels were clearly seen. Doctor Saleh burnt them with electrode competent after that he cut off a part of the brain membrane and he injected serum under that and since the blooding was not continued, he sewed it and he decided to see the window. The brain pressure was a bit high that for sure it should be due to brain inflammation. Therefore he preferred not to fix the brain to the former place exactly in order to let it to be a bit free. The skin pieces and membrane were put on the bone and then he started stitching them layer to layer.

He also put a perforated pipe between the bone and membrane in order to evacuate the blooding after the surgery and he connected the other tip to a plastic a spring-like cylinder in order to create vacuum for it. The surgery was almost completed and Doctor Saleh pointed to me by his head to put a bandage on the wound (to dress his head). I was putting the bandage on the wound suddenly an explosion wave that was so intensive compared to the past explosions and it cut off the light of the hospital.

The electricity line of the desert hospital had been damaged. Doctor Saleh shouted that they bring a flashlight but it was not accessible. The Anesthesiologist lit match. I put up the eyelids of the patient. The patient’s pupils had been smaller. Under the light shade of the match that was lit for two or three times by the anesthesiologist, I noticed the satisfaction light in the eyes of doctor Saleh and the anesthesiologist. The light of their eyes illuminated the dark surgery room for us.

The End