Now You See It - Now You Don't

Every surgeon is acutely aware of the risks associated with surgery and will rarely operate on poorly defined pathology except in dire situations. This usually works out very well; the X-rays show an arthritic hip and it's replaced or studies indicate a diseased gall bladder so take it out. Every now and then a red herring swims into the picture to muddle things up. This is a tale about preoperative evidence of pathology that could not be found after the patient was opened up, an unusual occurrence, but it sometimes happens and throws everyone for a loop.

A very pleasant, matronly seamstress was out shoveling snow from the sidewalk at  her place of business and experienced the worst headache of her life and collapsed. She was rushed to the hospital and cerebral angiograms revealed an anterior communicating artery aneurysm.  There was also blood in her spinal fluid, but there was some question that a traumatic tap could have accounted for this  finding. Given the conclusive angiogram the spinal tap was not repeated. The only treatment at the time  was an open craniotomy and clipping the offending aneurysm removing it from circulation. This procedure was pioneered in the 1930's by neurosurgeon  Walter Dandy (google him for a fascinating life story.) He is one of my personal heroes.

Dr. Oddo scheduled the surgery which was commenced on a  January afternoon. Everything was proceeding smoothy until Dr. Oddo gently exposed the offending artery and lo and behold there was no aneurysm to be found. Anesthesia always catches the blame when something without an obvious cause occurs and this was no different, "What did you do to her blood pressure?  She must be in shock because the aneurysm receded," Dr Oddo hollered. Anesthesia reported that vital signs were normal and stable much to Dr. Oddo's consternation.

Desperate situations are not conducive to good decision making. Dr. Oddo requested anesthesia for a pharmacologic boost in blood pressure. If there was a weakness in that anterior communicating artery he was going to find it. Remembrances of my uncle stuffing sausage popped into my head as the blood pressure escalated. "You can only stuff so much meat into the sausage 'til the casing breaks," was one of his admonishments. I began to worry Dr. Oddo was going to pop this ladies sausage aneurysm. Even with the pressure boost the artery held. No sign of the offending aneurysm.

The next victim for Dr. Oddo's high pitched screaming  would be the circulating nurse as Dr. Oddo shrieked, "Get those angiogram films up on the view box - pronto!" After what seemed like an eternity studying the films, Dr. Oddo was really discombobulated. The X-rays did indeed show an aneurysm and it was definitely involving the anterior communicating  artery.

It was finally time to take a lesson from Old King Cole so he called for his head mounted fiber optic light, he called for his loupe, and any neurosurgeon that might be free. Dr. Oddo's skeet shooting partner and fellow neurosurgeon, Dr.Penfield, made one of his usual grand entrances and the surgical site was unveiled  with the ceremonial removal of saline soaked sponges. Dr. Penfield was equally bumfuzzled by this bamboozling series of findings (no visible anteriot communicating aneurysm) and sauntered away from the table muttering something about a miracle being the only possible explanation.

Dr. Oddo quickly and very meticulously closed the craniotomy all the while contemplating what to tell the family. He finally concluded that if he told them the absolute truth, they would be angry eith him for ripping the ladies head open for nothing so the story he related was that the aneurysm had been "taken care of." This seemed to satisfy the anxious family and the lady was wheeled of to the neuro ICU where the nurses were enthralled by the incredible report of the surgery.

The neuro ICU nurses cared for her with a devout sort of respect reserved for those touched by a divine  being. Who knew what supernatural or celestial  power purged that aneurysm from her cerebral circulation? Churches have  lots of  stilted verbalizations  and relaxing  music, but God probably does most of his heavy lifting in hospitals.

This was the only miracle I have ever witnessed and this ladies wounds healed in an unusally brief period of time without any complication whatsoever. She walked out of the hospital four days later with a festive red scarf covering her bald head, a big smile on her face, and a twinkle in her eye. I always had the feeling that she knew more about what had happened than any of us ever realized.