A four hours surgery which made me exhausted.
It was 1986 when in one of July days of that year I was call out to emergency hospital, room care in Dezful city at fourth Air Force Base.
There was a 24 years old, an Army soldier wounded by a piece of shrapnel.
Each day, I always had many wounded army soldiers during the war.
In that moment, I had several thousand surgeries but the most shocking surgery is the one that I will be going to describe.
The war wounded man, laid on a stretcher in a sea of his own blood, there was a hole in his left chest dressed intensively and under pressure and whole set of his chest paste and dressing was wet by his own blood.
At least, a chest tube was assigned for him in front line of battle field in a mass casualty situation but this was the fourth vial filled by blood, this means that it cannot be delay to chest tube and chest opening was indeed necessary.
The situation was so fatal that I told them I don’t need chest x-ray or radiological photograph. I said that there is no time for these works.
The young wounded man was taken to operation room and was laid on surgery bed with blood pressure level 5 and was anesthetized.
I went for washing my hands … surgeons usually has to wash their hands by brush antiseptic for wearing mask, and formal surgery room dress, drying hands, wearing gloves and fastening dress by operation theatre personnel.
Anesthetizatist said that blood pressure was on level ۵ and it was going to drop to 4.
Penetrating trauma causing central bleeding into a body cavity requires surgery of
Some sort and severe internal hemorrhage may require urgent operation as part of
The resuscitation process. Such patients have a high priority for surgery.
I act immediately; there is no time to wash hands as Dr. said.
This falling blood pressure will result in Hemorrhagic shock and
Incapacitate kidneys. Anesthetist, Dr. Jamdar. Replied that there is
no time to waste.
I was wearing a suit and a beautiful white shirt.
I took off my coat and put on a pair of gloves and I incised all the skin and major and minor pectorals muscles and kept inter rib muscles away and opened thorax which a flood of blood disordered my vision.
I fixed Rib retractor was keeping ribs away from each other, between both ribs locations and I was turning its handle to keep ribs away and find enough location for vision and function, by all these endeavors I could provide a small sized location.
In lowest visibility, severe bleeding and meanwhile the left lung, was inflated under pressure of anesthetization machine and made an obstacle for our function and vision and was deflated.
These actions were so iterated that we heard voice of rib breaking due to Rib retractor tension. I did not mind at all as long, he should be kept alive.
Suction pump was operated and suctioned blood within thorax with a disgusting sound to allow me to see bleeding location.
I could not find bleeding location in no way losing a huge volume of blood.
The patient was getting blood from (2 blood bags) and isotonic crystalloid solution.
Yes, the left pulmonary artery was possibly torn or perforated.
I progressed to pulmonary navel with the left hand and compressed thumb and number 2 fingers … in surgery fingers have numbers I controlled the left pulmonary artery but where? 15 cm in depth of bleeding notch I found that with touching not by seeing.
How strong was this artery? How I could enter and fasten clump with this low vision and this massive internal blood.
Meanwhile, internal mammary artery along with three intercostal inter rib arteries bleeding: My left hand was becoming too numb.
Surgical technicians took the left lung in a side but it was inflated due to artificial respiration machine if they didn’t take the lungs I had no that narrow space. .. in that moment, both of my hands were busy.
I was thinking to myself, why human being has no more than two hands?
I wish I was a bird and taking internal mammary artery with my beak.
I was wandering to myself how I got involved in to this situation?
If you progress layer by layer and have enough time in surgery you can either block or clump bleeding arteries or cauterize them. But what could I do In this surgery in which thorax was opened extremely quickly and if we had no such speed we would loss the patient.
Bleeding and foraging large blood clots caused Mediastinum shift among (the most dangerous possible events in one- sided chest hemorrhages) tension pneumothorax.
Chest central part where the heart and Pericardium and large blood arteries are placed there a very horrible place for surgeons in, shift was changed right- handed and if this curvature and shift would not be corrected both lower vena cava inferior and the upper vena cava superior one and having thin walls would be bent and closed and blood will return heart from head and body no more.
My left hand became numb and would be loosen soon, ask surgery technician front of me to enter right angle, (a type of surgical clump and proceed it deeply to place of my hand fingers place only by touching not seeing apparently… it was a fruitless endeavor. Suddenly I left internal mammary artery compressed above which by my hand and targeted pulmonary navel depth via right angle and blocked a dentil touching side of my fingers.
It was well done apparently and bleeding has been arrested, and artery hemorrhage was stopped.
I want to raise my numbed and tired hand that I noticed ”oh my GOD the glove ridge was trapped with clamp.”
Who can open the clamp and put it again on the right location exactly? I said.
”Okay I can bring out my hand from the glove and changing the glove” …. A cold sweating I filled at my whole body ….because, I did not wash my hands before this surgery!
In all my life experiences, during this field when I had to turn out the hands of the angel of the death and disappointed him to back off. I will face with a hardest situation like this which ”I agree to death of the patient eventually.”
The death was flying over the operating room. They wanted to take him away.
”It was necessary for me to challenge this battle because the life and death of this patient was depending on me and God.”
Could I succeed?
The operation was repeated again and this time my life was like a clock doing tick tack in my heart thinking any second will ready to explode from too much stress and tiredness rather than patient.
This time taking artery was correct and complete.
In this period surgery technicians took and blocked internal mammary artery.
I catch a comfort breath.
Although, we done all these operations smoothly thorax was full of blood again and suction pump was evacuated it.
I asked myself which blood-vessel I took. But bleeding is continuing different way than before.
Blood clotting problems would be occurred if bleedings could no longer be blocked if the conditions continued in this manner.
In effect, good bloods of patient containing plackets was losing and however he took bloods from blood bank but that bloods were not as good as this fresh blood.
Hemorrhage process was differed from previous time!
How thorax had vein bleeding insidiously.
”May be Azygous vein is bleeding.”
I told myself I can`t see Azygous.
May be pulmonary vein which always is placed in a same sheet with pulmonary artery was perforated by shrapnel and damaged. Discharging blood was restarted.
I precede the thumb, disabled left hand into thorax depth.
Yes, the left pulmonary vein was perforated and torn as I thought.
Hemorrhage was stopped but now satanic intercostal arteries are still bleeding.
Using “satanic” term for these arteries because they are the lone arteries rece