godfather of surgery

Chapter 407 The highest emergency

A Falcon 9 rocket lifts off at the Kennedy Space Center in Merritt Island, Florida.

This rocket is going to send the Dragon spacecraft to the International Space Station. The spacecraft originally had to carry four astronauts, but now it only carries Susan, and the rest of the payload is given over to medical equipment and medicines.

Eight hours later, the Dragon spacecraft was captured by the Canadian robotic arm of the International Space Station and successfully docked with the space station.

Susan, the doctor astronaut, is already in space for the second time. The first time she stayed in space for six months, she completed a medical experiment and successfully developed a drug for treating lung cancer.

This time, she came up not for experiments, but for Steven's further inspection.

Among all the astronauts who can go to the sky at any time, only she can independently complete the DSA of the whole cerebrovascular system, which requires certain interventional treatment techniques.

Without a moment's rest, with the help of David Hawley, Susan fixed the equipment.

On the space station, in the microgravity environment, if anything is to be used stably, it needs to be properly fixed, otherwise it will flutter.

There are many common interfaces on the bulkhead to fix these devices. The manufacturer of the digital subtraction X-ray machine modified the machine overnight in accordance with NASA's requirements. Not only can it be successfully sent to the sky by the rocket, but it can also be fixed.

Steven also wanted to participate in these jobs, but was rejected by Susan. Before his illness became clear, he was not suitable for any physical labor and sports.

Everything was ready, and Steven was fixed on a flat board. The restraint belts on his limbs kept him from losing control, especially his head should be fixed and stable.

Susan is very used to this kind of microgravity environment. If it were someone else, even the best interventional doctor would not be able to use his skills in this environment.

After an iodine contrast agent allergy test was confirmed to be negative, Susan began to act formally.

Susan and David Hawley put on protective lead suits, David Hawley was an assistant, Steven's clothes were all taken off, Susan put on sterile gloves, and began to disinfect the right groin, up to the navel, down to the mid-thigh, including the perineum.

Adhesive film sterile drapes are used to spread the drapes so that the sterile drapes will not float up.

After local anesthesia, she began to puncture the femoral artery on the right side. The puncture was successful, and the spurted blood was suppressed by Su Shun in time, otherwise the red blood droplets would scatter everywhere. What is considered a simple action on earth is very difficult in space. difficulty.

This plan would not have been possible without Susan.

The puncture is pulled out, the sheath stays inside, the guide wire goes in and reaches the proper position, the catheter enters along the guide wire, the guide wire is pulled out, Susan connects the syringe, and begins to push the contrast agent.

Even after more than ten hours of training, her movements were proficient, and no blood droplets scattered in the cabin.

A special syringe filled with iohexol, attached to the end of the catheter, is injected into the artery.

The machine started to scan X-rays, and the image of blood vessels like ink began to gradually spread out, and the image was transmitted to the earth—Houston ground control center.

The members of the expert group who had been waiting for a long time concentrated immediately. Each person had a computer, and the graphics on the screen lagged a bit. Because of the uncertainty of network delay, this lag also has uncertainty.

The automatic picture capture function of the computer captures pictures one by one, and then stores them for careful study later.

Common carotid artery, internal and external carotid artery, vertebral artery, angiography of the whole brain, step by step, the images of blood vessels of the whole brain are spread out, each branch is thick and thin, meandering and connected, and the image is gradually perfected.

"Susan! Not sure if there is a risk of bleeding, don't heparinize!" Professor Massimo, a professor of Interventional Medicine at Johns Hopkins, is instructing Susan to perform a total cerebrovascular DSA.

The first meeting did not have this professor. Johannesson raised suspicion of intracranial diseases. This top interventional professor was invited, and he had to take the lead in continuing the intervention.

This interventional doctor has a very high talent, and he has made countless contributions to the interventional department, such as the popularization of TIPS surgery, and the design of many heart and intracranial interventional surgeries.

TIPS surgery, transjugular intrahepatic portocaval shunt.

In 1986, Dr. Palmaz used balloon-expandable stent technology to establish a shunt on the basis of his predecessors, and established the TIPS operation in the modern sense. In 1988, Frerburg first applied this technology clinically.

And this Professor Massimo, when he was young, designed a set of brand-new interventional equipment and operation methods, which lowered the threshold of the top technology of this interventional department and made it popular.

Massimo is extremely creative and has made great achievements in intervention, for which he has accumulated a huge fortune.

He invented many interventional devices and consumables. Medtronic, Abbott, Cooke, and Boston Scientific have all cooperated with him. Currently, half of the new products are directly or indirectly produced by him.

In terms of neurosurgery, Johannesson is the best in the United States, but in terms of intervention, he has to bow down to this gentleman.

"You guys wasted [-] million US dollars. If I give half of it as a bet, I will definitely dare to return to Earth like this." Steven said.

"Quiet, Steven!" Susan stopped him.

"How's the image quality? Professors, I don't dare to go forward with the catheter, so I can only inject contrast agent here and ask for guidance." Susan really didn't dare to go any further. The image quality will be better with root-by-root super selection.

"No need to go forward, enough."

Massimo's hair is white and black, he is personable, handsome face, slender and fit body, a pair of charming blue eyes, has fascinated many girls at Johns Hopkins University.

The image quality of this complex and diffuse cerebral angiography is not very good, but it can be regarded as a failed angiography.

Susan tried her best. If she was on Earth, her performance would be better and she could deliver a high-quality image.

Johannesson frowned. This probably requires GG's artificial intelligence to read the film. It is difficult to judge with the naked eye whether there is a problem and where the problem is.

Professor Massimo untied and took off his tie, and threw it on the workbench: "Oops! A small aneurysm in the life center of the medulla oblongata, a fatal aneurysm!"

Before all the doctors could react, Professor Massimo had already made a diagnosis. Johannesson and Eugene studied the pictures one by one and asked suspiciously, "Are you sure?"

"One hundred percent sure, in terms of imaging and intervention, as long as I am alive, no one can surpass me, Johannesson, Eugene, believe me, the central aneurysm of the medullary life is like a time bomb, ready to explode at any time, I want this guy Fate." Massimo undid another button of his shirt.

"Is your air conditioner broken?" Massimo asked.

Collins shook his head, how is it possible, isn't the temperature very suitable?
"Look, here is the aneurysm!" Massimo pointed out the location of the lesion.

It was a mass of black, and the details could not be distinguished, and it was looming. DSA also has a certain accuracy, and not all abnormalities can be found.

But Massimo said yes, so yes, this genius, almost half of the most classic interventional works in the world is his editor-in-chief, and more than half of the most advanced interventional techniques come from his creativity.

He is not bragging, nor is he arrogant. In terms of the level of intervention, he is really the top of the world, an existence that no one can surpass.

"You can stop, Susan, thank you for your hard work." Massimo ordered.

Johannesson finally spotted the not-so-obvious anomaly, and Massimo was right.

The computer is connected to the medical brain of GG Company, and the image is enlarged and processed for comparison, and then the contrast gradually becomes obvious. Sure enough, the small aneurysm passing through the medullary nucleus.

The pores of Johannesson's body tightened—this artery is the innominate artery, which runs through the heartbeat center.

There is only a one-thousandth possibility of such symptoms, and it happened to Steven.

"Small innominate aneurysm of the medulla, this artery is cursed by the devil, it passes through the heartbeat center." Johannesson's face was pale.

Collins' dry lips trembled a few times: "What shall we do next?"

Everyone in the control center froze, looking at Massimo, now he is the best hope.

"If you return to the earth, the high-speed fall will cause the aneurysm to rupture, and you will undoubtedly die. If you don't believe it, you can use a computer to simulate it." Massimo asked Collins to arrange for doctors to use the GG company's platform to model and perform return simulation.

"I take your word for it, and I wonder, what do we do?" Collins asked.

"If I were on earth, I would be 20.00% sure to complete this intervention. The target blood vessel is too complicated. No one in the world has done this kind of aneurysm intervention. The catheter guide wire and coils currently on the market can't do it." Done, but I have finer and better products in my lab, unfortunately not FDA certified, if I use these devices, on earth, I have a 20.00% success rate, I have done two hundred monkey animal experiments, damn , the air conditioner is broken." Massimo kept sweating.

Collins immediately said: "The incident must continue to escalate, and I am now reporting to Washington."

"He's on the space station now. Even if he takes the risk to send me up there, I won't be able to adapt to the microgravity environment above and complete the operation without enough training." Massimo shook his head.

"He's just an aneurysm, you are the best interventional doctor in the United States!" Collins was a little excited.

"Don't yell at me, I can't understand your current style, put away your prestige, I am not a member of your expert team, you invited me here, believe it or not, I will go back to Baltimore now, this is your NASA business , has nothing to do with me," cried Massimo.

"I'm sorry, I was too impulsive, forgive me." Collins found himself too impulsive.

Massimo nodded: "Be a gentleman, talk to me carefully. I hate people talking loudly. The incident must be escalated. He can't last for 3 days at most, which is 72 hours. The shortest or the blood vessel burst in the next second. If you cross the limit, you can explode at any time."

"This is not an ordinary intracranial aneurysm. It passes through the center of life. No one in the world has done this kind of intervention. Even on the ground, I only have a 20.00% success rate, which is already the highest level in the world today, but unfortunately, He is in the sky now, [-] kilometers away, and there is nothing I can do." Massimo put away his former self-confidence.

"It's still expanding, just a few precise measurements of imaging, it's expanding." Johannesson reminded.

"But Steven isn't feeling well?" Collins said inarticulately from his dry throat.

"Slow heart rate is the symptom, and the next symptom is death. Once it bursts, the heartbeat stops instantly." Massimo told Collins with an accent.

"I'm reporting now!" Collins looked at Massimo and Johannesson.

"Yes, report, this is not a problem you can solve, tell your director to roll over, don't sleep in Washington.

"I'll report right now!" Collins repeated.

He immediately reported to the chief medical officer of NASA: "Sir, we need to activate the highest level of emergency plan. Steven's brainstem heartbeat central aneurysm will rupture and die at any time. It will not last for 72 hours at most. Bad luck. die."

"Susan, put Steven under controlled pressure reduction, let him rest quietly, and don't even talk." Massimo ordered.

Susan was also very nervous. In the space station, she was the only doctor. What could those limited and simple equipment do?

She was helpless, extremely helpless.

(End of this chapter)