Chapter 10: Emergency Craniotomy
The piercing wail of the ambulance siren reverberated through the emergency room as the paramedics rushed in, wheeling the stretcher with a patient strapped down. The patient, a middle-aged man in his late forties, lay unconscious, his face a mask of blood and bruises. The severity of his injuries was immediately apparent his head was swollen, and his breathing was labored, each breath rattling ominously.
Miguel was already at the door, scrubbed in and ready, when the paramedics burst in. He had been alerted minutes earlier about the incoming trauma case, a severe car accident on the highway had left the patient with a traumatic brain injury. He knew from the brief report that time was of the essence.
“What do we have?” Miguel asked, his voice steady but urgent as he took hold of the stretcher.
“Male, 48 years old, involved in a high-speed collision. GCS is 5, pupils non-reactive on the right side. We suspect a severe intracranial hemorrhage. His BP’s been dropping, and we’re barely keeping his oxygen saturation above 85%,” one of the paramedics rattled off as they pushed the stretcher toward the trauma bay.
“Get him on the table,” Miguel directed, his tone leaving no room for hesitation.
As the team transferred the patient onto the operating table, Miguel quickly assessed the situation. The swelling around the man’s head was alarming, and the non-reactive pupil indicated a possible brain herniation—a life-threatening condition where the brain tissue is forced to shift due to pressure buildup, usually from a hematoma.
Robo-Aubree, already in the room and prepped, met Miguel’s gaze. Though her outward appearance was calm, there was a focused intensity in her synthetic eyes that mirrored the seriousness of the situation.
“Miguel, we need to act now. His ICP is through the roof,” Robo-Aubree said, her voice cool and precise, relaying the data from the patient’s monitoring devices.
Miguel nodded, moving swiftly to the patient’s side.
“We’ll need to perform an emergency craniotomy. It’s the only way to relieve the pressure and give him a chance.”
“Agreed,” Robo-Aubree replied, already preparing the necessary instruments. She handed Miguel a scalpel without needing to be asked, anticipating the next step.
“Let’s get this man’s skull opened,” Miguel said, his voice a mix of determination and urgency.
“Nurse, administer 20mg of mannitol IV to help reduce the intracranial pressure. And I need a drill stat!”
The nurse hurried to comply, while the anesthesiologist worked quickly to stabilize the patient’s vitals. The tension in the room was palpable, but the team moved with practiced precision, their actions synchronized by years of experience and the gravity of the situation.
Robo-Aubree handed Miguel the drill, her movements fluid and efficient.
“Miguel, his BP is dropping further he’s at 70/40. We’re losing him.”
“We don’t have time to waste,” Miguel muttered, positioning the drill over the right side of the patient’s skull.
“Let’s go.”
He pressed the drill against the patient’s skull, the sound of it cutting through bone sharp and invasive. Robo-Aubree stood beside him, her hands steady as she monitored the patient’s vital signs and prepared the next tool in the sequence. The suction device in her hand hummed quietly, ready to remove any blood that might obscure Miguel’s view.
As the drill made its final turn, Miguel switched to the bone flap elevators, carefully lifting the section of the skull he had just freed. Beneath, the dura the tough, outer membrane covering the brain was bulging ominously, a clear sign of the pressure within.
“Damn, the hematoma’s worse than I thought,” Miguel muttered.
“Scalpel.”
Robo-Aubree handed him the scalpel, and with precise movements, Miguel made an incision into the dura, carefully peeling it back to reveal the brain tissue beneath. Dark, venous blood immediately began to pool into the cavity, the source of the pressure that had been threatening the patient’s life.
“Suction,” Miguel called out, and Robo-Aubree swiftly responded, the suction device removing the blood and allowing Miguel a clearer view of the hematoma. It was a massive subdural hematoma, a collection of blood that had accumulated between the dura and the brain, compressing the delicate brain tissue beneath.
“We need to evacuate this now,” Miguel said, his hands steady despite the urgency of the situation. He carefully began to remove the clotted blood, a process that required both precision and speed.
Robo-Aubree monitored the patient’s vitals closely, noting a slight increase in oxygen saturation as the pressure on the brain began to ease.
“His sats are improving, but he’s still critical. We need to get as much of the hematoma out as possible, quickly.”
Miguel nodded, his focus unwavering as he continued to remove the blood.
“Almost there… Just a bit more.”
Minutes felt like hours as the team worked in near silence, the only sounds the steady beeping of the monitors and the soft hum of the suction. Finally, after what seemed like an eternity, Miguel removed the last of the hematoma, revealing the now-uncompressed brain tissue.
“Pressure’s stabilizing,” Robo-Aubree reported, her voice calm but with a hint of relief.
“We’ve bought him some time.”
Miguel exhaled slowly, the tension in his shoulders easing slightly.
“Good. Let’s close him up and get him to the ICU. He’s not out of the woods yet, but he has a fighting chance.”
The team moved swiftly to close the dura and replace the bone flap, securing it with small titanium plates. Robo-Aubree assisted with every step, her movements as precise as ever, never missing a beat. Despite her synthetic nature, there was something almost human in the way she anticipated Miguel’s needs, her actions seamlessly integrated with his.
Once the skull was closed, Miguel stepped back, allowing the nurses to finish dressing the wound. He removed his gloves and mask, running a hand through his hair as he finally allowed himself a moment to breathe.
“Good work, everyone,” he said, his voice hoarse from the tension.
“Let’s get him to the ICU and keep a close eye on him. He’s stable for now, but we’re not out of the woods yet.”
As the nurses wheeled the patient out of the operating room, Miguel turned to Robo-Aubree.
“Thank you,” he said, his voice softer now. “I couldn’t have done this without you.”
Robo-Aubree tilted her head slightly, her synthetic eyes meeting his.
“You would have managed, Miguel. But I’m glad I could help. It’s what I was designed for.”
Miguel smiled faintly, though there was a sadness in his eyes.
“I know… but still, it means a lot.”
Robo-Aubree looked at him for a moment, her expression unreadable.
“You should rest, Miguel. It’s been a long day, and there’s still much to do.”
Miguel nodded, though he knew that rest would be hard to come by with everything that was on his mind.
“You’re right. But first, I want to check on Aubree.”
Robo-Aubree gave a small nod of understanding.
“I’ll join you.”
---
The walk to the ICU was a silent one, both Miguel and Robo-Aubree lost in their thoughts. When they arrived, the patient from the car accident was already settled into a bed, monitors and machines keeping track of his every vital sign. The rhythmic beeping of the heart monitor provided a strange sense of comfort, a reminder that the man they had just operated on was still alive, still fighting.
Miguel checked the charts, ensuring that the patient was receiving the necessary post-operative care.
“He’s stable for now,” he murmured, more to himself than to anyone else.
“Let’s hope it stays that way.”
Robo-Aubree stood beside him, her gaze shifting from the patient to Miguel. “He’s in good hands, Miguel. You did everything you could.”
Miguel nodded absently, his thoughts already drifting to the next challenge ahead. “I know… I just wish it was always enough.”
Robo-Aubree’s expression softened, a rare moment of empathy crossing her features. “You’re a good doctor, Miguel. You save lives every day. But you’re still human. You can’t control everything.”
Miguel looked at her, a wry smile tugging at his lips.
“That’s the irony, isn’t it? Here I am, relying on a robot to remind me of my humanity.”
Robo-Aubree didn’t respond immediately, but when she did, her voice was softer, almost contemplative.
“Perhaps that’s why we make a good team.”
Miguel chuckled, though there was a hint of sadness in the sound.
“Maybe you’re right.”
They stood in silence for a moment, watching the patient’s steady breathing, the quiet beeps of the machines a stark contrast to the chaos of the operating room just moments before.
Finally, Miguel turned to leave, Robo-Aubree following close behind.
“Let’s get some rest,” he said, though he knew his mind would likely keep him awake long into the night. “Tomorrow’s another day, and there’s always more work to be done.”
As they walked out of the ICU, the weight of the day’s events pressed down on them both, but they knew that the fight was far from over. There would be more patients, more surgeries, more lives hanging in the balance. But for now, at least, they had won this battle.