Nearly 35 years ago, in one of the most remote regions of Canada, I looked down at an 11-year old girl and realized she was probably going to die.
A few months earlier, as my surgical residency came to an end, a colleague had suggested that I take a trip to Iqaluit—then known as Frobisher Bay, over 2,000 kilometres north of Montreal—because he thought it would be a good place for me to get away and study for my Royal College exams. At the same time, I could handle whatever surgical cases came up.
When I agreed, I didn’t realize this trip would shape my impending career as a doctor, and would end up affecting my entire life and future relationships.
The girl had been thrown from the back of a three-wheel all-terrain vehicle and hadn’t been wearing a helmet. As she lay unconscious before me, it immediately became apparent that she had a serious head injury.
If we’d been in Montreal, this young girl would have been sent to one of the two children’s hospitals, staffed by a qualified team of professionals using state-of-the-art equipment. Instead, all she had was me—a somewhat newly minted surgeon, who was licenced as a GP—as well as a pediatric resident from McGill and a scrub nurse. We were far from the dream team. However, what we lacked in experience, we made up for in determination and the sheer will to save this girl’s life.
She was intubated and hyperventilated to help reduce the pressure on her brain and to insure adequate oxygenation. But it soon became clear to me that we had to open up her head to release the pressure, decompress the brain and stop the bleeding.
Unfortunately, I didn’t have any experience in neurosurgery. I was trained as a general surgeon, who had last seen the inside of a skull a decade earlier as a medical student.
Nevertheless, we prepped the young girl for surgery. Lacking a proper razor to shave her head, and needing a drill to create a burr hole, we sent out for both. To our dismay, what we got back was a tool to shear sheep and a manual carpenter’s drill.
All we could do was collectively take a deep breath and begin shaving the patient’s head.
Then it was time to drill. However, without the help of X-rays or a CT scan, I had no idea which side of her head to work on. I was flying solo. I simply chose a side—I don’t remember which one—and began drilling manually. But the hoped-for results never materialized. As it turned out, I had drilled on the wrong side.
So I switched to the other side, and blood immediately started pouring out. Active bleeding through a small hole is not a good thing. I enlarged the burr hole by carefully removing a piece of skull, identified the torn artery and tied it off to stop the bleeding. Then the pediatric resident put her into a barbiturate coma.
She had survived the surgery, but just barely.
At the time, there was commercial air traffic in the area through Nordair. Luckily, a plane made a regularly scheduled stop the following day, and we instantly commandeered the space. We set up a makeshift ICU at the back of the aircraft, and it took off for Montreal, along with the pediatric resident, though I stayed behind.
Time passed. Eventually, I left the Arctic and arrived in Ann Arbour, Michigan, where I was to begin my transplant fellowship.
About three months later, the secretary to the Chairman of the Department of Surgery paged me, because someone in Montreal urgently needed to speak with me. I figured my time was up and my worst fears were coming true: I was going to get sued for malpractice or for practicing without a license.
I still remember tears forming in my eyes, as the voice on the other end of the line said, “The little girl you operated on in Iqaluit walked out of the hospital today as if nothing had ever happened. We thought you’d want to know.”
I thought of this life-changing experience in mid-November, as colleagues at a healthcare conference described how much they needed the right tools to advance digital—that is, connected—care. They had come from around the globe, including the Netherlands, Israel, the United States, Denmark, France and Canada. Many, if not all, agreed that the future is digital; it was the “how” that was subject to debate.
I’ve commented on the importance of connected care for many months. And I’ve listened to those who say we don’t have the “right tools” to embark on this ambitious initiative. Well, perhaps it isn’t always about having the right tools. Sometimes it’s about taking personal initiative and making the best possible use of the tools that are available right now—until the next generation of tools finally arrives. Maybe that’s how real change is forged.
In 1985, that’s how we did it. And the results were life-changing.
Lawrence