Phineas Gage pays a visit

Kandahar, Afghanistan

Actually, Phineas Gage died 150 years ago.  Gage was a young railroad worker who, while pounding on a tamping rod which had explosives packed below it,  had the rod blown through his cheek, traverse his brain and travel out other side of his head to land 80 feet away.  Gage was able to walk away from the accident, and despite becoming a bit of an eccentric relative to his pre-accident state, lived a normal life.

Last night, in the middle of an exceptionally busy day in which we admitted 29 trauma patients, we were paid a visit by an Afghani Gage.  This fellow somehow had an explosion detonated in front of his face which resulted in a 4 inch long bolt blown through the his right cheek, across his nasal cavity, resting adjacent to his second vertebral body.  Amazingly it missed the most vital vessels and nerves.  By report the patient presented to a local forward operating base with a chief complaint of "headache."  (You can't make this up.)  He allegedly walked into the clinic.  He was billed to us as another "IED blast victim."

He arrived at our hospital on an enroute care mission, already intubated and on a breathing machine.  This morning he was taken to the operating room.  Our neurosurgeon teamed up with our oral maxillofacial surgeon (OMFS) to extract the menacing object in a staged procedure.  Once it was determined that the dura - the cover of the spinal cord - was intact, and that no major vessels had truly been damaged, Steve, our neurosurgeon, methodically approached from the back at the base of the neck.

Sandra, our OMFS, was staged at his front side and debrided likewise, until she could feel the object.  Despite its size, she had a hard time locating the bolt which was located deep within his cheek or nasopharynx.

At one point I heard her say to Steve - who could easily see the end of the bolt from the back side, "Wiggle it a little so I can see it."  Like I said, you can't make this up.  Finally, Steve, who could better visualize where the bolt should be came to the patient's front side, inserted a plyers-like tool deeply into the gaping cheek-hole and plucked out the near pristine looking bolt, like a cork from a wine bottle.  We were amazed.

Tonight Steve examined the patient, after his breathing tube was removed.  He is moving all four extremities and speaking coherently.  Steve wants to get his picture with Afghan Phineas, standing side by side, and mount it in a photo next to the X-ray with that thing inside his head.  They'll have to flip a coin for the bolt I'd imagine.