As I sat in my clinic staring at the newspaper, the phone suddenly rang. It was the Accident & Emergency Unit, and they had an accident case for me. The voice at the other end of the phone sounded urgent, saying it was a bad case, asking if I would accept it.
The day had just gone pear-shaped.
Broken Glass Everywhere
I hurried over to find Mr Woon, a 26 year old man lying on a stretcher. He was pale and had a large blood soaked pack applied to his neck.
The ambulance person recounted the details – Mr Woon had been involved in a head-on collision with a van. He had been catapulted off his motorcycle and went through the windscreen of the van. That he was wearing a helmet probably saved his brain, but his neck had landed on the jagged glass of the shattered windscreen.
Gingerly, I peeled back the blood soaked pack to be confronted by an absolutely ghastly wound in the neck stretching from ear to ear.
There was some bleeding coming from the wound and he was partly breathing through the wound indicating injury to the windpipe (trachea).
Everywhere there was broken glass.
Hastily I replaced the pack. A quick glance at the monitor showed the blood pressure was holding well though Mr Woon had clearly lost a lot of blood on his way to hospital.
Quickly, I checked to make sure there were no other major injuries elsewhere. I then calmly told Mr Woon that he needed emergency surgery as soon as possible.
Mr Woon weakly nodded and extended a shaky hand to sign the consent.
I then spoke to Dr Wong, the On-Call Consultant Anaesthetist.
In a move of sheer brilliance, Dr Wong instructed me to send Mr Woon straight up to the operating theatre (OT) where he would resuscitate the patient rather than the usual process of admission to the ward first which would have wasted much time.
In OT, I encountered Dr Wong getting Mr Woon ready for general anaesthetic. The bleeding in the neck seemed to be under control with the pack in place. Next door, the nurses were busy readying the trolley and instruments. Blood had been ordered from the Lab but it would take some time as the blood had to be cross-matched first.
As I watched Dr Wong go about his preparations, suddenly Mr Woon coughed violently.
In that instant, something in his neck gave way. A huge amount of blood suddenly erupted forth from his neck, gushing to the floor.
His blood pressure, which had been 120/70 up to that point suddenly plummeted to zero – unrecordable!
For a split second, we stood rooted to the spot, horrified by the disaster unfolding before our eyes.
“O-negative blood! Forget about the cross match. Get me some O-negative blood! NOW!” barked Dr Wong, hastily slapping a new pack over the neck.
(O negative blood is used in desperate situations where there is no time at all for cross match.) All this was bad enough but what really scared me was seeing the normally calm and composed Dr Wong go totally pale.
There wasn’t a moment to lose.
Clamps, Clamps, Clamps!
I sprang through the door into the operating theathre, my mind racing as I went through what I would need and what I was going to do.
“Clamps! Lots of clamps! Vascular clamps. No, not those big ones! Medium sized and small ones. Bring the whole tray! Ties! Vascular sutures! Vascular needle holder! Skin prep! LOTS of it!”
I hastily scrubbed and gowned up, mindful that next door, Dr Wong was going through his own battle to maintain BP and do a crash induction of anaesthesia.
Surgical protocol dictates that at the start of each case, the surgeon carefully prepares the skin with antiseptic solution before carefully draping sterile towels exposing just the operative field to maintain sterility.
No time for that!
I figured all the sterility in the world was useless if the patient died from massive bleeding. If there was wound infection, I can always treat it with antibiotics later.
“Give me that skin prep!” I began pouring the skin prep all over the wound as the nurses looked on, protesting.
“Skin prep – DONE!”
I began clipping and clamping the bleeding vessels. One of the scrub nurses tried to arrange some towels around the wound to give it some semblance of surgical decency.
As I secured the bleeding, I glanced up anxiously from time to time to observe the BP monitor as well as the colour returning to Dr Wong’s face.
The rest of the operation progressed at a more measured pace.
I had to repair the jugular vein and the trachea. Then there was all the debris to clear, not to mention a lot of glass fragments.
The next day, I recounted to Mr Woon in a shaky voice what had happened in OT and how close we had come to losing him. He nodded feebly, understanding and whispered “Thanks”.
By then the hospital had got to hear of my little adventure.
It’s a curious feeling, having looked Death in the face, then having ripped someone from his jaws.
The “Hero Moment”
Years ago I was one of several short-listed candidates for a Registrar post in the UK. One of the other candidates was a smarmy lad with a smug face that looked on others with a patronising smile.
He spent his time in the waiting room telling the other candidates of a stab injury to the chest he had treated as a Casualty officer. The knife had penetrated the heart.
With tremendous courage and presence of mind, he opened up the patient’s chest in Casualty, withdrew the knife, then placed his finger in the wound to control bleeding while he sutured the wound in the heart.
He saved that patient’s life and was the hero of the day. He was known to the interviewers. None of the rest of us had a snowflakes chance in hell of getting that job. I went home dejectedly that day, like a dog with tail between the legs wondering why they had bothered to short-list the rest of us.
But here, right here with Mr Woon, my “hero moment” had arrived, unexpectedly.
What was it like?
Well, it was like walking on air for about a week. Sweet.
By the time I emerged from that state, it was time to send Mr Woon home.
I saw Mr Woon many times after that. He needed several minor operations to remove bits of retained glass that had slowly worked its way to the surface over the years.
But he never complained, and we were both glad he was alive. I can honestly say I couldn’t have chosen a nicer person to save.
And I could not have done it without the fantastic nurses at Lam Wah Ee Hospital and Dr Wong.
That is how every year without fail, a box of mooncakes appears at my door at the time of the Mid Autumn Festival. The mooncake followed me, even when I moved to Gleneagles Penang Hospital.
Yes, I do get other larger, more elaborate boxes of mooncakes too.
But it is this box that is, in its own quiet way, the most special one of all.
POSTSCRIPT – by Mr Woon
The first time I saw Dr Khoo was the next day after the accident. With a soft spoken voice, he told me what had happened the night before. I believe luck is not the only reason why I’m still living today; the skill and talent of Dr Khoo and all the personnel in the OT had saved me. Thanks Dr Khoo, you have become an integral part of my life.
Thanks for attending my wedding ceremony in 2004. My wife (then girlfriend) was riding together with me when the accident happened. She was, luckily, unhurt.
My daughter Zi Yi is 7 years old now. One day I’m going to tell her of the adventure I had.