Ellen & her Dad discuss surgery for Alec

[ellenkushner]

The story I'm frantically trying to finish on time, "The Man with the Knives" (about Alec on Kyros) needs, of course, a scene where he shows up and blows everyone in Sofia's village away with an unexpected feat of emergency surgery. My father's specialty is research & rheumatoid arthritis - but surely he knows enough to help me out? Particularly since he has a big collection of antique medical books. So: Phone call:

EK: . . . So anyway I've found a field manual from the Civil War online, but I'm not sure I understand what it's saying. [ADDED] Can I do something with crushed ribs and letting out a hematoma?
Dad: OK. Well, what century does this occur in?
EK: Sometime between 1500-1800
Dad: That's a little before the Civil War. [Discussion interrupted. Dad will call back later.]

EK emails Dad:
http://books.google.com/books?id=w2o-AAAAIAAJ&dq=field+hospital+surgery&printsec=frontcover&source=in&hl=en&ei=H6vSSq2MMcvelAfRuLipCg&sa=X&oi=book_result&ct=result&resnum=11&ved=0CC0Q6AEwCg#v=onepage&q=rib&f=false

p. 107 "When the lungs are wounded . . . . "
??
earlier in chapter - trephining?

Dad to EK:
Yes!

Trephining is good.
From Wikopedia:
"Evidence also suggests that trephanation was primitive emergency surgery after head wounds[2] to remove shattered bits of bone from a fractured skull and clean out the blood that often pools under the skull after a blow to the head. "

Have him trephine to evacuate a subdural hematoma.
DAD

And so it goes. We just had a lovely talk about scalp wounds. Any surgeons out there?

Or even someone who can quote Patrick O'Brian chapter & verse? I betcha anything Stephen Maturin does cool surgery I could steal. Scalpels only, if possible, please. A drill would simply ruin the scene.

Comments

[brewsternorth.livejournal.com]

Reminds me of a trepanation from M*A*S*H (the novel, not the movie or TV series) when one of the medics makes an incision into the patient's head to reveal the skull, then makes the hole in the skull using a hammer and chisel and a steady hand. (Which I think, before the advent of specifically-sized drills, was the SOP for trepanning.)

Other than that, got nothing. Not a surgeon, me.

Erk about the PO'B - never read them, but I was once familiar with the fandom...

[tamago.livejournal.com]

Didn't Dr Maturin do this in the Master & Commander movie?

[ellen-kushner.livejournal.com]

Great minds think alike - I just added that last line to my post!

[rm.livejournal.com]

Patty wants you to know that there is evidence of cavemen performing trephanations, so she figures Alec can handle it.

[ellen-kushner.livejournal.com]

What did they use for drills?

[wordsofastory.livejournal.com]

Flint axes or polished stones, most likely. It's pretty interesting, actually (http://www.uic.edu/classes/osci/osci590/13_3%20Trephination%20An%20Ancient%20Surgery.htm)!

[lyonesse.livejournal.com]

unless there's a conveniently-hole-makin' amount of bone damage, i'm afraid you're stuck with a drill, awl, or chisel. knives don't do much to bone, as those of us who eat meat can testify ;)

(i'm not a surgeon, but i'm a neuroscientist.)

[(Anonymous)]

There's a scene in O'Brian's novel HMS Surprise where Stephen performs surgery on himself to remove a bullet. Does that help?

Jim Cambias

[scbutler.livejournal.com]

The Greeks trepanned. Maturin makes note of this when he trepans a member of the crew (I don't remember which book). After the operation the crew of the Surprise treat Maturin as a religious holy man through the rest of the books.

[abrakadabrah.livejournal.com]

In GG Kay's Lion's of Al Rassan, Jehane's father does cool trepanning while blind.

Apparently there are some interesting medieval texts about it - I bet he would know more source material. You're friends with him, I believe you mentioned previously.

[henrytroup.livejournal.com]

Notably, most of the skulls show healing, so the patients often survived.

[sartorias.livejournal.com]

Maturin uses a drill to trepan a fellow in the first book. He operates on himself in the third book to remove a bullet from near his heart.

A lot of his scalpel work is actually on dead bodies.

[tamago.livejournal.com]

My husband is the big fan of the Aubriad in the house, but he couldn't remember the book off hand. I see you've got more answers below.

[rikibeth.livejournal.com]

Maturin's specialty was "suprapubic cystotomy," which I think has to do with removing bladder stones. Also, in the trepanning, it is notable that he had one of the crew hammer out a coin very thin to serve as a skull plate afterwards. Joe Plaice was the one with the hole in his skull. Did you need book/chapter/page cites? The books are right over THERE.

[ellen-kushner.livejournal.com]

Oh, Stephen. Bladder stones might be just perfect! If you can find a quick reference I can crib from, I'd be much obliged.

[rikibeth.livejournal.com]

From this handy glossary website:
http://www.alia.org.au/~kwebb/Maturin/MMRZ.html

suprapubic cystotomy (PC 62, 434, DI 85, WDS 180, YA 211, BATM 230):

An incision into the bladder to provide an opening.

That'd be page cites for Post Captain, Desolation Island, The Wine-Dark Sea, The Yellow Admiral, and Blue At The Mizzen, in case the abbreviations don't make sense.

And here's Wikipedia on the operation itself:
http://en.wikipedia.org/wiki/Suprapubic_cystostomy

Can't wait

[(Anonymous)]

This is a part of Alec's story I've always wanted to read.

Nancy Werlin

Re: Can't wait

[ellen-kushner.livejournal.com]

Hmmm....any chance you've got time to read a draft this weekend?

[belledewinter.livejournal.com]

Yes, more Riverside! ♥ *makes grabby hands*

[ellen-kushner.livejournal.com]

The internet is truly wonderful - and so are you! Many thanks.

I can actually see Alec & Stephen having a lovely time together. In a perfect world, they both attended the same University for a time. Although, at that age, they may not have gotten along.

[redrose3125.livejournal.com]

exactly my thought!

[rikibeth.livejournal.com]

Stephen was a flaming revolutionary in his youth, and he dueled a lot! I fear they might have come to grief. If they'd met when they were older, though, that might be something.

[thumbelinablues.livejournal.com]

I feel like the trephining may get overused because it's so dramatically helpful and can be done with just a drill - the bladder stone thing could be good, though! For my two cents, I just read about a cool thing: in case of flail chest (two or more contiguous ribs broken in two or more places, creating an entirely separate section of the chest wall that moves in when the patient breathes out, and out when s/he breathes in, which a] hurts and b] will eventually poke a lung and cause even more bleeding, cause there's probably already a contusion from the blunt trauma that produced the flail chest - sorry, longest parenthetical EVER - ::breathe::) -- you put the broken ribs in a counterweight-traction set-up. Found a page on it ()!

I'm voting for this partially because I want to see Alec shout "FETCH ME SOME BANJO STRINGS AND A BOTTLE OF WINE," then drink half the wine, pass the banjo strings under the injured rib sections, and use the rest of the bottle as a counterweight while the people of Kyros go, "...what just happened?"

[ellen-kushner.livejournal.com]

Ribs! I knew it!

I love you more than I can say. When can I take you out for a bottle of wine? (You bring the banjo strings)

linkage

[ellen-kushner.livejournal.com]

Your flail chest link it linketh not - again, please?

[thumbelinablues.livejournal.com]

Squee! Love you also. If we go out for a bottle of wine, I will bring a whole banjo.

Here's the link; I won't try to use l33t HTML this time: http://www.primary-surgery.org/ps/vol2/html/sect0256.html

[yaoi-in-exile.livejournal.com]

So distressed for the welfare of the characters, it is not EVEN funny, oh-dear, oh-d-d-dearie-dear... *frets*

'Alec' and 'emergency surgery' in the same context do not a calm anticipatory reader make.