WILSON da SILVA
"YOU'VE NEVER seen an operation before?" asked Dr Chris Pike as we entered Theatre One at the Prince of Wales Children's Hospital. "Well, you've picked just about the most gruesome one for starters."
We are to see a fairly new technique for spinal correction, a Cotrel Dubousset operation. Dr Pike travelled to France last year to learn the method, in which metal rods are inserted into a patient's back and the spine straightened through rotation.
A 13-year-old Lebanese girl lay face down on the operating table, naked and raised in the mid-section by a cushioned bench. She has scoliosis, a spinal deformity brought on by puberty which affects about one in a thousand adolescent girls.
A metal crown was riveted to her skull, and a set of weights attached which pulled on the crown, partially straightening her otherwise crooked spine. Green cloth was placed over everything but her back, and stitched to her skin so it would not slip off. An antiseptic was painted on, and a straight line drawn down her back.
Dr Pike made a 15 cm incision into her right hip, reaching the hip bone. Scissor-like grapplers held open the cut some 7 cm. With a chisel-like instrument and a stainless steel hammer, he began to chip away at the bone.
The scrub sister held out a small bowl into which Dr Pike dropped pieces of chipped bone.
"That's for the bone graft," he said. "She's going to need that later."
He cut a 35 cm line down her back. Using an electrically heated scalpel, he continued to cut deeper and deeper into the flesh. Four more of the scissor-like grapplers came out to hold back the flesh.
The heated scalpel cauterised ruptured blood vessels as it cut, reducing the flow of blood. A younger doctor, holding a mechanical sucker, worked around Dr Pike, sucking blood away where it began to pool.
Dr Pike occasionally hummed with the Muzak coming from overhead.
"You know what that song is, anybody?" he asked as his gloved hands worked inside the girl's back. "That's True Love, a song from a movie called High Society, with Bing Crosby and Grace Kelly."
Soon, all of the flesh was peeled back and the girl's spine, twisted up into her right shoulder, was visible. It was a mass of spongy red, white and mustard. Dr Pike chipped more bone away deeper into sections of the vertebrae, then inserted stainless steel hook-clips up and down the spine.
There were eight in all. He occasionally referred to a foolscap page pinned to the green cloth, on which he had drawn the girl's crooked spine and where the hooks were meant to go. The yellow-coloured paper was sprayed almost white with steriliser.
"I remember a registrar I had working with me who I used to have competitions with (over) who could pick the most number of tunes. I beat him hands down, but over the months he started getting better. He got so good he could pick a tune before it had started properly. I used to dread Friday mornings."
He looked across to the clinical physiologists who were monitoring signals sent up and down her spine, checking for any breach of the spinal canal. They signalled all was well.
"So we agreed to a showdown one Friday. The week before I rang the matron to ask for a list of next Friday's Muzak. She said she didn't know where to get them, but said that (the registrar) would know, cause he's had the advance list for months."
The hook-clips in place, Dr Pike called for the bowl with the girl's chipped bone. He covered the space around the hooks with bone, sealing it into vertebrae sections.
Using a two-handed tool, he bent a 20 cm metal rod into the now only slightly irregular shape of the patient's spine. When it matched, he inserted it through the hooks, using a large pair of pliers with a screw-grip holder.
"If I tried to buy this from a surgical supplier," Dr Pike said, motioning with the pliers, "it would have cost me $600. I got the same sort of thing from BBC Hardware for $60."
The first rod was inserted, holding the girl's spine rigid. Screws were driven through the hook-clips and into the rod.
"Now for the moment of truth," he said.
With the help of his assisting registrar, he grabbed the rod with two pliers and slowly rotated her spine about 50 degrees back to the left. Another, much straighter rod was inserted into the four other hooks, and two bridging clips held the rods together.
Bits of excess stainless steel rod were bolt-cut away, and more screws riveted in. The screw heads were broken off. The "Harrington" rods were now irreversably in her back.
"She'll be up in four days and back to school in three or four weeks," said Dr Pike, as he left the closing-up to junior surgeons. "It's an amazing procedure. Before this they had to wear a plaster vest for three months, and a plastic vest for another three months after that. With this, in six months she she can play tennis."
The next morning, he visited the girl in the children's ward. She lay on her back, and was happy to see him. She twitched her toes for him, lifted her knees. Her spine was okay.
"You are Doctor (Pike)?" asked an elderly lady in a thick accent. "You are a good man, a very good man, doctor. Thank you."
He turned to me, partly embarrassed by the emotion and sincerity of the woman, partly afraid to be painted by this reporter as a hero.
"Don't quote that," he said.