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Harry's New Toy
by Charles Kaluza
They were no sooner in the air when Harry was told, "Commander, I recommend you try and get some sleep. Here's a sleeping pill to help you. There is a sleeping berth in the aft section for your use."
Harry replied, "I should get some sleep but I don't think I'll need the sleeping pill."
"Sir, the sleeping pill isn't optional. It is essential that you arrive rested with minimal jet lag. My orders are specific regarding the use of the sleeping pill."
"What's in it?"
"Sorry, I don't know."
Harry did as he was told but not without mumbling under his breath about the damn military. His mind was racing and he regretted the extra glasses of wine which still fuddled his thinking. He thought, "This is a hell of a way to ruin my long-delayed honeymoon. Shit, I hope Martha is doing okay. She's probably right about this being connected to that damn virtual surgery project, my "new toy" she called it. I should have never got involved with it, in the first place. Must be an important somebody to have the President activate my status to active duty." His thoughts rambled on with less coherence as the medication took effect.
Harry fell asleep, a deep and dreamless sleep without any concept of time. He became aware of his present reality only when he heard a calm voice repeat, "Commander, it's time to wake-up."
He opened his eyes to the sight of the Lieutenant Commander holding a cup of coffee for him. He asked, "Where are we?"
"We're 30 minutes out from landing. You'll be transferred to the hospital via helicopter."
"But where are we?"
"Commander, your mission doesn't require knowledge of the geographic location."
"How long did I sleep."
"You slept the designated amount."
Harry sat up and gratefully accepted the cup of hot coffee. He asked, "Can you tell me what my mission is?"
"You will be fully briefed when you arrive at the hospital. I do know the equipment you use has already arrived."
Harry put the cup of coffee down and said, "If they're expecting me to perform surgery I'd better skip the coffee."
Harry did not realize it was daytime until he walked out of the jet. The sun was low in the sky but he could not tell if it was morning or evening. He was looking over a military airfield which had the same vast blandness of most military airfields. A jeep was waiting for him and transferred him to a helicopter which took him to the hospital. The helicopter had no windows in the back and he was deprived of any visual clues to his whereabouts. When the helicopter landed, he was escorted immediately into the hospital through an unmarked side entry and down some stairs to the basement. The technician he had worked with at the University research lab met him. Their amicable greeting was short and the technician immediately led him to the quiet room. They repeated the now familiar head shave and Harry was helped into the virtual reality suit. "When is someone going to explain what we're doing?" he asked.
The technician said, "They told me to get you connected as soon as possible. Apparently they'll be briefing you through the virtual reality circuits."
Harry was still grumbling to himself when the shield on the virtual reality helmet closed and the system activated. He felt the tingling sensation of the neuro-sensors on his bare scalp and his sensory fields were flooded with colors, sounds, odors and touch sensations . He followed the setup protocol and moved his extremities through the required motions to calibrate the system. Harry became directly linked to the miniature robot. His every move would be duplicated by the robot and every sensation the robot perceived he would sense.
A caricature of an admiral greeted him as soon as the setup was completed. The admiral welcomed him and apologized for the unusual secrecy and urgency. He explained, "We have a patient with a leaking berry aneurysm of the brainstem. The angiographers cannot reach the site because of the tortuous vessels. The neurosurgical team is prepared to perform a major resection of the skull base in an attempt to reach the site. It is in the nation's best interest that this individual not undergo such a radical surgery. It is our hope that you can reach the site through a small burr hole using the micro-robotics."
Harry remembered enough neuro-anatomy to realize the difficulty of the task. He explained, "I am a laproscopic surgeon not a neurosurgeon. I don't feel qualified to perform this surgery."
The caricature replied, "Commander, this has been reviewed at the highest levels. Your ability with the virtual surgery equipment is established. The neurosurgical team is here to back you up. It is your mission to use the skills you have acquired to save this person's life."
"But, virtual surgery is still a research project. The technology isn't perfected. I've never done anything like this!."
"Nobody has, but you're our best hope."
"Who's the patient and is it even legal for me to perform surgery?"
"The identity is not your concern and the legal issues have been resolved by military council. As an officer in the United States Navy you are being ordered to serve your country in time of emergency. Do you accept your duty?"
"Yes Sir. When do we start?"
"The patient is already in the operating room. The neurosurgery team is preparing to perform the burr hole. You will have 20 minutes to review the anatomy and proposed surgical procedure. Any questions?"
Harry replied, "I'll do my best but I'd better make a trip to the head before we start. "
When Harry returned to the virtual reality, he was immediately immersed in a three-dimensional MRI scan. Someone, a radiologist probably, guided him through the neuroanatomy from the temporal lobe down to the brainstem. He recognized the major vessels, and as they descended into the brainstem, a very well defined aneurysm. Harry realized how appropriate the term "berry aneurysm" was because this aneurysm look just like a large berry attached to a branch by a very small stem. A small blush was evident on the side of the aneurysm. He was told, by the faceless voice, that the leakage had decreased only when the patient's blood pressure was dropped significantly with medication.
Harry began to appreciate the difficulty in reaching the site. The vessels were small and twisted which prevented access of the angiography catheters. In order to reach the site directly a major portion of the skull base would have to be resected, resulting in significant surgical morbidity and a fair possibility of a surgical death. Even with the radical surgical procedure access would be marginal. Virtual surgery using micro- robotics did make sense. Having him do the surgery is what didn't. He asked, "Why can't one of the neurosurgeon's use the equipment?"
The admiral caricature returned and said, "We do not have time to train another surgeon. You are our only choice. If this aneurysm ruptures, the patient will die. If we must resect the skull base, our country will suffer. Commander are you ready to start?"
"Yes, Sir." Harry lost his pre-game jitters, it was time for the kickoff.
The entire virtual reality system activated. Harry found his virtual self inside the patient's head. He recognized the convolutions of the temporal lobe of the brain. He was walking on the stiff tentorial membrane which looked like glistening white burlap. He became aware of a voice directing him to move forward. Harry did as he was told. He could not resist reaching up and touching the soft substance of the brain just above his virtual head. The gray matter was covered with a soft velvety layer of the meninges which contained a lattice of blood vessels. The brain had the consistency of soft bread dough and the surface undulated into a pattern of sulci much like the texture of braided bread. The voice was telling him to angle more to his right. He moved carefully, immersed in the clear cerebro spinal fluid. The pulsations from the heartbeat were strong enough that every beat of the heart seemed to squeeze Harry. In addition another movement, a rocking sensation of the tentorial membrane was present. It was like the gentle swells of a protected ocean bay. Harry was immersed in silence except for the voice which was directing him. The exhilaration of actually being inside somebody's head and exploring their brain was awesome.
The voice said, "You should be able to see the tentorial notch, ahead on your left. I want you to follow it to the right until you come to the posterior cerebral artery."
Harry responded, "There is a rise ahead and then it drops off suddenly. I presume this is the tentorial notch. The space is becoming a little tight. Can you provide some traction?"
"We are already retracting the lobe as much as we dare. Can you make it?"
"It's tight but I can make it." Harry stooped his virtual self to move ahead. He was walking along the edge of a cliff. Up and to his right was the undersurface of the temporal lobe of the brain, which acted as a ceiling. To his left was a vertical tube that descended into an abyss which contained the brain stem and the spinal cord. As he looked up to the left, he saw nerves which appeared the size of telephone poles entering the substance of the brain. He came across a large vessel which looped around the edge of the cliff. The voice identified the vessel as the posterior cerebral artery.
The voice commanded Harry, "Follow the artery as it descends and connects with the basilar artery."
Harry did as he was told, climbing over the edge of the cliff and pulling himself along the artery. It felt as if he were crawling crossing a deep canyon on a log bridge which pulsated with every beat of the heart. His bridge was only a fraction of an inch long but to his virtual self it was a major crossing. He looked down the became dizzy and concentrated on looking forward. He saw the artery joining others to form a large vessel. The voice identified it as the basilar artery and told him to keep going. He was now climbing down the brainstem and thought, "My God, this is the very essence of life. The brainstem evolved almost a billion years ago and has changed very little. It is the control center of all critical life functions." The surface was still covered with the velvety meningeal membrane but the texture of the sulci were replaced by a flat smooth surface.
He reached another branch of the artery and the voice said, "You are at the superior cerebellar artery. Follow it half way around the brainstem and you will come to the aneurysm." Harry turned and followed the smaller artery. He seemed to be half floating with poor traction and the resistance of pulling the connecting wires and micro-tubes was making forward progress difficult. His built in light illuminated the immediate area, but the region ahead curved and disappeared in darkness. He was sweating profusely from the exertion and excitement. His physical status must have set off an alarm because the voice told him, "Commander, take five."
Harry was happy to comply. He spent his rest just looking at the myriad of structures arising in the brainstem, each of which was essential for life. It was easy from this view point to understand why minor strokes at the level of the brainstem were so catastrophic. His rest period ended quickly and Harry returned to work. The space remained tight and had an obvious curvature. He crawled on his virtual hands and knees, half wedging himself between the artery and the brainstem, pulling the connections along. Harry was concentrating so hard on moving forward that he was startled when the voice announced, "You should have visual on the aneurysm now."
Harry looked up and saw a bright red beach ball attached to the side of the artery where another branch came off. He acknowledged the voice saying, "I have visual. The aneurysm looks very fragile."
Harry approached within touching distance of the aneurysm. It was pulsating with the heart beat and a trickle of blood revealed the small leak on the topside. The neck of the aneurysm was about the size of his virtual hands and the aneurysm itself was at least the width of his shoulders. The voice asked for several views of the aneurysm. Harry maneuvered his virtual self around the aneurysm providing a complete three-dimensional view. Close examination of the leak revealed a stream of blood cells arising from the microscopic opening They were quickly diluted in the CSF fluid. It resembled a wisp of smoke arising from an old campfire.
His introspection was interrupted by the voice asking, "Commander, can you place a tie around the neck of the aneurysm?"
Harry responded, "I can maneuver a tie around the neck, but I am not sure I can tie a knot that will hold. Can we coat the aneurysm with TissueGlue?"
There was silence for moment before the voice responded, "Your irrigation system will plug if we use the TissueGlue first. We will pass you a special suture tie through the irrigation catheter. It works like the cable ties which slide in only one direction. You must wrap the tie around the neck of the aneurysm and insert the free end in the locking device. As you apply traction to the free end, the suture will tighten. After you have secured the neck of the aneurysm, we will use the TissueGlue."
Harry had used his virtual hands to explore the surface characteristics of his surroundings and to control the surgical instruments. He had never tried to do anything as delicate as placing a suture. The voice asked, "Commander, are you ready?"
"Ready." Replied Harry, but his thoughts were much less certain as he tried to visualize using his virtual hands to control the suture.
The voice said, "We will be floating the suture through the irrigation port. Point the irrigation away from the aneurysm. When the end floats free of the irrigation port, you need to make sure that it does not tangle."
Harry dutifully pointed the irrigation port away from the aneurysm and watched the irrigation fluid create swirls in the slightly cloudy CSF fluid. Soon, a small rope began to float out of the irrigation port. Harry carefully directed the port so the rope would not tangle. His virtual image revealed a rope which was about twice the diameter of his thumb. He knew in reality it was a very delicate suture, finer than most sewing thread, but in his miniaturized world it was a thick rope. The connecting end did not float free of the irrigation tip. Harry did not wait for advice and began pulling on the rope trying to free it. It was stuck and his virtual strength was not adequate to dislodge the rope.
The voice advised him, "Continue pulling while we increase the fluid pressure to see if we can dislodge the suture."
Harry pulled for all his virtual self was worth. The sudden release of resistance sent him tumbling backwards off of the artery he has standing on. Only the resistance of the connecting wires prevented him from falling further down the brainstem. He regained his footing still holding onto the suture. He was a little dizzy from the rapid attitude change. The voice asked, "Are you okay?"
Harry responded, "It'll take me a minute to regain my balance. I don't think this simulator suit and chair were designed for such aggressive maneuvers."
It took several minutes before Harry felt comfortable moving about. He climbed back up to the aneurysm. He carefully looped the suture over the aneurysm trying not to touch it directly to prevent a catastrophic rupture. It was proving difficult to keep the suture from floating out of position, while trying to connect the two ends. His virtual hands just did not have the dexterity to control everything at once. After several minutes of frustration he said, "I am going to try creating a lasso effect by inserting the free end into the locking end first. I will then place the loop over the aneurysm."
Harry concentrated hard on inserting the free end into the locking device. He pulled a small amount of the suture through the locking device to create an easily held loop. Using his outstretched arms, he draped the loop over the aneurysm. The noose tightened on the neck of the aneurysm as he began carefully pulling on the free end while holding the locking end in his other hand. The miniature hands lacked a perfect sense of touch and the left hand slipped from the suture. Harry instinctively tighten his arm muscles to control the robot arm motion but not quick enough. The robotic hand brushed against the aneurysm. A minimal touch but it was enough to puncture the fragile membrane. The out rushing blood pushed Harry's virtual self away like a fire hose and it was all he could do to hang on with his right hand. The blood covered his visual sensors and blinded him. He groped with his lift hand blindly until he again grasped the free end of the suture. Harry tightened the noose with all of his virtual might strangling the aneurysm and stopping the flow of blood. His visual sensors were clearing and he stepped back to inspect the aneurysm. It appeared as a limp beachball hanging from a tree limb. The bleeding had stopped but the brain fluid was clouded by the blood.
The voice said, "Commander, that was close. You responded well. We will begin pumping the TissueGlue through your irrigation device. Several light coats should be applied over the entire aneurysm."
Harry pointed his irrigation port away and watched the cleaning solution swirl out of the tip. When the much thicker TissueGlue became evident, he turned the port onto the aneurysm. He painted the entire structure with several coats of the glue. It was like painting a beachball with an airbrush. He stepped back and looked at his work, thinking,"Not to bad, if I say so myself but it was almost a catastrophe."
The voice said, "Return along the arterial path. Nice job."
Harry was enjoying the adrenaline rush, and would have liked to have explored some more, but did as he was told. He had no sooner climbed over the edge of the cliff, when his virtual reality ended. The visor opened and he was again just Harry, sitting in the simulator chair. The technician helped him remove the suit and Harry realized how much he had been sweating. The suit was drenched.
The technician smiled and said, "Commander, I would suggest a shower was in order. I don' t know what you were doing, but you were sure working hard. I was surprised to see the simulator chair going inverted."
Harry responded, "I am not sure I want to ever experience it inverted again. The shower does sound good and maybe a bite to eat."
When Harry got out of the shower and dressed in a set of surgical scrubs, a sandwich, an apple and a glass of water were waiting for him. He was finishing the simple lunch when the Lieutenant Commander who had accompanied him walked in. He told Harry, "I understand your mission went well."
"Thanks. I would like to give my wife a call."
"I'm sorry sir, it's not allowed. The helicopter is waiting to return you to your wife."
It was night when Harry climbed into the helicopter. The air felt very dry and the terrain seemed flat. He could visualize some city lights in the distance but he still could not figure out his location. Harry and the Lieutenant Commander had no sooner transferred to the small jet when he was again advised that some sleep was in order. Harry accepted the sleeping pill knowing that it was not optional. As he lay on the small bed, he thought of Martha sitting alone in the hotel room. He remembered how disappointed she was when he had to cancel their first honeymoon. Harry had worked hard, taking double call, to free up enough time during his residency for a honeymoon. They were just getting ready to leave for their honeymoon, when he the telephone call came, informing him that two of the residents had been injured in an auto accident. His leave was canceled and Martha missed out on her honeymoon. He would do his best when he got back to give her the honeymoon she had deserved for so long. The medication took effect and sleep again overcame him. He was awakened by the calm voice repeating, "Commander, it's time to wake-up."
Harry was still sleepy and asked, "Are we there yet?"
"We will be landing in 30 minutes and I will have you back to your hotel by 9:30 A.M.."
Harry gratefully accepted the offered cup of coffee. His breakfast consisted of prepackaged pastries and a child's box of juice. He concentrated on his coffee.
As Harry finished his first cup of coffee, the officer began the short debriefing. He advised Harry, "Your mission will remain classified. You are not authorized to reveal any information regarding your mission. You will receive one week of reserve officer pay for your time on active duty. Any questions?"
"No, none I suppose which can be answered."
Harry was escorted back to his hotel and knocked on their room door saying, "Martha, I'm back."
Martha opened the door and without saying anything reached up and grabbed Harry around the neck giving him a passionate hug. She ignored the naval officer accompanying Harry. They were interrupted by a discrete, "Excuse me sir, I will be leaving you now."
Harry turned and said, "Thanks for your help."
Martha grabbed Harry's hand and pulled him into the room, closing the door behind them. She sat him in the chair and started to turn off the TV. Harry said, "Wait. I want to see this."
The morning news was reporting on the interruption of the mideast peace talks because of Yasser Arafat having undergone surgery to remove a benign lesion behind his left ear. The telecast showed him leaving a hospital with a bandage over his ear. He waved to the cameras as he climbed into his limousine.
When the report was over Harry told Martha, "You can turn it off now."
Martha looked at Harry and asked, "Did you have something to do with his surgery?"
Harry shrugged his shoulders, and said, "I'm not sure."
Story © 2003 by Charles Kaluza email@example.com
Illustration © 2003 by Romeo Esparrago
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