The Great Wall of China18. The TBI

Dr Chen's story was less innocuous than mine. I presented at the first hospital with little or no indication of trauma. The medical team became suspicious when I started responding to questions with inapplicable answers. The lucid interval was followed by intermittent loss of consciousness. A low GCS score led them to the first CT scan. That revealed the cerebral laceration and subdural hematoma. I was transferred to Beijing Tiantan Hospital, the leading neurosurgical center in China, when the first hospital determined that they could not adequately treat my intracranial trauma. I was unresponsive on arrival and admitted into surgery where the neurosurgical team performed a craniotomy to relieve intracranial pressure.

Much of what Dr Chen said was gibberish to me, but I noticed that he bragged about his hospital. That is very common in China. No matter what city they live in, it is always a leader in some field or has the best of something in the world. No one ever lives in some dirtwater town somewhere. And it is hard to contest their boasts. Is Beijing Tiantan Hospital the leading neurosurgical center in China? How would I know?

But then it started to sink in. Neurosurgery is brain surgery. The word craniotomy meant nothing to me, but -otomy is surgical cutting. Cranium is the skull. My second greatest fear in the entire world is having brain surgery. If the first hospital told me they wanted to cut into my skull, I would have refused treatment. I don't want brain surgery anywhere in the world. And I really don't want brain surgery in China. When I touched my wrapped head, Dr Chen kept talking. The fabric was too close to my scalp. My hair was not twisted underneath. It was gone.

When I asked Dr Chen what a craniotomy was, he explained it in clinical detail. My head was shaved and I was intubated endotracheally. Under general anesthesia, an incision in the scalp was made and a pattern of small burr holes were cut into the skull. The bone was cut progressively between adjacent burr holes and the bone flap was separated from the surrounding skull. An incision in the dura exposed the hematoma, which was irrigated and excised. Following successful relief of intracranial pressure, the dura was closed with polyglycolic sutures and the bone flap restored with polyether ketone plates. The scalp was stapled closed and dressed. An external ventricular drain was inserted to continuously monitor ICP and drain cerebrospinal fluid. An arterial catheter was used to monitor blood pressure.

I was monitored in the ICU and given corticosteroids to control swelling, prophylactic anticonvulsants to prevent seizures, and antibiotics to prevent infection. Sequential compression devices were wrapped around my legs and medicine was administered to prevent blood clot formation. Blood was routinely drawn to determine sodium and potassium concentrations and red blood cell levels. Brain activity was monitored with continuous EEG and follow up MRIs. When extubated, oxygen saturation levels were monitored by pulse oximetry. Neurological checks were performed over the next 72 hours.

In addition to everything north of the border, they also did a pregnancy test, which seemed strange to me. None of my injuries were anywhere near that neighborhood. Not that it mattered. I'm officially and not surprisingly not pregnant. I found out much later that some of the drugs they gave me could have been fatal to any pregnancy. The Chinese government might not want anyone to have babies, but the Chinese doctors routinely check to make sure everything is safe just in case.