The Godfather of Surgery

A Falcon 9 rocket lifts off from the Kennedy Space Center in Merritt Island, Florida.

This rocket will send the Dragon spacecraft to the International Space Station. The spacecraft was originally supposed to carry four astronauts, but now only Susan is carried, and the rest of the load is given to medical instruments and medicines.

Eight hours later, the Dragon spacecraft was captured by the Canadian robotic arm of the International Space Station and successfully docked with the space station.

Susan, a doctor astronaut, has been in space for the second time. The first time she stayed for six months, she completed a medical experiment and successfully developed a drug to treat lung cancer.

This time, she came up not for experiments, but for further examination by Steven.

Among all the astronauts who can go to the sky at any time, only she can complete the DSA of the whole cerebral blood vessel independently, which requires certain interventional treatment techniques.

Without resting for a moment, Susan fixed the equipment with the help of David Hawley.

On the space station, in a microgravity environment, if anything is to be used stably, it needs to be properly fixed, otherwise it will float.

There are many common interfaces on the bulkhead to fix these devices. According to the requirements of NASA, the manufacturer of the digital subtraction X-ray machine modified the machine overnight, so that it can not only be successfully sent to the sky by the rocket, but also can be fixed.

Steven also wanted to participate in these jobs, but was rejected by Susan, who was unfit to engage in any manual labor and sports until his condition was clarified.

Everything was ready, Steven was fixed on a flat board, and the restraint belts of his limbs kept him from losing control, especially his head was fixed and stable.

Susan is very accustomed to this microgravity environment, and even the best interventional doctors would not be able to perform techniques in this environment.

After the iodine contrast agent allergy test was confirmed negative, Susan began formal action.

Susan and David Hawley put on protective lead clothing, David Hawley was assistant, Steven's clothes were all taken off, Susan put on sterile gloves, and began to disinfect the right groin area, up to the navel, down to the mid-thigh, including the perineum.

The sterile sheet is spread with adhesive film, so that the sterile sheet does not float.

After local anesthesia, she began to puncture the right femoral artery. The puncture was successful, and the spurted blood was suppressed by Su Shun in time. Otherwise, those red blood droplets would have been scattered everywhere, which is considered a simple action on Earth, but very special in space. difficulty.

This plan would not have been possible without Susan.

The puncture is pulled out, the sheath remains inside, the guide wire goes in, and reaches a suitable position, the catheter enters along the guide wire, the guide wire is pulled out, Susan connects the syringe, and starts to push the contrast agent.

Even after more than ten hours of training, she was able to move proficiently, and no blood droplets were formed in the cabin.

A special syringe loaded with iohexol is attached to the tail of the catheter and injected into the artery.

The machine began to perform X-ray scans, and the ink-like images of blood vessels began to gradually diffuse, and the images were transmitted to the Earth--Ground Control Center in Houston.

The members of the expert group who had been waiting for a long time immediately focused their attention, each one had a computer, and the graphics on the screen were somewhat lag, because of the uncertainty of the network delay, this lag was also uncertain.

The computer's automatic picture capture function captures pictures one by one, and then saves them for later study.

Common carotid artery, internal and external carotid artery, vertebral artery, whole brain angiography, step by step, the whole brain blood vessel image spreads out, the thickness of each branch is meandering, interconnected, and the image is gradually improved.

"Susan! Not sure if there is a risk of bleeding, don't heparinize!" Professor Massimo, a professor of interventional medicine at Johns Hopkins, was instructing Susan to perform whole cerebral vascular DSA.

There was no such professor at the first meeting, and Johanneson raised suspicions of intracranial disease. This top professor of interventional medicine was invited, and he had to take the lead in the continuation of the intervention.

This interventional doctor has a very high talent. He has made numerous contributions to the interventional department, such as popularizing TIPS surgery and designing many cardiac and intracranial interventional surgeries.

TIPS surgery, transjugular intrahepatic portocaval shunt.

In 1986, Dr. Palmaz used balloon-expandable stent technology to establish a shunt on the basis of predecessors, and established the TIPS operation in the modern sense. In 1988, Frerburg first applied this technology to the clinic.

And this Professor Massimo, when he was young, designed a new set of interventional instruments and operation methods, which lowered the threshold for the top technology of this interventional department and made it popular.

Massimo is very creative, and has made extraordinary achievements in intervention, and has also accumulated huge wealth.

He has invented many interventional devices and consumables, and Medtronic, Abbott, Cook, and Boston Scientific have all cooperated with him, and half of the current new products are directly or indirectly produced by him.

In neurosurgery, Johanneson is the best in the United States, but in terms of intervention, he has to give in to this gentleman.

"You wasted 100 million dollars. If you give half of it as a bet, I will definitely dare to return to Earth like this." Steven said.

"Quiet, Steven!" Susan stopped him.

"How about the image quality, professors, my catheter doesn't dare to go any further, so I can only inject contrast agent here and ask for guidance." Susan really didn't dare to go any further. Root super selection, the image quality will be better.

"No need to move forward, enough."

Massimo's hair is white and black, he is personable, handsome face, slender and fit body, a pair of charming blue eyes, he has fascinated many girls at Johns Hopkins University.

The image quality of this complex and diffuse whole cerebral angiography is not very good, but it can be regarded as a failed angiography.

Susan did her best, and on Earth, she would have performed better and could deliver a high-quality image.

Johanneson frowned, I am afraid that this requires the artificial intelligence of GG company to read the film, it is difficult to judge whether there is a problem with the naked eye, and where the problem is.

Professor Massimo untied and took off his tie, and threw it on the workbench: "Oops! Small aneurysm in the life center of the medulla, lethal aneurysm!"

Before all the doctors could react, Professor Massimo had already made a diagnosis. Johanneson and Eugene studied the pictures one by one and asked suspiciously, "Are you sure?"

"100% sure, in terms of imaging and intervention, as long as I am alive, no one can surpass me, Johanneson, Eugene, believe me, the central aneurysm of the medulla oblongata is like a time bomb, ready to explode at any time, want this guy life." Massimo unbuttoned his shirt again.

"Is your air conditioner broken?" Massimo asked.

Collins shook his head, how could it be, isn't the temperature just right?

"Look, here is the aneurysm!" Massimo pointed out the location of the lesion.

It was a black mass, and it was impossible to distinguish the details. If it was looming, DSA also had a certain precision, and not all anomalies could be found.

However, if Massimo said there is, then there is. This genius, at present, the most classic intervention works in the world, more than half of which are his editor-in-chief, the most advanced intervention technology, and more than half of which come from his creativity.

He is not bragging, nor is he arrogant. In terms of intervention level, he is really the top of the world, an existence that no one can surpass.

"You can stop, Susan, thank you, hard work." Massimo ordered.

Johanneson finally discovered the not-so-obvious anomaly, and Massimo's judgment was correct.

The computer is connected to the medical brain of GG Company, and the image is enlarged and processed for comparison, and then the contrast gradually becomes obvious. Sure enough, the small aneurysm passing through the medulla oblongata nucleus.

Johanneson's pores tightened—the innominate artery, the artery that runs through the heartbeat center.

With this symptom, only one in a thousand is possible, but it happened to Steven.

"Medullary Innominate Aneurysm. This artery is the devil's curse. It crosses the heartbeat center." Johanneson paled.

Collins' dry lips trembled a few times: "What shall we do next?"

Everyone in the control center froze, looking at Massimo, now his best hope.

"If you return to Earth, a high-speed fall will cause the aneurysm to rupture, and you will surely die. If you don't believe it, you can use a computer to simulate it." Massimo asked Collins to arrange for doctors to use the GG company's platform to model and perform a return simulation.

"I take your word for it, I wonder, what should we do?" Collins asked.

"If I were on Earth, I would be 20% sure that the target blood vessel would be too complicated to complete this kind of intervention, and no one in the world has done this kind of aneurysm intervention. Currently, there are catheter guide wires and coils on the market. There is no way to do it, but I have finer and better products in my lab, but unfortunately there is no FDA certification. If I use these devices, I have a 20% success rate on earth, and I have completed 200 cases. The monkey animal experiment, damn, the air conditioner is broken." Massimo kept sweating.

"The incident must continue to escalate, and I am reporting to Washington now," Collins said immediately.

"He's on the space station now. Even if he takes the risk and sends me up, without enough training, I can't adapt to the microgravity environment above and can't complete the operation." Massimo shook his head.

"He's just an aneurysm, and you're the best interventional physician in the country!" Collins was a little excited.

"Don't yell at me, I can't stand your current style, put away your prestige, I'm not a member of your expert group, you invited me here, believe it or not, I'll go back to Baltimore now, this is your NASA business , has nothing to do with me." Massimo cried.

"I'm sorry, I was too impulsive, forgive me." Collins found himself too impulsive.

Massimo nodded: "Gentleman, talk to me well, I hate people talking loudly, the incident must be escalated, he can last no more than 3 days, that is, 72 hours, the shortest or in the next second the blood vessels burst, the blood vessels have been Beyond the limit, it can explode at any time."

"This is not an ordinary intracranial aneurysm. It passes through the center of life. No one in the world has ever done such an intervention. Even on the ground, I only have a 20% success rate, which is already the highest level in the world today, but It's a pity that he is in the sky now, four hundred kilometers in the sky, and I can't do anything about it." Massimo put away his former self-confidence.

"It's still expanding, and it's expanding just a few times with precise measurements," Johanneson reminded.

"But Steven isn't feeling well?" Collins' dry throat slurred.

"Slowing heart rate is the symptom, the next symptom is death, and once it bursts, the heartbeat stops instantly," Massimo told Collins in an accent.

"I'll report now!" Collins looked at Massimo and Johannesson.

"Yes, report, this is not a problem that you can solve, let your director roll over, don't sleep in Washington.

"I'll report right now!" Collins repeated.

He immediately reported to NASA's chief medical officer: "Sir, we need to activate the highest-level emergency plan. Steven's brainstem heart aneurysm will rupture and die at any time, and it will not last for up to 72 hours. Bad luck, at any time. die."

"Susan, give Steven a controlled blood pressure, let him rest quietly, and don't even talk." Massimo ordered.

Susan is also very nervous. In the space station, she is the only doctor, what can those limited and simple equipment do.

She was helpless, desperately helpless.