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Doctor Russ moved into the prep room, scrubbed and sterilized his hands, stepped into a surgical gown, and donned sterile gloves and a mask. Then he stepped into the cramped operating room.
His patient, an engineering crew member named Franklin, was already on the table, unconscious but breathing, hooked up to the monitor and receiving oxygen. The man’s friend looked up as the doctor entered, putting down the electric groomer with which he had been shaving Franklin’s head. “Just his queue left, your honor. I don’t need to shave that off, do I?”
“This is fine, thank you, Devon.” Stephen cleaned Franklin’s head with soap, then isopropanol, then providone-iodine, and finally epi-stat; then considered the gash across the man’s right temple. The tissue had swollen, but the bleeding had stopped, and Stephen’s palpating fingers found no crepitation. “Very good,” he said.
Taking his point of departure from the superior temporal line at the zygomatic process, he directed Devon to press an emesis basin against Franklin’s head and began his incision, working quickly and carefully, dividing the skin and the superficial fascia, then then incising the temporal fascia and dividing the temporalis itself. He had never performed surgery in space before, and the living deck beneath his feet was distracting at first, but by the time he reached the periosteum he no longer noticed. “There,” he said to Devon, “see the crack? That is our culprit. Will you pass me the red-handled osteotome now? The small chisel-like instrument on the left?”
Devon found and passed the osteotome. “There may be some blood, now,” said Stephen, “so be ready with that suction catheter.” He scraped the periosteum away from the bone, then traded the osteotome for the trephine. “Hold the suction catheter here, now,” Stephen directed, and he pressed the diamond cutting edge to the bone, turning the handle and grinding into the living tissue.
He felt the subtle give as he entered the diploë, then the resistance again as he met the inner table. Suddenly the blade plunged into the skull, releasing a spurt of gelatinous, semi-clotted blood that Devon siphoned away, the catheter slurping and gurgling as it worked. Stephen peered into the hole, which rapidly filled with pulsing blood, then reached in with one finger to find the leaking artery. “There is a square, blue button on the monitor,” he told Devon, “could you press it, please? About the size of your thumb nail.”
Devon found the button, pressed it, and the blood pressure cuff cycled. Yes - the pressure was coming down. “Are you touching his brain, your honor,” asked Devon.
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