Medical Chronicle

In the waiting room

Sam Davies en formation médicale 2
© Eloi Stichelbaut

A day like any other in the South. The solo skippers seem to be coping well, but suddenly it all changes. A lot flashes through your mind, the call, the cries of pain, suffering and despair. Instanttly, you understand. It’s serious, but the suffering is so strong that he is unable to express it. Wait for him to calm down, even if you know it’s urgent to know what is happening. Reassure him. Keep him talking. Tell him you’re there to help. Let him get over the stress and come to terms with the fact that his life is in danger. Come up with simple questions with clear answers. Put them a different way to check. That sounds better. He is no longer panting and seems calmer. He knows now that he is not alone and that others are there to take care of him to get out of there.

He tells you about the incident, the pain, his fears. All he went through to get to the phone. In such situations, where there is a serious threat, the body is only half conscious, where reactions come naturally without any need to think. The power of life itself is in these instant reactions, that consciousness and feelings can only shut off.  First the pain is turned off to stop it paralysing the body. Thanks to endorphins, a natural morphine secreted in minute doses within the pain compartment of the brain, the pain simply turns to numbness, a burning sensation that is much easier to stand. Then, there is the need to act to move away from the danger.  In the core of the brain, the hypothalamus, the survival, alarm and defense organ, triggers the appropriate neurological processes and simulates a chain reaction of secretion of substances like catecholamine.  Instantly, the pulse and breathing accelerate, the blood is concentrated in the vital organs, and the spleen empties.  The sugars in the liver come into play. Boosted by the excess oxygen and energy from the glucose in the blood, the brain switches to supercharged mode to enable it to take the required decisions without the need for thought processes and consciousness.

Boosted by the extra oxygen and energy from the blood flow, the brain switches to overdrive, to be able to take the required decisions without any real conscious thought. Often in these situations, it is only once back and sheltered that you realise how serious the injuries were.

Will it be the same again today? No, it’s not a distress call. The lad is talking calmly. Relief. “Where did you cut yourself?”
-  In the middle of the finger and there’s a lot of blood…
-   Where exactly? Is it deep?”
The replies are reassuring, but you need to be sure.
“Can you look at the wound?”
The injury may have affected a nerve or tendon. He has a guide on board to identify medical problems. He rang back a few minutes later. He has feeling in his finger and can move it. He sends a photo, but it isn’t very clear. “Press firmly on the cut for a few minutes to stop the bleeding. If that doesn’t work add some coagulant. When the bleeding stops, close up the wound with sticky strips and add some skin glue. Just like you did during your training. I’ll explain it again in an e-mail.”

During the medical training for the race, he learnt the basic safety measures, which is something you have to learn in such extreme conditions. This training was based on past experiences. From Bertrand de Broc for example and his famous tongue sewing surgery. Back then, there wasn’t the satellite phone or training. Bertrand followed the advice I sent by telex. There have been changes to the onboard pharmacy. Today it contains 120 different products, based on experience and the feedback of other doctors and the French sailing federation’s medical committee.

Sometimes it can be really nasty. In the 1996-1997 Vendée Globe, Pete Goss rescued Raphaël Dinelli and dropped him off in a port in Tasmania. Goss set off again towards Cape Horn. He had been having problems for several weeks with his elbow. In spite of the antibiotics, an abscess had formed. He had to pierce it to get rid of the pus. A technique was found to carry out this operation. Pete fixed a mirror on his lap to see the reflection of the tip of his elbow. With the scalpel, he cut the skin in the right place using his left hand and with care to avoid cutting an artery or nerve. And this had to be done in thirty-knot winds and nasty waves, which was nigh on impossible. So he needed to wait for the right conditions. The weather affects what the doctor can prescribe. The seas would calm in a few days, giving him the time to plan his operation. 3 days later and everything was in place. Pete sat down, made the cut and the abscess burst. By the time he got back to Les Sables, it had healed.

It is 0830. The photo of the finger appears on my computer screen. Everything is fine. A professional job. I send him an e-mail to congratulate him on his skills and suggest he keeps an eye on the scar. Time for me to get my head down in this office, which has beome a waiting room. Where it is the doctor who waits. A doctor, who needs to be patient, as fortunately he doesn’t have work to do every day in this Vendée Globe.


Dr Jean-Yves CHAUVE

 

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