Monday, March 29, 2010

Auto-appendectomy




If you have a weak stomach, consider skipping this post. It is not about the heroic biopsy that the scientist in the Antarctic performed on herself. It is not about the horrific instances in which pinned hikers amputate their own limbs. It is not about trepanation, which some have carried out on themselves. And it is not about the psychologically dubious act of self-castration. It is about 2 specific instances - 40 years apart - of doctors who performed their own appendectomies.

American surgeon Evan O'Neill Kane (1861-1932) believed that the general anesthetic ether was being used too liberally and wanted to test whether patients could tolerate surgery under a local anesthetic. Using mirrors, he removed his own appendix in 1941 - this at a time when the surgery required a much larger incision than it does today. The appendectomy was a success and he was back at work 36 hours later. This was just 1 of 3 self-surgeries by Dr. Kane: in 1919 he had amputated his own finger after it became infected, and in 1932 he repaired his own inguinal hernia (1st image). Of the hernia surgery, Time magazine reported, "To the operating room in Kane Summit Hospital he summoned a, reporter and a news photographer. While they recorded details he propped himself on an operating table, cleaned the left groin where he was to cut, gave himself a local anesthetic, proceeded to operate. He chatted and joked with the nurses as he cut, sponged and sutured for 1 hr. 45 min." Again, he was back at work less than 2 days later.

Russian physician Leonid Ivanovich Rogozov (1934-2000) spent September 1960 to October 1962 caring for 13 researchers at the remote Novolazarevskaya Station in Antarctica. While there he suffered weakness, nausea, fever, and abdominal pain that indicated peritonitis. With no option for evacuation, the only life-saving alternative was to take out his own appendix. He performed the 2-hour surgery in a semi-reclining position, half-turned to his left side (2nd image). Three men stood by: one to hand him instruments, a second to hold a mirror and adjust the lighting, and a 3rd to stand by in case either of the others couldn't continue. "I didn’t permit myself to think about anything other than the task at hand. It was necessary to steel myself, steel myself firmly and grit my teeth....My poor assistants! At the last minute I looked over at them: they stood there in their surgical whites, whiter than white themselves. I was scared too. But when I picked up the needle with the novocaine and gave myself the first injection, somehow I automatically switched into operating mode, and from that point on I didn’t notice anything else," remembered Dr. Rogozov. He anesthetized the area with novocaine, removed his perforated appendix, and administered antibiotics directly into his peritoneal cavity. A 1/-hour into the operation, he began experiencing weakness and nausea, so he paused frequently, but he recovered fully in 1 week and 2 weeks later resumed his normal duties.

While Dr. Kane's operation is accepted as the 1st example of a self-appendectomy, Dr. Rogozov was unaware of it when he performed his operation under dire consequences and with no possibility of outside help.

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