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I remember one soldier in particular in December 1967. I believe the missile came either through his right eye or upper face. I vividly remember retracting the frontal lobe upward from the orbital plate, severing the right olfactory tract to get room, and saw the fragment jutting out of the bone back toward the carotid. When I removed the fragment, a huge gush of blood shot out of the carotid and overpowered my suction. I had the nurse anesthetist put pressure on the patient's carotid in the neck to decrease the flow to the point that I could be able to see and operate. The flow diminished enough for me to suction away the blood and visualize the carotid. I had only one choice: I had to clip the carotid above and below the laceration or he would bleed to death. Our clips were lousy, but I had received a supply of old Mayfield clips from my residency program that were up sterile.  I put one on the carotid proximal to the cut and stopped the huge anterograde blood flow. The retrograde blood flow was minimal, so I knew the patient's collateral circulation through the anterior communicating artery was poor. I knew he would end up with a severe stroke, or might even die from the carotid clipping.  I had no choice - he was dead if I did not stop the bleeding - the carotid was torn in 50% of its circumference.  I put two silver clips on the distal end, then ligated the carotid proximally with a silk suture.  I removed the Mayfield clip to save it for someone down the line who might need it.  Indeed, the patient woke up paralyzed on the left, but with aggressive treatment for brain swelling, he survived.

 To my sorrow, my operative notes and discharge summaries from December have been lost. I have documentation from most of my cases from March through August and most of September, and went on emergency leave in September. I returned in October, and my personal records were not nearly as complete after that, though I had to prepare the same documentation. Perhaps I left them when I was given five minutes to pack on February 5 to catch the plane to the US.  The last thing I cared about, during Tet and all, was making sure I had my records.  I have some reports, even at that, but I guess I had my mind on other things that day - like saving my skin.  I  remember the case because it was so stunning and I had no choice but to sacrifice the carotid to save a life.  There was no possibility of sewing the hole closed and saving the carotid without a microscope and micro instruments, which we did not have.  They still do not have these in neurosurgical units of  the Army Reserve hospitals which were mobilized for the Gulf War.

I hate that such a fine young man was so damaged by the mortar fragment and want to wish him all the luck in the world.  I remember how grateful I was when later in his hospital stay, the swelling of his brain began diminishing and it began to look like he would live.  

Contact Don Patrick by email, if you wish. 

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Updated: July 7, 2003