Book Excerpt: 'The Scalpel and the Soul,' by the UA's Dr. Allan Hamilton
Dr. Allan J. Hamilton, a neurosurgeon and professor of surgery at The University of Arizona, has been awarded a 2009 Nautilus Silver Award for his book "The Scalpel and the Soul: Encounters with Surgery, the Supernatural, and the Healing Power of Hope," which tells the stories of patients he's encountered during his years in the operating room.
The Nautilus Book Awards recognize inspirational and "world-changing" books, as judged by a team of book reviewers, librarians, authors, editors, bookstore owners and publishing industry leaders. As a Silver Award winner,Â "The Scalpel and the Soul," Hamilton's first book,Â will now move onto the highest level of judging for the Nautilus Awards, the Gold Award level.Â
"This award is a gift, not a reward. It reminds me the world is like that: Beautiful things are given to us without our having done anything to deserve them," said Hamilton, who has been at the UA since 1990.
The following excerpt from "The Scalpel and the Soul" relates the story of Thomas, a 10-year-old boy burned beyond recognition. While Thomas was in a coma, his father died of a heart attack.
Hope prevailed. The decision was made to take Thomas to the operating room and cover him with his father's skin. At 8:30 a.m., we removed all the dead graft tissue covering Thomas. Painstakingly, over the next eight hours, we quilted his father's skin onto him. To me, the grafts looked lifeless and gray. I had little confidence. All I could think about was the waste. Thomas's young life. His father's. Long parts of our own lifetimes.
By dinnertime, we had finished. Fresh bandages in place, Thomas's comatose body was wheeled back into its slot in Mummy World. His vital signs seemed stable enough. We knew he'd survived considerable surgery, but we had doubts about his physiologic reserves. I went into the call room and fell asleep instantly. I had been on the move for more than forty-eight hours straight.
Only seconds seemed to pass before I woke up angry and disoriented. A nurse was knocking loudly on the call room door. I looked at my watch. I'd been asleep for over two hours. The nurse was hammering, and it suddenly flashed into my mind that Thomas was probably dying. Maybe his heart had already stopped. Maybe she was calling me to supervise CPR. I steeled myself to be able to call it off. Let him slip away. We'd done everything possible. I was to let go.
I opened the door. The nurse was stammering. "It's Thomas . . . he's . . . he's trying . . . to talk!"Â
That simply wasn't possible. Thomas must be having problems with his ventilator. She'd misinterpreted his respiratory efforts as an attempt to talk. Hadn't he been in a coma for nearly a month?
I went right to the ICU. Not only was Thomas trying to speak, he was moving all of his limbs â€“ something he's never done before. He was fighting his bandages and constraints. It must have been extremely painful, as many of the fractures hadn't yet healed. But the efforts were unmistakable. He was trying to pull the endotracheal tube out of his windpipe. Of course, his hands were wrapped in dressings and tied down. There was no way he could bend his arm enough to reach it.
I slipped my hands inside the plastic-encased arm ports and reached around his throat to undo the knot. There's a small balloon at the end of the tube that helps hold it securely in place at the top of the trachea and below the larynx. I got the tie undone and deflated the balloon. I could hear Thomas trying to move air around the deflated tube. So daring more than hoping, I pulled the tube out of his mouth.
He coughed violently a couple of times. Suddenly, he spoke. His voice was perfectly clear.
"What happened to my father?" were the first words out of his mouth.
Of course, no one had said a word to Thomas about his father. How could we? He'd been unconscious the entire time! The nurses looked at me. It was my responsibility to answer. After all, I'd been the one who removed the boy's endotracheal tube.
I decided to lie. "Nothing has happened to your father, Thomas. He's just fine," I said.
Thomas looked at me in confusion. "Are you sure?" The boy was completely lucid.
"Yes. I'm sure. He's fine. He'll be glad to hear you're getting better."
Today, I deeply regret that lie. I should have told him the truth right away. But I was a young resident. I didn't know better. I thought I was being kind. Thomas knew something was wrong.
"My dad's just standing there at the end of my bed. Why doesn't he say something?" There was the hammer blow.
For a crazy instant, I blanked out what actually happened. The father's death. The harvest of skin. Then reality returned. Thomas must be seeing someone through the plastic, a distorted silhouette that reminded him of his dad. I looked around. No one was there. Just the drapes and the lights beyond.
"Thomas," I asked, choking back tears in disbelief, "where do you see your father?"
"He's standing right there," he answered, staring at the empty foot of the bed. "Hi, Dad!" he called out, and he feebly attempted to wave.
One of the nurses choked back a sob.
"Thomas, your dad's passed away," I admitted. "He died three days ago. He had a heart attack."
I could see the shock registering within, even beneath so many layers of bandages. Then I heard him whisper something. I leaned over.
"That must be his ghost then that's waving back at me," he said softly.
I know without a shadow of a doubt that what Thomas saw at the foot of his bed was his father's actual spirit standing there, watching over him. Here was my own fragile moment of awakening. It left me tingling all over, as if sparks were dancing off my skin.
Thomas got better. He didn't reject his father's grafts. And over the next month, a researcher at the Massachusetts Institute of Technology announced a new research method to harvest epidermal cells. The patches of skin required for this experimental technique were exactly like those Thomas had still intact. Harvested cells from these patches were taken to a laboratory, induced to grow, and spread atop a layer of denatured collagen. Eventually, the cells would coalesce on the collagen sheet and it could be grafted directly onto the patient. Since the original cells were all derived from the patient (who was now the donor and later would become the host), there was no risk of immunologic rejection. Thomas was the first patient in medical history to undergo this procedure. His survival was, in effect, the culmination of a long sequence of miracles â€“ not the least of which was the protection his father's spirit had provided.
Reprinted from "The Scalpel and the Soul," by Allan J. Hamilton, M.D., FACS, by arrangement with Jeremy P. Tarcher, a member of Penguin Group (USA) Inc. Copyright (c) 2008 by Allan J. Hamilton. Now available in paperback.