Drilling to save a boy’s life

Rural South Australian GP Dr Jeff Taylor got a phone call in 2004 that would change several lives, including his. He tells Mark O’Brien how he went from relaxing in front of a Saturday football game to drilling a hole in a young boy’s skull.

IT WAS June, 2004, and Dr Jeff Taylor was second on call at the Naracoorte Hospital, roughly 3.5 hours’ drive south of Adelaide.

“A 10-year-old boy had fallen from a quad-bike on a nearby property and been knocked unconscious, and I was called in to assist,” he says.

The boy had already been assessed and the hospital had called a retrieval team from Adelaide by the time Dr Taylor arrived, but one look at the patient revealed the situation was critical.

“His blood pressure was high and his pulse was low and his right pupil was fully dilated,” Dr Taylor said.

“It’s a sight you would never forget.

“He was ‘coning’ – pressure builds up inside the skull and pushes the brain back down the brain stem like water draining down a plug hole.”

With only one treatment available – drilling a hole in the boy’s skull to release the pressure – Dr Taylor retrieved the hospital’s burr hole kit and set about finding a neurosurgeon to advise him.

“What the boy really needed was a neurosurgeon, what he didn’t have was time,” he said.

“We took him into the operating theatre and got a neurosurgeon on the phone who talked me through the landmarks on the skull: two fingers in front of the ear, then two fingers above that.

“We had him all prepped and everybody was talking, but then, as I was about to make the cut, everybody stopped talking and the theatre went completely silent.

“But when I made my first cut and drilled in, nothing happened.

“By this stage his left pupil had dilated as well. This boy was dying right before my eyes and when you see those pupils fixed and dilated, it’s like looking into the soul.”

On the advice of the neurosurgeon, the boy was rolled onto his other side and Dr Taylor repeated the procedure.

“Out came this big rush of blood and he stabilised almost immediately,” he said.

“The neurosurgeon asked me, does the brain look swollen?

“I said, I don’t know – how is it supposed to look?”

Meanwhile, the retrieval unit from Adelaide was battling poor weather that threatened to shut the local airport.

“The rain and fog was moving in and the doctors on the plane told us the pilot asked them what would happen to the patient if they were unable to land?”
Dr Taylor said.

“They told him the boy would die, and I think it is a testament to the skill of that pilot and the doctors on board that they were able to get him back to Adelaide alive.”

The boy spent “a good couple of months” in hospital in Adelaide and, while he suffers some lingering memory deficits, he made a good recovery.

“My biggest fear at the time was, what if I did do something and it half-worked and left him in a vegetative state?” Dr Taylor said.

“But he was dying right in front of us and I couldn’t stand around and do nothing.

“I was able to see him in hospital in Adelaide about a week after the accident, but for the first month after the procedure I was really worried that what I had done may have produced a bad outcome.

“What has helped me through it all is that he has had a pretty good outcome.

“I knew the family quite well before the accident and although they have since moved to another town, I get to see him at the local field days each year.

“When I see his father he tells me, ‘I don’t want to have a headache when you’re around’.”

These days the burr hole kit sits back on the shelf at Naracoorte Hospital and Dr Taylor, who visited the boy’s school in the days after the accident to explain it to his class, said he is in no rush to take it down again.

“It is one of those things you’re taught in medical school; I distinctly remember the lecturer saying, one day you might have to do this.

“A lot of people want to know how it felt and people ask themselves what they would have done in your place.

“You hope you will never have to do it, but when you’re in that situation…
I would have been disappointed in myself if I had sat back and waited for the retrieval unit.”