Like I need a hole in the head…

Dr Vernon Coleman

The patient had come in to have a cyst removed from the top of his head and he’d been lying on a hospital bed for three hours. Three hours is plenty of time for a patient to start imagining the worst.

The senior surgeon had left the theatre and gone for his morning coffee. He’d just finished one long case and had another one due to start as soon as I’d finished. Apart from the nurse designated to help me, the theatre staff were busy clearing up the debris from the last operation and preparing trolleys for the next one. Instead of being a silent, tidy place the operating theatre looked more like a busy railway station buffet.

The porter brought the patient in on a trolley and helped him climb off and on to the operating table. As the cyst was on the back of his head, we had to get him to lie on his face, resting his chin on his hands. It looked very uncomfortable.

I carefully picked up one of those green towels with a neat hole in the middle and draped it over the man’s head. A tuft of greasy black hair sprang up through the hole. I pulled the towel off and sat down for a minute or two while the theatre porter found a razor and shaved a convenient area around the cyst.

He must have been an unusually enthusiastic porter for when I looked again a few seconds later, he’d shaved a huge circle in the middle of the man’s head. The poor fellow would have only needed an old dressing gown and he’d have been able to go to a fancy dress party as a monk.

I put the towel back and accepted the scalpel which the nurse offered me. I was just about to start cutting when the man reached up and scratched at his scalp, pulling the sterile towel off. I pointed out that it would be easier for both of us if he kept still.

The blade was only about a quarter of an inch away from the man’s head when I realised that I still hadn’t put in any local anaesthetic. Wearily, I handed the knife back to the nurse and drew up some local in a syringe.

‘Can you feel anything?’ I asked, prodding the area around the cyst with a needle after I’d injected some anaesthetic.

The man shook his head, dislodging the towel again.

The nurse put on a fresh towel. I picked up the knife once more, and began to cut through the skin. It was hot in the theatre, the air conditioning had broken down for the third time in a week and I think I would have been sweating if I’d been working in a fridge. It was a big cyst which seemed to be getting bigger every minute. I couldn’t help thinking that if I removed it I’d have a huge flap of spare skin and the man would have a hollow skull. My mask was sticking to my mouth, my boots were flooded with sweat and I had an itch at the back of my neck.

Eventually, I got the cyst out. For the first few minutes of the operation the patient kept up a steady stream of chatter, and then slowly he quietened down, perhaps silenced by the nurse’s gasps of surprise as the cyst slipped out, perhaps worried by the rivulets of blood trickling down his scalp.

Where the cyst had been there was now a hole about an inch deep and an inch across. I was looking at it, wondering how best to close it, when one of the anaesthetists came in.

‘Gawd,’ he said. ‘What a big hole!’ He called to one of the porters. ‘Come and have a look at the enormous hole Coleman’s made in this guy’s head.’

Frantically, I tried to catch his eye, to let him know that the patient wasn’t unconscious. But he’d already turned away and was trying to persuade a couple of very junior nurses to come and look at the enormous hole I’d made.

Desperately I tried to sew up the hole as quickly as possible.

‘Are you all right?’ I asked tentatively, as I put in the last stitches. There was no answer. I repeated the question. There was still no reply. I bent down so that I was only a foot away. ‘Are you still there?’ I called. I took the green towel off and swabbed away some of the thicker rivulets of blood. The patient didn’t move. ‘It’s OK,’ I said. ‘I’ve finished, you can move now.’ Still he didn’t move.

I was getting rather frightened. Perhaps I had dug down too deep. Perhaps that stuff I’d thought was part of the cyst…perhaps the patient had taken umbrage at the anaesthetist’s remarks…

‘It’s all over,’ I shouted. The theatre staff preparing for the next big case came into theatre to see what was the matter.

With a yawn the patient pushed himself up onto one elbow and then rubbed his eyes.

‘Are you all right?’ I asked.

Blearily the patient nodded and blinked. ‘Sorry,’ he said. ‘I must have dropped off. Haven’t you started yet?’

First published in The Sunday Times 12.12.71

Taken from `Stories with a Twist in the Tale’ by Vernon Coleman, available on Amazon.

Copyright Vernon Coleman August 2023