As 16-year-old Yasser Lopez was in the paramedic helicopter en route to Jackson Memorial Hospital with a three-foot long fishing spear through his skull, the team at the trauma center was mobilizing to receive him.
“Time is brain,” explained Leo Harris, the physician’s assistant on Lopez’s surgery, who has been working in neurotrauma for 15 years. In cases of traumatic brain injury, according to Harris, seconds could cost brain function, and a miscalculation could be fatal.
On the afternoon of June 7, Harris got a call from Dr. George Garcia, the trauma surgeon at Jackson. The two work so closely together that they “almost know what each other is thinking,” Harris said, and they moved methodically through the critical first steps to save Lopez’s life while neurosurgeon Dr. Russ Bullock arrived at the operating room down the hall.
“He was awake and talking when I got up to the helipad,” Dr. Garcia said of the teenage patient. “But within a minute or so of getting to the hospital, he started getting agitated from fear or pain, or because the initial shock had worn off, and we had to sedate him to keep him from thrashing around.”
Earlier that day, Lopez was about to go spear fishing with his friend, when the friend accidentally discharged the spear gun he was trying to load. The fishing spear entered Lopez’s skull about an inch above his right eye and stopped just millimeters short of piercing the skin on the back of his head. He has no memory of the event, and his family has requested privacy until he makes a more complete recovery.
Dr. Garcia said that he has seen some intense injuries in his career as a trauma surgeon, but he acknowledged that this case was “pretty unique because the spear was so long.” He emphasized there was no time to get distracted by the sensational scene, and his team shifted into high gear of their “regimented” response routine.
After verifying that the patient had no additional injuries beside the obvious one, the first challenge was how to get Lopez into the donut-shaped CT scan machine with a three-foot spear protruding from his forehead. The paramedics had done an incredible job of getting the patient to the hospital without disturbing the shaft, according to Dr. Garcia, but given the lucky—and precarious—trajectory of the spear through Lopez’s brain, any movement could have proven fatal.
“Our initial thought was to cut it off with bolt cutters,” said Dr. Garcia. “But one the firefighters that brought him in said it looked like stainless steel, and we were afraid of causing more damage. So we called the Miami-Dade Tactical Rescue Team, and within minutes they were there with rebar cutters.”
As the trauma team was handling the patient’s first crucial moments of care, Dr. Bullock’s neurosurgery team was laying out a surgical plan.
“It’s always gut-wrenching to see this kind of thing because the stakes are so high,” said Dr. Bullock. “When the patient is conscious and talking but has an injury that could be lethal, the first instinct is to get this thing out of there, but if you do that then chances are high that the outcome would be bad. So we had to work out a strategy for surgery.”
He explained that the barbs in the spear that are supposed to make it stick in a fish also make it more complicated to pull out of a human brain. After consulting with the teenager’s parents, Dr. Bullock found that the tip of the spear was unscrewable. The plan that the neurosurgeon laid out had total consensus from the rest of the team, according to Harris.
“We used a high speed drill to create a hole about two inches in diameter at the exit point and a one-inch hole at the entry point,” Dr. Bullock said. “We were able to stop the barbs from unfolding fully in his brain, and we eased the tip off. We had to wait to see if there was any bleeding. The whole time there were two vice clips in the front to hold the shaft in place.
“By some God-given miracle, when we went to wash the tract [of the spear through the brain] to ward off infection, the wash fluid just flowed straight through. It’s amazing that there wasn’t any brain swelling or bleeding.”
When asked more specifically about the anatomy of the brain, Dr. Bullock described a “one in 10 million” chance of an object traveling through the brain in a way that caused such minor damage. The spear entered on the right side, while most motor skills and cognitive function are controlled by the left side of the brain, especially in a right-handed person like Lopez. It did not cross the midline, where it would have severed crucial blood vessels, but rather tore through the “white matter” of a fiber bundle that conveys information from the cerebral cortex.
When Lopez woke up the next day, he was able to “squeeze my finger and stick his tongue out,” Dr. Bullock said. Now, almost two weeks after the accident, his only symptoms are a bit of weakness of the left side of his body.
“There is a good chance that he will have a perfect recovery,” Dr. Bullock said. “Young people have this amazing capacity for the uninjured part of the brain to take over functions controlled by the damaged part. Just as gymnasts and other athletes or artists can grow certain parts of their brain with training, there is an incredible plasticity that allows the brain to regenerate cells.”
Lopez was moved from the intensive care unit to a normal hospital room on Tuesday, and Harris, the trauma physician’s assistant, went to check on him before leaving work that day. He reported that the teenager was eating solid food and looking forward to watching the Heat game that night, which turned out to also be a victory.
“He was very very very upbeat,” Harris said. “He talked a lot about basketball and about how great the food tasted. And how appreciative he was to be alive.”