Dr. Joshua B. Bederson awoke early Tuesday morning in Florida, where he had addressed a conference of neurosurgeons on Monday. He knew he had a big day scheduled: return to New York, where he is the head of neurosurgery at Mount Sinai Medical Center, and perform two operations starting at 11 a.m.
He flew into La Guardia, went home to Manhattan, changed into running clothes and headed for Central Park. He had made it once around the reservoir when his phone went off. A police officer had been stabbed in the head.
Dr. Bederson, 55, ran out of the park, up Fifth Avenue, and through the doors of Mount Sinai Hospital’s emergency room, on Madison Avenue north of 99th Street. He threw his scrubs on over his T-shirt and sweat pants — “I was sweating all over the patient” — and got to work.
The first new piece of bad news was that the patient, Officer Eder Loor, had pulled the knife out.
“I would have preferred to see the knife still in there,” Dr. Bederson said, because the blade might have been holding a lot of the damage in place, and because pulling it out performed a second slicing action.
“Remember that famous adventurer who got stabbed in the heart by a stingray?” Dr. Bederson said in a phone interview from his office Wednesday afternoon. “He died because he pulled it out himself.”
A scan showed blood building up inside Officer Loor’s head, inside and outside the brain. A large blood clot inside his brain – “thick, like grape jelly” — was exerting tremendous pressure. It had already shoved the left side of his brain a centimeter across the midline.
“You don’t want to overemphasize, but he was at death’s door,” Dr. Bederson said. “He was at the very, very end of what he could compensate for.”
To save the officer, Dr. Bederson’s team had to open up the skull, relieve the pressure, find the sources of the bleeding and stop it.
Out came the knives and drills. The doctors cut a huge bone flap in his skull – almost seven inches in diameter.
Inside Officer Loor’s head, Dr. Bederson saw that the knife had sliced through the vein in the Sylvian fissure, which contains crucial blood vessels. It had nicked but not penetrated the middle cerebral artery, the main blood supplier for the brain’s left hemisphere.
If the blade had gone through the artery, Dr. Bederson said, “It would have all been over.”
Even so, Dr. Bederson said he worried that the artery was damaged and that the blood clot pressing against it was all that was keeping it from bleeding.
“I said ‘Uh-oh,’” he recalled. “I said, ‘This is a microscope case. Let’s bring in the microscope.’”
The operating room, already crowded with nurses, residents, anesthesiologists and student observers, began to fill with spectators. “Whenever there’s an interesting case, your colleagues will come,” Dr. Bederson said. Eventually, he said, “there was such a level of interest that I asked people to leave.”
He was not nervous, but mindful of the stakes.
“You don’t get preoccupied, but you don’t forget that you have a human being,” he said. “A young human being with a 25-year-old pregnant wife.”
The knife blade, three inches long, had plunged all the way through the temporal lobe, just missing centers that control speech and vision, and lodged in the base of the skull, clipping a vein next to the carotid artery but stopping just short of the artery itself. The blade had cut into the maxillary branch of the trigeminal nerve, which controls feeling in the face. But it did not slice through the main bulk of the nerve.
“It was a millimeter from everything,” Dr. Bederson said. “It was ridiculous.”
The operating-room microscope floats above the patient, held in place by a complex metal contraption. Dr. Bederson looked through the eyepieces as he cut and cauterized, sealing off the Sylvian vein, which was responsible for about 80 percent of the bleeding, and the venous complex surrounding the carotid artery, which was responsible for most of the rest.
The hematoma had been evacuated. The bleeding was stopped. The surgical team put Officer Loor’s skull back together and sewed him up.
Two hours and 40 minutes had passed.
The officer was brought out of anesthesia. He moved all his limbs. He spoke clearly. He saw; his eyes tracked. Dr. Bederson later told reporters that he expected the officer to make a full recovery.
Officer Loor’s only complaint, besides pain, was that “his cheek and his jaw are numb and he can’t feel his nose on the left side,” the doctor said.
He may have to learn to live with it.
“Probably at least some of the fibers were severed; he may be left with a little bit of numbness,” Dr. Bederson said. “It’s not the end of the world.”
This post has been revised to reflect the following correction:
Correction: April 19, 2012
An earlier version of this blog post, based on information from the hospital, misstated the duration of Officer Eder Loor’s surgery. The surgery lasted two hours and 40 minutes, not four hours.