Germany (Fall 2009)
Sebastijan’s first independent animal experiment at Harvard transpired in the manner of something Edgar Poe could have written—if he knew anything about animal experiments and stereotactic neurosurgery at his time. Sebastijan, however, wasn’t there to read about it, or to write about it. He was there to survive it.
He started operating on his rat around nine in the evening. He was doing well, and time and fatigue were entities that had nothing to look for in his mind next to his enthusiasm—the thrill of a first operation and the thrill of surgery were far too great.
After administering gas anesthesia, he inserted a catheter in the artery of the rat’s tail. The catheter led to a transducer connected with a monitoring device that gave him the beeping sound of his little patient’s heart rate. The heart rate was around 270 beats per minute, and the rat was breathing fine. Perfect. The next step was to dissect the phrenic nerve in the neck and attach monitoring electrodes to it—this demanding procedure gave him an objective value of the rat’s respiration rate. Finally it was time to turn the rat over and to fix its head in the stereotactic frame. Sebastijan was about to do this when Bruce Clark walked in.
“Hey dude! How is it going? Wow, that looks great. Clean, tidy…and fast. It’s not even eleven. Sweet. I wasn’t as good and quick when I started doing this. You’re about to fix the skull and drill? Go ahead.”
And so Sebastijan fixed and drilled. Drilled bone smelled like the dentist’s office, and the unexpected spectator challenged his inner calm. Sebastijan felt he wasn’t progressing with the drill and hesitated, but Bruce Clark’s affirmative nodding encouraged him to continue. After drilling some more, he felt the bone flap loosening—it was exactly as Bruce Clark showed him and described over the previous weeks. The big challenge was not to drill inside the skull and kill the animal by making its brain into an even greater mash of amorphous mass than it was. This did not happen; Sebastijan tidied up the trepanation edges, and lifted the quadrangular bone flap with a forceps.
The brain was revealed—bare, pulsating, exciting.
“Good, good. Very good. Nice job. You’re basically all set.” Bruce Clark took the animal’s head with his two fingers and tried to move it. “Very good. Well, if it wasn’t fixed well you would’ve already had problems during craniotomy. This is exactly as it should be.”
“I reduce gas now?”
“Exactly, now you can turn the knob down to two or two and a half. See, if you did an EEG now it would be a flat line. Brain death, basically. This is what somehow made the brain stem so sensitive to our poking yesterday, and caused respiratory failure. It’s actually a paradox, you could say, but I see it every time. It might be an interesting study in itself. What you want is at least some brain activity before you probe the brainstem. Very, good, this really looks sweet.” Sebastijan could feel that Bruce Clark was genuinely pleased, without pretense. “Why don’t you play some music in here?” he asked. “You’re alone. I’m sure you brought some cool Croatian music with you.”
“Yes, yes. I don’t know. Not now. For now. I have to concentrate on the operation.” Sebastijan responded.
“Absolutely dude. Plenty of time for you to play music and chill.”
“How is the clinic?” Sebastijan asked.
“Oh…good. Mostly good. Had two traumas last night. Both had epidural hematoma. It wasn’t that bad, took an hour for the first one, another hour and a half for the second.”
“Epidural hematoma is quick. Right?”
“Very quick. Absolutely. Especially if Price does them. He’s the trauma hotshot. I was assisting him yesterday. He’s a cool guy. Impressive scientific career, made assistant professor at thirty-five. We talked research yesterday while we were washing, says he might join in on the project.”
“Do experiments with us?”
Bruce Clark laughed. It was quite eerie, how his laughter resonated in the empty basement. Maybe it was just that Sebastijan was tired.
“No, man. Fat chance that we’ll get Steven Price to operate on rats with you down here. He might get his lab involved, he said.”
“Oh, OK. He has a lab….”
“Yeah dude, the man’s got a lab. And one heck of a lab, I’ll tell you. Ever since I’ve known him he has at least three big NIH grants running side-by-side, and I don’t even know how many people are working for him. He’s a serious player. Well, we’ll see what happens. We might do some collaboration. Look, I’ll let you do your thing in peace, and I’ll go grab coffee across the street before I check in. This whole week is a disaster; I’m pulling six straight nights. Haven’t been home for two days. On Saturday I think I’ll sleep ninety-five hours.”
“Don’t worry. I’ll be fine. I slide the electrode in, slide it out, kill, clean up.”
“You can’t do much wrong. You have good hands, I can see that. You have to clean up, bring the rat where I showed you and go to sleep. Use the privilege while you have it. Tomorrow is the same drill, but we go one step further and record the brainstem potentials. Then you know the whole experiment and can get going by yourself to generate data.”
Bruce Clark patted him on the back and sped away like Zoro, his long white coat soaring behind him.
Sebastijan picked up an electrode to insert it in the brain of the animal. “To generate data” sounded good, sounded like something worth dedicating oneself to. He started to slide the electrode towards the brain until he felt the resistance of the dura, the hard envelope of the brain. He pushed, perforated the dura, and slid the electrode in its place with ease. Having reached the goal of his practice, Sebastijan removed the electrode and started to detach the small animal from the apparatuses surrounding it. He saw a tiny bleed from the spot where he inserted the electrode, and he coagulated the surrounding dura with the bipolar forceps. He did it just for fun; the animal was to be euthanized anyway. It didn’t stop the bleeding. Annoyed, he coagulated some more. The bleeding got worse but he didn’t bother anymore, being close to admitting how tired he was and how badly he wanted to get out of the lab. “The only fun you have in the lab is the moment you’re leaving it,” Sebastijan remembered his roommate Yagub saying. He believed he disagreed, in principle. But at this moment he did badly want to trade the lab and its bright lights and strange odors for a dark room and a bed.
After disconnecting and unscrewing the rat, Sebastijan laid it flat in his palm, and took it to the euthanasia chamber on the opposite side of the room. According to regulation, rats were euthanized with carbon monoxide, an easy method for the scientist. Supposedly it was also easy on the animal.
Sebastijan thought he felt the animal twitch. It must be breathing hard because it’s getting pure oxygen now, he thought. Not quite. The rat convulsed and Sebastijan froze. It convulsed some more, first with the head and then with the whole body. The tail started contracting and hit Sebastijan on the wrist. He dropped the rat. The animal hit the floor, bleeding out of several openings in its small body, including the skull. The convulsions were getting stronger and the rat awoke. Every time it shook blood splattered over the floor—much like a dog trying to dry himself after swimming, except that it was a rat and it was soaked with blood. It took some blood to get on Sebastijan’s shoes for him to unfreeze and try to react. There was a good reason for this; this nice pair of black Italian shoes was the crowning purchase he made with his mother during extensive preparations for the transatlantic journey. ”You need good shoes,” his mother had said back then, ”You’ll be working all day long, and that’s impossible without good shoes. One can’t get a fine pair of shoes in America.”
He knew he had to get the rat back in the cage somehow—and kill it for messing up his shoes. He went for its tail and almost got hold of it, but the animal, in severe pain, bleeding from multiple places in its body, and having realized it was missing half the skull, decided against confiding itself to Sebastijan for the second time. It fled and disappeared under a cupboard.
He got down and tried to look under the cupboard. Darkness. Damn. What am to I do now? Every couple of seconds there were dull thumps to be heard. Probably the rat is slamming against the bottom of the closet when he convulses. Maybe if I wait long enough he’ll beat himself to death? Or bleed out? He was bleeding a lot, true enough, but to wait for it to bleed out was not one of the best ideas in Sebastijan’s career.
Cold sweat poured down his neck. He had no idea what to do, but the idea of leaving a bloody convulsing rat with a bulging brain to roam free around the lab was not appealing. He went down to the janitor’s closet in the hallway and sought out a broom. Back on his knees again, he started thrusting the broom under the cupboard. After the third thrust the rat squeaked. Is it dead? If I’m lucky.
”Oh hell! There it goes!” Sebastijan cried and jumped on his feet, scared of the wild animal. The rat ran looking for better fortune in the next dark corner. After every few steps it froze in place for a moment, leapt in convulsion, shook off blood, dust and dirt, and continued. It was progressing by dragging itself with the two left paws; the right side of its body was paretic as a consequence of Sebastijan’s surgery, and it kept losing balance and falling to the right. The brain was mashed, and it leaked slowly from the side of its head.
Sebastijan could not believe his eyes—He had seen some grotesqueness during his medical education but he had never encountered a similar sight. The rat was gone and Sebastijan had to follow the bloody trail to track it.
He found it curled up in the corner under the operating table, shaking as if the cool night air was its only problem. Sebastijan could not compose a single coherent thought in his mind, and the best course of action he could devise was to take an empty cage, invert it, and attempt to slam it over the beast. The rat disagreed with the plan and fled to the opposite corner. Sebastijan was helpless.
He looked at the clock.
After half an hour of desperate attempts Sebastijan realized he was not going to capture the animal. He almost started to wail in despair. His neurasthenic mind was losing the ability to focus on the problem, and all kinds of things started moving through his head: his mother, yes, and the shopping sprees they had just little over a month ago, also his (now former) girlfriend, his friends, his home hospital and home university, home town—home everything. He missed the evenings on the beach with friends spent drinking beer, smoking, and going for a night dive; he missed going for drinks to bars where people knew him and called him doctor; he missed walking down the street and nodding to some, and talking about some passersby, while holding the hand of a beautiful girl who listened to him in reverence as if he were Harvey Cushing in person.
It would suit the scene to say it was through tears that he said this, but it wasn’t. Sebastijan never cried in his adult life. Still he said aloud, to himself and the rat, in English:
“Why did I need all this?”
This isn’t getting me anywhere. Think, Think … If I was to devise a trap of sorts, I could suspend the cage with something in one corner, beat the rat out of the other corner with the broom and tip the cage on top of it. He got another broom and he set to constructing his contraption.
He caught himself smirking.
“Dude, what are you doing?”
Sebastijan crawled from under the table and saw the astonished face of Bruce Clark. As he stood up he observed how Clark’s expression changed from astonished to petrified. He looked at his lab coat and became aware of his appearance. He was pale, soaked in sweat, glasses falling down his nose; his clothes were covered in dirt and blood. He looked like Ernesto Guevara’s insurgent on the day of liberation of Havana.
“What happened here?”
“Oh, hi Bruce, how is it going?” Sebastijan smiled like a madman. “Everything… all is good, don’t worry. I’ve got it under control. A minor mistake, that’s all it is!”
The young neurosurgeon bowed down to look at Sebastijan’s construction, and, just as he was about to ask what it was, he saw the rat.
“What have you done to this animal?”
“Nothing. Absolutely nothing. I’ve… I just did as we said, wanted to euthanize it and it started convulsing. The rat did it to himself!”
“Convulsing? They shouldn’t convulse. Hell … How could it convulse? The rat did it to himself? What are you talking about? And why did he convulse?”
There was a thump.
“See? Convulsing!” Sebastijan’s genuine enthusiasm for the fact was misplaced with Bruce Clark.
“Do you understand they could shut us all down if anyone saw this? If this had happened in daytime? You know how packed this place is during the day. Animal rights people would tear us apart, they would—we’d probably never get funded again. They would shut down the whole hospital. And why does it convulse, for God’s sake? What did you do?”
“I didn’t do anything. Was it an epileptic rat?” The look on Bruce Clark’s face told Sebastijan he shouldn’t pursue the theory.
“And how do you intend to catch it?”
Sebastijan explained. This time Bruce Clark gave him the look of a man who cannot believe what he’s hearing, but after processing the matter for several moments he finally said: “Go ahead. Wait, let me help.” He took off his white coat and kneeled next to Sebastijan.
After some cursing and after chasing the invalid rat to and fro a few times, the two scientists managed to capture it in a cage.
“I have to go back to clinic. You need to clean this mess up, right? And not a word to anyone! Anyone! Otherwise we’re screwed. Big time! Tell me what you did. Once more. Step by step.”
Sebastijan started retelling in his struggling English and superfluous details—about the probe, perforation of the dura, removal of the probe, the bleeding and electric coagulation … Bruce jumped at the last piece of the story. “There you are. Never! Man, never coagulate with the bipolar on the rat’s brain! See what happens?”
“But, but, neurosurgeons … they coagulate brain all the time.”
“Yes, man, but we coagulate a brain that is two hundred times larger with about the same power. I’m surprised the animal survived.”
Sebastijan regularly got annoyed when Bruce Clark, a second-year resident, referred to himself as a neurosurgeon, usually by choosing his wording in a way that would allow him to say things like ”we, neurosurgeons.” But now he was far too tired to even notice a thing like that.
“Of course it will convulse, you caused a status epilepticus. See what it looks like! Kill it please, any way you know and clean this up. Kill it with an axe if you need to—just don’t let it slip again. I’m terribly sorry you had to go through this. Not the best start one can have. Get some sleep—we’ll talk tomorrow. Not a single word to anyone, man! Not even to God, if you pray before bed.”
Sebastijan, although not entirely devoid of religious aspirations in his life, could not have cared less about praying at the moment. After forty-five minutes of scraping brain particles and cleaning blood from the floor and furniture, he dragged himself to his room.
It was after three in the morning when he pushed open the unlocked apartment door. The hairy insomniac literature student Yagub was delighted to see him and insisted that he join in on the third bottle of wine that he was opening that night, and to listen as he read a brilliant passage from Venedict Yerofeyev’s “Moskva-Petushki,” that he simply “had to hear.”
Without a word, Sebastijan went to his room and collapsed on the bed. Moments before fainting he would think, for the second time during that night:
Why did I need all this?
FILIP ŠIMUNOVIĆ is a Croatian-born, final year medical student in Heidelberg University, Germany.