How To Do Brain Surgery In A War Zone
"Sorry for late reply. We've been under nonstop air strikes today, and I've been with emergency patients all day."
I received that Skype message in response to a request to interview 32-year-old neurosurgeon Omar Ibrahim, originally from Egypt but based for the past five years in Syria and the last two in Idlib, the northwest province that has been experiencing heavy bombardment by government forces and their allies since late April. According to reports from doctors on the ground in Syria and provided by Union of Medical Care and Relief Organizations-USA, in that time 19 hospitals and medical clinics have been damaged or destroyed, further straining the area's already impaired health care network. NPR spoke to Ibrahim via Skype on May 31 during a break in his schedule. The interview has been edited and condensed for clarity and space.
Where are you now?
I'm in south Idlib [province], in a hospital where we have just moved into the basement [because of] the attacks. We have two operating rooms for all surgeries. We are now the only working hospital in south Idlib.
How many patients are you able to see and treat a day?
About 50 patients on average make their way to the hospital daily. We see mostly war-related injuries, car accidents and other emergencies. We cannot do elective surgeries.
We have a general surgeon, a vascular surgeon and other specialists to perform other surgeries. As a neurosurgeon, I mostly treat brain and spine injuries.
What is your schedule?
I work in cycles of four or five days weekly. I go to sleep at 4 a.m. and wake up by 9 or 10. But emergencies can come in anytime. So I don't get regular sleep, and that is a problem.
Are there cases resulting from the bombings that particularly affect you?
Children who come in with severe brain injuries, dying or brain dead. In most bombings you see one or two children with severe brain injuries. I have [seen] hundreds [of children with brain injuries]. They sometimes come in gasping, dying and die in the hospital. It is very sad to see them and [know] you cannot help save their lives.
How many patients can you help?
That depends on the severity of the injuries. Most of the simple injuries or fractures you can stabilize.
And the more difficult cases?
Some patients come in with shrapnel in the brain or spine. A 30-year-old man came in two days ago with a severe injury in his back. Shrapnel was compressing the nerves in his spine, and he was in severe pain. He was unable to move his right leg, and his left leg was very weak. Our surgery succeeded in removing the shrapnel, a very big piece, 7 or 8 centimeters [2.75 or 3.15 inches]. He will need physical therapy to help his movements, but this relieved his pain. It was very satisfying to be able to help him.
If you look at my Twitter feed, you can find other cases there.
Penetrating cervical spine injury. Bullet lodged in the anterior arch of C1. This lucky young man has no neurological deficit. Those are the type of injuries we see in #IDLIB #Syria #neurosurgery #UHC @sams_usa @keepark @global_neuro @HarvardPGSSC pic.twitter.com/xFuboTJfVG— Omar Ibrahim (@Neurosurg_Omar) May 29, 2019
How do you stay calm?
You concentrate. You have to be calm because people are scared, the civilians and the patients are scared, and they can't see you scared.
How do you calm down the patients and their families?
We just tell the truth. You don't have time to explain the details but just to say if the patient is going to die or going to make it.
How do they respond when they hear very grim reports?
Most of them have patience. Some come yelling and screaming, but most accept the situation.
They see we are doing the best we can to make the patients survive. You do the best you can to make the patients calm and get them to trust you.
Are you scared?
The [greatest] fears are that we [the medical personnel and hospitals] are being targeted. We try to take precautions [like moving the hospital to the basement].
I have no regrets about doing this work. Because I have passion for my work, and this work inspires me.
[A phone rings in the background.]
Sorry I have to answer the phone, just a second ...
[I can hear him speaking in Arabic; then he resumes the interview.]
I'm sorry. I have to go to the emergency room; there was a car accident. I have two patients I have to see.
Diane Cole writes for many publications, including The Wall Street Journal and The Jewish Week, and is book columnist for The Psychotherapy Networker. She is the author of the memoir After Great Pain: A New Life Emerges. Her website is dianejcole.com.