- In miracle surgery, doctors save man shot in the head with five-foot metal spear that lodged in his skull - Medics call it a ‘case for the ages’
It was a horrific case of violent trauma, the images stomach churning and unbelievable for the medical professionals when they first saw them. In fact, as one doctor puts it, they were stunned into silence. Yet after one of the first of its kind...
It was a horrific case of violent trauma, the images stomach churning and unbelievable for the medical professionals when they first saw them. In fact, as one doctor puts it, they were stunned into silence.
Yet after one of the first of its kind miracle medical procedures – that involved two major operations that lasted some five hours – the almost invisible scar at the bottom of his right eye makes it nearly impossible to envision the horrendous injury Lamar Nephew suffered weeks before.
Today, both patient and doctors marvel at the turn of events more than three weeks ago when he was rushed from Mandeville Regional Hospital to the University Hospital of the West Indies (UHWI).
The labourer from Alligator Pond in Manchester was shot in the head with a five-foot metal spear from a makeshift bow, a foot of which lodged in his skull.
He was allegedly shot by someone with whom he had a long-running dispute, which escalated the day before and culminated with the violent attack on Sunday, April 30.
When he was taken to Mandeville Regional, they immediately sought assistance from the largest trauma centre, the Kingston Public Hospital (KPH), but when they were unable to receive the patient, UHWI was contacted.
Images sent from Mandeville Regional to UHWI were not for the faint-hearted, the medical practitioners said. And The Sunday Gleaner team agreed when they were shown to us.
The images showed the patient with more than three feet of a foreign object protruding from his face with a portion lodged in his skull. It entered just below his left eye, but at that point they were unclear of the length of the piece that was lodged in his skull.
At Mandeville Regional, they were able to cut off about two feet of the arrow.
An MRI later showed that about a foot of the object was lodged in his skull. As the doctors explained, on entry it took the trajectory of a plane taking off, up through his skull and brain, stopping a few millimetres from exiting, towards the top and back of his head.
Within an hour, UHWI assembled a high-powered team of neurosurgeons assisted by the hospital’s maintenance team, accident and emergency medics, anaesthesiology, ENT nurses, porters, imagining medics, awaiting the patient’s arrival.
The neurosurgery team included consultant neurosurgeon Dr Carl Bruce; specialist Dr Ronette Goodluck Tyndall; Dr Kevin Wade; consultant neurosurgeon Dr Chrystal Calderon; Dr Brittni Fullerton, junior surgical resident; and Dr Renee Cruickshank.
Speaking with The Sunday Gleaner last week, Dr Goodluck Tyndall, a Fellow of neurosurgery with the sub-specialty of cerebrovascular – all disorders of the brain impacted by blood flow – said it was hard to imagine how someone could be that lucky to survive such a trauma.
“From the time we got the call from MRH and saw the images, a bunch of activities were put in motion. The head of the team, Dr Carl Bruce, myself and all the Residents were out, planning ‘how are we going to cut this down (the arrow) safely? How were we going to get him to the scanner, to angiogram (X-ray used to examine blood vessels) and to theatre?’” she shared.
The intensive care unit (ICU) staff was also arranging bed space, so that everything would be in place “so that when he got here it would be a straight ride”, she said.
“With all skills set on board, we immediately went to the CT scanner and the angiogram where we did that special test to see if the important main vessels in the brains were damaged. We know the CT can have some artifacts, that’s why we went ahead with the angiogram. We had to get maintenance team to lend us some of their equipment. We went through a list of the options of how we were going to cut the arrow,” Dr Goodluck Tyndall explained.
“Once we got to the angiogram suite, the maintenance team was there with the equipment. We selected the one that would cause the least vibration, because you don’t want anything that would cause anything to shift. When he came his vision was perfectly intact, his eye movements were intact, and he had no deficits at all, so we wanted to make sure that he remained the same at the end of what we were about to do.”
Armed in their protective gears, including eye shield to prepare for cutting with a power saw – to reduce the length of the arrow – another angiogram was done and he was immediately ushered to the operating theatre.
‘Missed everything critical’
“Fortunately for him, that spear missed everything critical by just a few millimetres. It went into the eye socket, just beside the optic nerve. It went beside the carotid – major blood vessels that provide the brain with blood supply – just beside it. The vessel in the back of the brain more or less, it was sitting on it, grazing it, but not injuring it. I would say he was very lucky. Where the spear landed it was like a few millimetres just behind that main draining vein in the brain,” she explained.
Dr Goodluck Tyndall said the doctors were concerned about the entry point of the arrow and where the arrowhead settled. Luckily for Nephew, there was no barb at the tip and the medics were able to decide the exit. His skull was then opened in two places where the spear entered to make sure it was loose, and another in the back where the bone was fractured.
“We had to be very careful with that venous sinus – a group of blood channels that drains venous blood circulating from the cranial cavity – so that when we take it out we don’t cause any injury. Once everything was released, we had our maxillofacial surgeons there to help to ensure that it was loose towards the face, then we gently extracted it, and immediately after we finished closing, we took him back to the scanner and we saw that everything was still fine. Vessels were still untouched and there was no brain haemorrhage,” said the leading neurosurgeon.
Nephew was kept unconscious for the first night in ICU in a medically induced coma to allow the brain to rest. The next day, when the sedation wore off, he woke up and his movements were not unnatural. He was again taken to the intervention suite, tests were repeated and everything “was perfect”.
The team was finally able to exhale. All was well.
In spite of it being a very risky procedure, the doctors said they were confident in their medical capabilities, but they believe the 32-year-old was “divinely lucky”.
Nephew is now receiving a course of antibiotics, as the arrow was “very rusty”. The antibiotics are to pre-empt any infection that could arise.
“He has been well, and we are hoping to get him home soon,” Dr Goodluck Tyndall said.
Called “a case for the ages”, Nephew’s case will feature prominently at the Caribbean Conference of Neurosciences in 2024, Dr Bruce told The Sunday Gleaner.
The doctors said the weapon appeared to have been crudely modified. Investigations for their paper will include a visit to the fishing community for more and better particulars about the weapon, which is believed to be used for spearfishing.
‘Him always a disrespect mi’
Nephew welcomed The Sunday Gleaner team into his hospital room last week, saying he was tired of staying in the bed.
Sitting on a chair near his bed, his head still bandaged, he was singing along with the songs being played from the mobile phone friends brought him the night before.
The intravenous fluid line apparatus by his bedside gave no indication of the trauma he suffered. Nor was he superstitions about his bed number, 13.
Nephew accepts that it took a miracle from God and top-notch medical skills to save his life.
He shared that he was injured by an individual who he claims “has always disrespected me”.
“I was at a shop on my lane with these three ladies. I always play music fa dem, or cook, and him always come deh an disrespect de girl dem tuh,” he explained, rambling sometimes as he spoke.
“Every wey him guh him always disrespect mi. An a always tell his bredda dem, and his nephew say, ‘tell him to leave me alone, cause everybody know say him a troublemaker’.
The arrow was apparently intended for the back of his head but he was alerted that the individual was taking aim at him with the bow. As he turned to face the alleged attacker, he felt the arrow shot through his face.
On impact he said he felt no pain. There was no bleeding. He only vomited once inside the vehicle that was taking him to the hospital.
Nephew said he had no argument with the man on that fateful day of April 30, but days before he was told by him to do disrespectful things to his mother. Claiming to have taken the high road, he said he told the agitator not to speak with him. He also claims to always be on the receiving end of his disrespect, and has never retaliated.
“Night before dis happen, him disrespect de girls dem so much dat dem lock de shop. So a tell dis guy to guh wey and leave me and him pulling a knife. By the time him fi pull de knife, me grab him before him pull it and tell him to leave me alone. So it end up dat fi him own knife cut him in him hand,” he explained.
He recalled saying “God, don’t mek the devil get the best a mi”. He meant to retaliate, he said, but did not want to be killed by someone he claimed to be “the devil”.
Nephew said they first stopped at the nearby Alligator Pond Police Station and was advised to go directly to the hospital.
At Mandeville Regional, “dem cut off piece a it, an den dem rush wid me dis side (Kingston),” he told The Sunday Gleaner.
Nephew said the whole time he was praying to not die like his father, who was murdered when he was a young child, nor did he want to lose his sight. Last year an uncle was also murdered.
“And God did. I know, he answered my prayer,” he stated.
In payment to God, Nephew hopes to change the lives of others through his dream to start a music business and building on a conscious philosophy.
No formal report has been made to the Alligator Pond police, as he has been hospitalised since the incident. The police said they were investigating, although they are yet to take a statement from him.
“The police must go to the hospital and interview him. That is the protocol. They hear about the matter, so they must speak to the complainant and find out if he wishes to pursue the matter. That is their job,” King’s Counsel Valerie Neita Robertson told The Sunday Gleaner.