Close call with a chainsaw
Donald McKay was at his friend’s property cutting wood with his trusty chainsaw, which he’d been using for 40 years. He was shaving off twigs from the tree and throwing them into a nearby burn bin when he suddenly caught the tip of the chainsaw on the edge of the bin, and the blade bounced back into his face. In an instant, his face was cut badly, bleeding profusely, and McKay was alone on a farm property outside rural Thorndale.
McKay needed to act quickly – he held a handkerchief to his face to stop the bleeding as he drove down the road in search of help.
A close call with a chainsaw is the stuff nightmares are made of, and in fact for several weeks after this incident McKay would wake in the night dreaming about the incident. Amazingly that was the only lasting consequence of this injury.
On this day the Trauma Team Leader, Dr. Ian Ball, oversaw the work of each trauma team call. London Health Sciences Centre is a teaching hospital that empowers residents to refine their medical skills under the supervision of more experienced physicians. In McKay’s situation, Dr. Shane Smith, fifth year general surgery resident, led the team, which included Amy Makish, Nurse Practitioner, and Dr. George Pang, first year general surgery resident, on rotation with trauma. When McKay entered Victoria Hospital, the primary and secondary survey examination began in the trauma room.
“It was like something you see on TV. They cut off my shirt, checked my eyes and nose, they checked from one end to the other to make sure I could feel everything on both sides. Everybody explained what they were doing,” McKay remembers.
Dr. Pang is inspired by what the trauma team can accomplish during these rapid and comprehensive examinations. “Trauma can be so unpredictable, it’s a team sport. Everyone has a role to play.”
McKay’s injury was not life-threatening, and was isolated to the wound on his face.
“He was incredibly lucky,” explains Dr. Smith, “He didn’t hit his eye or throat. It could have been much worse.”
During this time, McKay’s wife, Monica, called at work by the same neighbor who called the ambulance, was anxiously waiting at the hospital to hear about her husband’s condition. After a very positive prognosis from Dr. Smith, Monica was shown to the trauma room to see her husband. McKay had a dressing covering his wound, but she could see that his lips were split apart as he talked to her.
Dr. Smith, Dr. Pang and Makish all recalled how McKay was laid back and pleasant.
“Many patients in a similar situation would be understandably panicked and nervous. If the patient is conscious, usually a major part of the trauma team’s work is calming the patient down and assuring them of the care plan,” says Dr. Smith
Throughout his ordeal McKay stayed incredibly calm and reserved. He explains, “It happened. You got to get it fixed. It doesn’t help anybody if someone is wound up like a corkscrew.”
When Monica asked if the pain was unbearable, McKay’s response was that he had felt worse pain.
“Really? Worse than a chainsaw to the face?” Monica wondered. It turns out the freezing agent used to numb McKay’s face before sutures was worse.
Dr. Christine Nicholas, fifth year plastic surgery resident, was called to assess McKay’s wound. She cleaned the laceration before administering freezing, and then she and Dr. Pang proceeded to stitch for over two hours. Before this process started, Dr. Nicholas took Monica’s cell phone number to keep her updated.
Dr. Nicholas says, “It can be confusing and chaotic in the emergency department, and I knew the sutures would take a long time. I wanted to offer some measure of comfort around what to expect.”
Dr. Nicholas’ task was to essentially put McKay’s face back together, but stitching a patient’s face is much more complicated than a laceration anywhere else.
“This was more of a reconstruction. I needed to match cosmetic components on his face, like the upper lip and rim of the nose. You need to connect the cosmetic borders with really small sutures, and then add stitches over the rest of the cut,” Dr. Nicholas explains.
In McKay’s case, follow up consists of monitoring the scaring. No matter how the plastic surgeon approximates the stitching, due to trauma there is scarring and scars become thicker as they heal. Because the cut was so close below his eye, the skin around his eyelid has been monitored to make sure the eyelid hasn't scarred down, exposing the lower eye.
McKay appreciated the painstaking effort that Dr. Nicholas took to carefully stitch his wound. Dr. Pang also benefitted from this approach as he learned from the hands-on viewing of major facial suturing.
McKay explains, “Dr. Nicholas is a great doctor. She talked the whole time she was working by telling me what she was doing and how it was going. I felt involved in the care. She kept me calm with her kindness and humour.”
After the stitches were completed, McKay remembers Dr. Nicholas jokingly reassuring him that he was now pretty enough for the cover of “Chainsaw Monthly.”
The nightmares McKay experienced faded away after a few weeks, so other than a few follow up appointments with the plastic surgery service, and a faint scar across his left cheek, McKay has made a full recovery from the incident.
“Everybody we saw that day said he was very lucky and it all worked out best case scenario. This very scary day for us was routine and manageable for the team. My husband is okay, and in large part that is due to the amazing treatment he received,” says Monica.
McKay explains, “I’ve cut wood with that saw for over 40 years. I’m not new to cutting wood, but it only takes one time for something to happen. I still cut wood regularly, but I now have a brand new chainsaw with the proper safety features.”