Anyway... I Forgot to Tell You!

By Erik Hagen

Medicine can be both fascinating and terrifying.

This statement can be applied equally to those who practise medicine, but also to the ‘lay’ person who observes from afar but eventually, and sadly inevitably, becomes enmeshed in it. Usually as a reluctant patient.

Erik Hagen has been practicing medicine for the last forty odd years. He has been involved in country General Practice, Emergency medicine, Retrieval medicine with the Royal Flying Doctor Service of Australia and also in motor sport medicine at both the national and international level, especially in the fields of Formula One and World Rallying.

This collection makes up the second volume of short stories, the first being “Imperfect Recollections; Memory Fragments from and Ageing Medico”, published in 2020.

Some of the stories are just that – stories; but some of the subjects are possibly more reflective than the first book, attempting to examine the questions that confront us all.

Perhaps that kind of musing afflicts all of us who have fewer years ahead than behind us or perhaps it is just that we are vain enough to imagine that we have something worth saying.

• Language: English
• Publisher: Austin Macauley Publishers
• Release date: Dec 16, 2022
• ISBN: 9781398489325

Erik Hagen

Erik Hagen has spent over 40 years in the field of medicine in such diverse areas as country general practice, retrieval medicine with the Royal Flying Doctor Service of Australia and in various emergency departments, all whilst pursuing his passion of motorsport medicine which includes involvement in Formula One and the World Rally Championship. This is his second book, a sequel to 'Imperfect Recollections; Memory Fragments from and ageing Medico'.

Book preview

About the Author

Erik Hagen has spent over 40 years in the field of medicine in such diverse areas as country general practice, retrieval medicine with the Royal Flying Doctor Service of Australia and in various emergency departments, all whilst pursuing his passion of motorsport medicine which includes involvement in Formula One and the World Rally Championship.

This is his second book, a sequel to ‘Imperfect Recollections; Memory Fragments from and ageing Medico’.

Dedication

For Michael Quinlan:

A gentle-man, a scholar, a teacher, physician extraordinaire, a healer, my mentor and my friend.

RIP

Copyright Information ©

Erik Hagen 2022

The right of Erik Hagen to be identified as author of this work has been asserted by the author in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988.

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of the publishers.

Any person who commits any unauthorised act in relation to this publication may be liable to criminal prosecution and civil claims for damages.

The medical information in this book is not advice and should not be treated as such. Do not substitute this information for the medical advice of physicians. The information is general and intended to better inform readers of their health care. Always consult your doctor for your individual needs.

A CIP catalogue record for this title is available from the British Library.

ISBN 9781398489318 (Paperback)

ISBN 9781398489325 (ePub e-book)

www.austinmacauley.com

First Published 2022

Austin Macauley Publishers Ltd®

1 Canada Square

Canary Wharf

London

E14 5AA

Acknowledgements

Like for the previous tome, there are many people to thank.

Again, Steve Dunjey for his proofreading, ensuring that I did not stray too far from the straight and narrow medical pathway. My friends such as Don Degiglio and Lachlan Murray MacTaggart for their thoughts.

Also to my family, especially my lovely Margie – who helped me, read and constructively critiqued each story.

To you who liked the first book and encouraged the second.

Finally, to my colleagues and above all, my patients who let me into their lives and without whom these stories would never have been possible.

Introduction

This is the second book in a series of two. There are more medical stories with some musings about various topics like ageing, death and morality. Perhaps, as I have more years behind me than ahead, I have mellowed slightly and become more philosophical.

It has been said that wisdom comes with age and experience but there are enough examples to the contrary to almost invalidate that assertion. I fear that might also apply to me.

I think that the more we collectively and individually search for the ‘meaning of life’ and reasons for why things are the way they are, the more elusive the answers become.

Perhaps the answer to the ‘Ultimate Question of Life, the Universe, and Everything’ is indeed what Zaphod Beeblebrox is told by the super computer, Deep Thought, in the Hitchhiker’s Guide to the Galaxy and that is 42.

No one has the answer and those that claim they do might just be desperately hopeful, trying to make money or just have delusions of adequacy.

Anyway (there is that word again!) I hope you enjoy this one too.

1. It Is Just a Family Matter…

I sort of fell into motor sports medicine in the late 1980s and now I have been pursuing it as a passionate hobby for 30 plus years.

It started when I was a country GP in the south west of our state. An old friend and colleague of mine asked me if I would help out on the medical side of things for the Australian round of the World Rally Championship (WRC) which, at that time, was held in our state. The rally route had Special Stages close to our town and indeed a temporary Service Park (for refuelling and mechanical repairs) was set up on our town’s football oval.

My friend was the Chief Medical Officer for the event.

I said to her that I couldn’t possibly help as I was far too busy! That said, I strolled across the road to the Service Park after Saturday morning surgery and I was hooked.

The cars were wonderful. Having a limited, proscribed time for repairs and refuelling at a number of servicing opportunities each day, they pulled up efficiently at the temporary tents and workshops, choreographed mechanics attended to them without a wasted movement and they were on their way again within the allotted 30-minute period with a deeply impressive throaty burble from their exhausts.

I remember being particularly impressed with one crew who changed a whole gearbox within the 30-minute time limit. Last time I had that done to a car of mine it took three days and cost an absolute bomb!

The very next day, I rang my friend and said, I’m in! – and that was basically that.

Over subsequent years, I went from being a doctor in a Medical Intervention Vehicle (MIV) on the Special Stages and occasionally in the Safety Helicopter (great fun) to becoming the Deputy Chief Medical Officer and then taking over from her as Chief Medical Officer when she moved interstate.

Later, I became involved in national rallies, the national motor sport authority and finally in the Australian F1 Grand Prix. I was able to travel to other countries, near and far, to assist them setting up both their rally events and their F1 events. I also work as a Medical Delegate in the WRC for the international motor sport governing body, the FIA (Federation Internationale d’Automobile) and in that capacity attend WRC events in our region to ensure that the medical side of things conforms with the rigorous requirements of the FIA.

Motor sport has been very good to me and I have had a great time!

The story I want to tell you today, relates to one of those overseas ‘gigs’ that was one of the major ‘perks’ of my involvement in motor sport medicine.

A friend of mine, called Peter, (don’t be so surprised and even unkind… I do have the occasional friend) has ended up as a sort of ‘Doctor Motor Sport’ in the UK. He loves it and works very hard at it.

In that capacity, he used to help one of the major World Rally Championship (WRC) Teams and provided medical cover for that team when they travelled outside of Britain to events in different parts of the world. Besides that, he had a busy hospital based surgical practice in the middle of the UK.

Peter used to do most of the European rounds of the WRC but for a number of years in the mid-2000s, I used to fill in for him when the WRC went to Japan as that is a long way from the UK, and involved too much time away from his surgical practice. Me being in Australia, I was at least 12 hours travel closer than he was.

The Japanese round of the WRC was then based in the northern island of Hokkaido, which is beautiful and quite rural in the area where we were based. I went to look after a major WRC team but also be the doctor for the second tier of competition, at that time known as the Production WRC.

So, off I went.

My job was mainly to act as a GP for the nearly 150 team personnel in both the main WRC team and also the Production WRC teams. Peter had an extensive medical kit which included a lot of pharmacy items such as antibiotics, anti-nauseants and various other medications and creams. I found it amusing that a number of team members were kindly asking for assistance on behalf of an un-named friend who had a rash or even a discharge ‘down there’!

As I was based in the main Service Park, a lot of the time was spent having coffee with friends and the other team doctors (they were friends too!) and eating at the many hospitality areas set up by the WRC teams. Hardly an onerous work load!

Anyway, a good time was had by all until the late morning of the second day of the three-day rally competition.

Then disaster struck.

My major team’s second manufacturer car was involved in an accident and the co-driver seriously injured. The driver was an odd sort of bloke. Most people agree he was definitely ‘on the spectrum’ and had absolutely no people skills but when he got behind the wheel of a rally car he was magic personified. His co-driver was a very experienced French guy called Pierre who was universally liked and respected in the WRC family (believe me it is a family – sometimes the siblings squabble amongst themselves but they unite in times of crisis and also against outsiders that they decide they don’t like).

Anyway, what happened was as follows.

Most of the stages were in the beautiful, agricultural countryside. Besides various crops there was also a lot of livestock and, where there are livestock, there are also fences to contain them.

On one particularly sweeping left-handed bend, the corner post of the fence, in this case a particularly heavy steel angle-iron type upright, was less than a metre from the road on the outside of the bend. The driver took the corner at speed and drifted out a little and the heavy steel post impacted the right side of the vehicle by the co-driver (the vehicles are left hand drives).

The post hit the car in the right front wheel arch, just behind the tyre, and then intruded into the cockpit and hit the co-driver on the inside of his right thigh, abruptly forcing his legs apart, fracturing (or rather shattering) his right leg in two places and also fracturing his pelvis and causing damage to his intestines and to the blood vessels supplying them. To say that he was in some pain is a gross understatement.

The car then spun away from the post, rolled once and thankfully ended up on its wheels but obviously going nowhere.

The monitoring system in Rally Control was able to detect that a significant accident/incident had occurred, so the stage was immediately stopped and the Medical Intervention Vehicle (MIV) based at the start dispatched or ‘scrambled’ to the scene.

Pierre was not able to exit the car by himself so the MIV crew, concerned about the possibility of internal and pelvic injuries put a collar on his neck and strapped his knees together to stabilise both his cervical spine and his pelvis. At that stage, they were in the countryside and obviously unable to investigate the full extent of Pierre’s injuries but nonetheless treated him on the basis that there well might have been significant neck and pelvic injuries.

Once out of the car he could be placed on the ambulance stretcher (the ambulance having also ‘scrambled’ but travelling slower and taking longer to arrive at the scene) and he could then be more completely assessed and treatment begun (including pain relief) before being evacuated by helicopter to the main regional hospital.

There he was further stabilised and his injuries further elucidated with various imaging such as X-rays and CT scans.

The findings were not particularly good.

His right lower leg had fractured both the tibia and fibular (the two bones of the lower leg).

There was free bleeding into his abdomen noted on CT, with accompanying intestinal disruption.

The worst injury, however, was to the pelvis. This had, what is described as, an ‘open book’ fracture. This means that the pelvis has opened up or fanned out in a manner similar to the pages of an open book. This is a very severe injury. The pelvis has a multitude of both arteries and veins that form a network inside it and this type of fracture tears these delicate vessels and causes what can sometimes be catastrophic bleeding, which is almost impossible to stop.

So, Pierre had severe injuries but also had lost, and was continuing to lose, a lot of blood. Most of this was internal bleeding and not obvious to the outside observer.

It was decided, quite rightly, to take him to the operating theatre and stabilise his broken legs, repair his intestinal damage and to try and stop the haemorrhage from his dangerous pelvic fracture. Most importantly the pelvis would have to be stabilised so any inadvertent movement would not cause further damage, and most especially further bleeding. He would also need to be given blood transfusions to replace what blood volume he had lost.

Unfortunately, Pierre’s blood group was (and still is) A Rhesus-negative which is a very rare blood group for Japan. Indeed only three units of A negative blood could be located anywhere in the hospital and the surrounding region.

What to do…

As the team medico, I put out the word in the WRC Service Park for help from anyone in the teams, officials and press who was A Negative blood group to donate.

Amazingly we got nine donors who were not only the right blood group but also ready, willing and able to donate. Many others put their hands up but were not the correct blood group. I arranged for them to go to the hospital and give their blood. As an aside, I found out later that I also had A Negative blood but I comforted myself with the thought that I was too busy organising things to find out my blood group. Besides if I donated blood, who could possibly be in charge?

One donor was a friend of mine from Australia who was at the event as an FIA official and despite his age (he was 75 years old) insisted on giving blood. Another person who lay down to give up a bit of the ‘red stuff’ was one of the Team Principals of a ‘rival’ Team. Good on them all!

Usually blood donations are carefully screened for diseases such as AIDS and Hepatitis but on this occasion we, and more specifically Pierre, did not have time for that. I signed a waiver to safeguard the hospital from any future comebacks and the transfusion commenced.

The blood was literally taken directly from the donor, mixed with a little citrate preservative and infused straight into Pierre’s arm.

In those days, most of the blood replacement therapy in trauma cases was based on giving a salt solution plus red blood cells only – known as ‘packed cells’ in the trade.

However, Pierre was losing whole blood, not just salty water and red cells. The good thing about him receiving blood straight from the donor was that he was getting what he was losing – ordinary whole blood with the important red cells but also with platelets (the clotting cells) and plasma containing the vital clotting factors to help him stop bleeding.

Interestingly, these days if a person is bleeding badly they not only get packed red cells but also platelets and fresh frozen plasma containing the clotting factors. It is known as the ‘Massive Haemorrhage Protocol’. At the time of Pierre’s accident that was not in vogue, so I always think we (and he) were lucky that we actually gave him what he needed most and what has now become standard trauma treatment practice.

Anyway, the operation had gone fairly well so far. The leg had been pinned, the gut and its blood vessels repaired and the pelvis stabilised with external metal fixators. This is done by screwing metal rods into the various bones of the pelvis (through the skin – yuck!) and then attaching them to an external metal cage which then holds the mobile bones of the pelvis (made mobile by the injury) in their normal fixed, rigid anatomical position. Hopefully this then limits further damage to the delicate pelvic blood vessels.

The pelvic cavity was then packed with swabs to try to stem the haemorrhage as it was still bleeding briskly. Unfortunately, the pelvis is a large area and packing it to put pressure on any bleeding points is not as successful as doing it in other areas of the body.

So far so good but the bloody pelvis was still bleeding – what to do?

These days what is done to stop the bleeding is to get a specialist in what is called Interventional Radiology to place a thin catheter into the blood vessels in the groin and feed it into the area where the blood vessels are damaged, then under X-ray guidance put a blob of super-glue in the bleeding artery to block it off. As there is a whole leash of arteries and veins in the area, blocking one won’t have any major deleterious effects to the blood supply to the pelvis and its organs.

At that time, Interventional Radiology was in its infancy but the hospital, where Pierre was, is one of the pioneers in the field. How lucky was that!

In that manner, the pelvic bleeding was stopped and with the infusion of ‘whole blood’ from our Service Park donors, Pierre’s condition could at last be slightly stabilised. I use the word ‘slightly’ as he was definitely not out of the woods and was critically unwell. He had had 12 units of whole blood transfused into him and as each unit is approximately 450 ml, his total blood volume had been replaced twice!

It was touch and go if he would survive the night in the Intensive Care Unit.

By now, it was around 11 pm at night and myself and the team had been at it organising and attempting to help on the side lines for the last 12 hours – I was exhausted but well off compared to poor Pierre. I was still at the hospital. I talked to our Team Principal, Mark, (a really nice guy, very concerned) and we decided as Pierre was so unwell, the best thing would be for me to stay overnight at the hospital and be on hand in case anything happened (not that I could have done much as the Japanese doctors were doing a fantastic job but perhaps for moral support).

For the princely sum of $50, I was allowed to sleep