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Almost every case turns on an interval.

Thirty-four cases, ordered by the clock each one runs on: six hours of tissue viability, sixty-six hours to treatment, fifteen years untreated. Switch to the figure index to browse by diagram instead.

34Cases published
33Original diagrams
1Reviewing physician

Hours

Where the tissue is still alive and the window is closing
  1. 0 hmachine still attachedMC-026EmergencyThe hand arrived still inside the machineA welder freed him in theatre. The amputation was decided by something much simpler than the damage.
  2. within hoursone heart, two bodiesMC-008ChildrenParasitic twin: the twin with no heartA second head with eyes and lips, and no circulation of its own. Waiting would have made her weaker, not safer.
  3. 3 hafter the biteMC-005EmergencyViper bite coagulopathy: the scan that showed nothingThree hours after the bite his blood could no longer clot. A normal ultrasound is what kept him out of theatre.
  4. 6 hof viabilityMC-010ReconstructionReplanting an arm: the clock, and the harder questionSix hours of viability, and a decision about whether to reattach a limb the patient removed himself.
  5. 34 hfrom walking in to deathMC-033InfectionA stomach ache, no fever, and septic shockShe looked well and was afebrile. Her blood pressure was 75 over 50 and her white cell count had almost vanished. The organism was named after she died.
  6. 66 hto treatmentMC-020EmergencyHe stayed at Camp 4 to help another climberGrade 4 frostbite, treatment 66 hours late, and he lost half of two toes.
  7. on arrivalsitting forward to breatheMC-031EmergencyHe could breathe sitting up, but not lying downHis face hit the steering wheel and the midface came away from the skull. The position he was holding on arrival was the finding that mattered most.

Days

Long enough for a drug or an infection to declare itself
  1. a few daysbetween the two operationsMC-029ReconstructionTwo flaps, and no microscopeA radical resection took the left side of his mouth. Both muscles used to rebuild it stayed joined to their own blood supply and were swung into position.
  2. same dayinfected from the same sourceMC-030InfectionBoth boys were infectedThe most reproduced vaccination photograph in medicine is usually captioned wrongly. The vaccinated boy caught smallpox as well. It simply never got going.
  3. 2 daysrash to diagnosisMC-012DiagnosisPurple ears: the adulterant, not the drugA net-shaped rash, collapsing neutrophils, and antibodies pointing two ways at once.
  4. 5 daysbefore anyone looked againMC-006DiagnosisWooden foreign body on CT: the scan said gasWood reads as air on a scan. The clue that overturned the report was an infection that would not settle.
  5. 6 daysbefore anyone could undo itMC-027ReconstructionThe shark did not cause the contractureThe bite took tissue. The hand was lost to a wound closed too tightly, and by the time she reached a second hospital it was already fixed.
  6. 1 weekheadache to confusionMC-016InfectionThe abscesses in his brain came from his teethThe veins of the face have no valves. Nothing stops infection travelling the wrong way.
  7. 10 daysof leeches, and ten litres of bloodMC-034ReconstructionThe bleeding was the treatmentHer scalp came off in one piece and was sewn back on within four hours. Getting blood in was the easy half; the flap was drowning in blood that could not leave.
  8. 10 daysfrom impalement to homeMC-036EmergencyThey cut the branch down. Nobody pulled it out.A road accident drove a branch through the side of his face and out of his mouth. It was cut from eight feet to two, left in place, and removed only once the vessels around it could be controlled.
  9. 11 dayswound to first spasmMC-015ChildrenThe wound was cleaned. She still got tetanus.She reached a hospital the same day. The one injection that would have prevented it was never given.
  10. 12 dayson the drugMC-017DiagnosisIt looked like a virus. It was the medication.He was taking lamotrigine. Much of the risk with that drug is in how fast the dose goes up.

Months

Healing itself becomes the injury
  1. 2 monthsfrom operation to lost to follow-upMC-028ChildrenThe surgery was free. The cure was not.A visiting team removed a childhood sarcoma at no cost. The chemotherapy that decides whether she lives was months away, and her family could not follow it.
  2. 7 monthsbefore he was referredMC-021ReconstructionHe was a face transplant candidateThe surgeon who assessed him performs face transplants. He rebuilt this patient from his own tissue instead.
  3. 10 monthswithout a surgeonMC-003ReconstructionBurn scar contracture: face healed to the chestTen months without a surgeon turned a survivable burn into a disfigurement that took twelve operations to reverse.
  4. 1 yearof a brain under pressureMC-032ChildrenA twin inside a skull, benign and still fatalIt had a spine, a face and hands, and it was not a cancer. The only thing that decided the outcome was where it happened to grow.
  5. 15 monthsfor the wound to closeMC-018InfectionIt does not eat flesh. It cuts off the blood.Her IV antifungals were not working. The answer was to stop relying on the bloodstream entirely.
  6. 16 monthsthe gap in median diagnosisMC-009ChildrenRetinoblastoma: the cancer a photo can catchOver 95% survive when it is found early, around 40% when it is not. The tumour is the same.
  7. a yearin silenceMC-019ChildrenThe operation removes the hairball, not the habitHair cannot be digested and cannot be pushed along, so it stays and builds for a year in silence.

Years

The interval no one was counting
  1. 1,500 hof dissectionMC-025AnatomyTwo students, 1,500 hours, and no shortcutVessels can be filled and cast. Nerves are solid, so the only method is removing the body around them.
  2. 10–25 yrshow long implants lastMC-013OrthopaedicsA knee replacement does not replace the kneeAbout a centimetre comes off each surface. The rest of the operation follows from that.
  3. 14 yearsand 70 operationsMC-022ReconstructionHe was not going blind from the fireHis eyes survived the burns. His eyelids did not, and nothing grafted can be made to blink.
  4. 15 yearsuntreatedMC-007ReconstructionKeloid vs hypertrophic scar: fifteen years untreatedMinor cuts to the jaw, no treatment available, and fifteen years for a scar to become a disability.
  5. 15 yearsbefore the transplantMC-011ReconstructionTwenty operations rebuilt his jaw. None gave him a face.Reconstruction restores structure. A face is not structure. What the transplant cost him came seven years later.
  6. 28 yearsone side, by the windowMC-035DiagnosisThe window stopped the sunburn, not the damageTwenty-eight years at the wheel of a delivery truck, and only the side of his face next to the glass aged. Window glass filters out the rays that burn and lets through the ones that go deeper.
  7. 50 yearsafter birthMC-014DiagnosisA vein that closed at birth, reopened fifty years laterCaput medusae is the visible detour. The one that kills is in the oesophagus.
  8. yearsof slow expansionMC-023ReconstructionIt was never cancer. It still had to come out.Benign and harmless are different words when the skull has no spare room.
  9. 1824the first lithotrityMC-004HistoryBladder stone surgery in 1824: the nail-and-hammer mythNo nail, no hammer. A blind operation inside a conscious man's bladder, and the first minimally invasive surgery.
  10. since 1663the method itselfMC-024AnatomyYou are not looking at blood vesselsThe vessels were dissolved too. What is left is the shape of the space inside them.