Every Day Heroes: Inaugural Edition

Not all heroes wear capes. In fact, outside of comic books and Marvel movies, heroes are completely nondescript — you could be sitting beside one right now and not even know it. Real world heroes are single mothers who work two jobs just so their children can play sports. They’re firefighters and police officers who put their lives on the line for the safety of others.

They’re soldiers, they’re teachers, and they’re doctors. Here at McMaster University’s Department of Surgery, we’re lucky enough to work side-by-side with heroes every single day. Our surgeons routinely perform remarkable, livesaving surgeries. They push the ball forward in clinical practice, research, and academics. They help thousands of people combat illness, injury, and trauma.

Every day, our surgeons save lives. As such, we’ve decided it’s high time to give them the praise that they deserve. Every few months, we’ll be naming an “Every Day Hero” — a McMaster surgeon who exemplifies dedication, diligence, and courage all in a day’s work. First up: Dr. Niv Sne and Dr. John Harlock!

It’s not every day that surgeons are called to perform surgery outside of the hospital, so when Dr. Niv Sne and Dr. John Harlock were rushed to the horrific scene of a partial-dam collapse, you can imagine the cocktail of adrenaline, concern, and excitement coursing through their bodies. Here, roughly one year after the incident, they reflect on what is sure to be one of the most unusual days of their entire medical careers.

By Blake Dillon

rogreston Falls is a beautiful, serene place. Located just outside of rural Carlisle, Ontario, the private parkland is home to a harmony of plants, animals, and natural wonder.

A tributary of Bronte Creek cuts through the area, spilling over a 54-foot-wide cliff that forms a classic wide-terraced curtain waterfall that many locals routinely gawk over. But on July 21, 2016, that serenity was juxtaposed with horror.

Sixty-three-year-old Ben Paavilainen was called to Progreston Dam for a routine construction project. During his initial inspection, however, a huge concrete wall of the dam came loose and crushed him, pinning his body to the riverbed below.

ton General Hospital to see if they could get some surgeons on scene to help amputate a trapped civilian’s legs.

In incredible time, police, fire, and paramedics were all on scene to attempt to rescue Paavilainen. Despite the fleet of emergency responders, however, the group was no match for the 25-ton concrete wall. Paavilainen was stuck.

“The natural response when you learn of something like this is to start preparing the operating room,” he says.

“But, for the first time in more than 15 years of doing this, they said, ‘no, no… you’re going out there.’ They told me that the emergency responders were concerned that there would be no way to pull the concrete slab off of the patient, and the poor gentleman would require bilateral lower-limb amputation.”

Stuck as he was, however, he was alive and well — or as well as he could have been given the situation. The plan was, if the slab could not be removed from Paavilainen, he would be removed from it. The first responders called the emergency unit at Hamil-

Dr. Niv Sne, a McMaster University trauma surgeon, clearly remembers receiving the call from the emergency physician who apprised him of the situation.

Dr. Sne’s first order of business was to decide who he’d

bring along with him — enter Dr. John Harlock.

“Dr. Harlock is an esteemed vascular surgeon, and I called him without hesitation and asked him what he was doing,” Dr. Sne recalls.

“He goes, ‘Not much.

Just about to eat lunch.

What’s going on?’ I told him, ‘Put the lunch aside — we’re going out to the field to do a bilateral lower-limb amputation.’

His first reaction was, ‘Nah — you’re kidding.’

But I sadly wasn’t and we were on our way to the scene before either of us knew it.”

Upon their arrival, both surgeons were awestruck by the extreme juxtaposition of the scene.

“It was kind of surreal,” Dr. Harlock recalls. “I remember there was a family of ducks swimming peacefully on one side of the river and a serious trauma unfolding on the other. It was crazy.”

“It was totally picturesque,” Dr. Sne adds. “A beautiful site host to a horrible incident.”

The day was exceptionally hot, and, dressed in OR scrubs and running shoes, the two surgeons were ill prepared for the journey down to the foot of Progreston Dam. It’s a

steep climb down along a path lined with jagged, moving rocks — a path tough enough to descend in proper hiking gear. But with the guidance of a few firefighters, the two surgeons were on scene and ready to operate.

For both doctors, the accident was far worse than imagined. Not only was the concrete slab crushing more of the patient than expected, but there was also another critical detail that neither Sne or Harlock were prepared for.

“He was awake,” Dr. Harlock says. “Awake.

Aware. Alert. Talking.

Moaning and groaning.

He was breathing on his own, and maintaining blood pressure.”

Performing a bilateral lower-limb amputation on a sedated patient in the comfort of a hospital operating room with the help of power tools is one thing for two experienced surgeons like Drs. Sne and Harlock. But, performing a surgery as complex as that on a patient who’s completely alert, lying in a river, and pinned to the earth by 25 tons of concrete using only a string-saw — the kind of saw you’d use to cut wood in a forest — was a completely different story.

Dr. Sne described the situation as “organized chaos.” He says that the first responders did an outstanding job of controlling the situation, but there were still far too many factors preventing them from simply swooping in and performing surgery.

As such, the first order of business for the surgeons was to intubate the patient.

“The OR can be quite chaotic,” explains Dr. Harlock. “People die. They come in bleeding from ruptured aneurisms or gun-shot wounds, but, even then, it’s still relatively controlled chaos. It’s my workplace. It’s what I’m used to.

Performing any kind of surgery in a riverbed is a lot different. You’re out of your comfort zone. So, when we got the patient intubated, things felt a lot more controlled and we were able to get to work.”

And get to work they did. The plan was to use a scalpel to cut through his muscles and nerves and use the string-saw to cut through the bone. Dr. Sne looked after the initial intubation and took control of the bleeding. Dr. Harlock cut down on the patient’s thigh to place clamps on his blood vessels. Together, they ensured his vitals were okay, that he was properly sedated, and that he was well looked after.

“I knew then and there that it wasn’t going to be a nice amputation, being so high up on the legs,” Dr. Harlock says. “It would have been tough to get proper tissue coverage, and I was just going to do a guillotine cut straight down and do my best to repair it when we got the patient back to the hospital.”

Notice Dr. Harlock’s use of past tense. “Wasn’t.” “Would have.” “Was.” Just as the surgeons were about to perform the amputation, they got word that a crane was approaching to help lift the slab off of the patient — music to their ears.

In a few short minutes, the crane was on site, attaching its pulley to the slab. Even then, though, there was more uncertainty than relief.

“My mind was racing,” Dr. Harlock recalls. “Is he bleeding out under the concrete? What state were his legs in?

Would the concrete fall further onto his body if the crane slipped up at all? The whole situation was really tense.”

With the fire chief directing the crane, Dr. Sne, Dr. Harlock, and the rest of the first responders were ordered to temporarily vacate the area due to the very real risk of the slab tipping onto somebody else. With all its might, the crane managed to lift the 25-ton slab about six inches off of the patient — just high enough for him to be slid out from underneath.

To both surgeons’ surprise, the patient’s lower limbs

were in an okay state, all things considered.

“Because it was a true crush injury, all of his blood vessels were sent into spasm, meaning there wasn’t as much bleeding as you’d expect,” Dr. Sne explains.

“We got him on a stretcher, put a tourniquet on his legs,

dics waiting there — people from plastics, too. Mix in Dr. Sne from general and myself from vascular and it was quite a team effort.”

After a lengthy operation, both legs were salvaged. Although he suffered fractures in several locations, the patient didn’t require any sig-

of night. We were lucky it was in the summer, and not the dead of winter. All things considered, I’m sure the circumstances could have been a lot different if the stars weren’t so well aligned.”

Lucky or not, the truth is Drs. Sne and Harlock acted heroically that fateful day at Pro-

“The OR can be quite chaotic...

But it’s my workplace. It’s what I’m used to.”

-Dr. John Harlock and got him ready for transport to the hospital.”

At this point, Dr. Sne says there was a lot of communication with the hospital.

They already had an operating room set-up; all they had to do now was get the patient there alive.

Dr. Sne travelled back to the hospital with the patient and the paramedics by helicopter, while Dr. Harlock went back in an ambulance with a police escort, which arrived at the hospital five minutes before the helicopter did.

“When the patient arrived, we bypassed emergency and went straight to the operating room,” Dr. Harlock says. “We had people from orthopae-

nificant amputation, except for a small bit of work on his right foot. Considering what was originally planned, this was a major win for both the patient and for the surgeons.

Alotgether, the whole excursion was just a few hours long. But with so much uncertainty and so many uncontrollable factors, the day seemed like an eternity for Drs. Sne and Harlock (and surely for the patient, too).

“In hindsight, there were a lot of things Dr. Harlock and I did not think about,” Dr. Sne says. “We now have a lot more protocols in place, in case something like this ever happens again. We got lucky that it was during daytime, and not the pitch black

greston Falls. They were calm in the face of chaos, and decisive in the face of urgency. If you ask them, they’ll tell you that they were just doing their jobs. Modest, yes, but also true — they were just doing their jobs. And that’s what’s so amazing about it all. Every day, Drs. Sne and Harlock help people in need and save lives. For that and more, we’re proud to call them our Every Day Heroes.

Believe it or not...

It did happen again. After the publication of this article, both Dr. Sne and Dr. Harlock were called to a farming accident in Flamborough, Ontario. As Dr. Sne suggested, the newly established protocols made their second excursion feel a lot less chaotic than the first.