Late Phillip Hughes' doctor's heart skips a beat at every bouncer

Sydney Everyone talks about the pressures of international cricket and playing in front of packed houses Professional cricketers have to be used to that But what about a doctor who is unexpectedly thrust into the most important position in world cricketDr Tony Grabs head of Trauma and Emergency Department at the St Vincents Hospital in Sydney yesterday PicAshwin FerroDr Tony Grabs Head of Trauma and Emergency Department at the St Vincents Hospital here and his team who performed their 100minute operation on Phillip Hughes who was hit by a bouncer from Sean Abbott during a Sheffield Shield match on November 25 last year were put under exactly this pressureIn an exclusive interview with midday Dr Grabs 52 recalls what happened in the 48 hours since Hughes was rushed postlunch into the citys premier hospitals emergency intensive care unit on that terrible Tuesday exactly four months agoHe says that even as the entire cricketing world prayed for the 25yearold batsmans recovery his team of doctors knew the very moment they saw Hughes in hospital that there was very little hope given the extent of the injuryExcerptsDo you think cricket is a dangerous sportCricket has got the lowest rate of injuries in my experience of almost 20 years at this hospital And there are numerous cricket fields in and around the Sydney Cricket Ground with many people mdash adults and kids mdash playing the game We get a lot of injuries from soccer or Australian rules football or rugby because these are impact sports so fractures joint dislocations and major bruises are common but none in cricket There have been cases of body blows in cricket right from the Bodyline series in as early as the 1930s and following that protective hats and helmets were the logical way forward Closein fielders wear helmets and thats the right thing to do Head injuries must be avoided at all costsPhil HughesWhat are your thoughts on bouncers in cricketI think they are part and parcel of the game But personally my heart skips a beat every time I watch a bouncer directed straight at a batsmans head The other day the Pakistanis Wahab Riaz were bowling some fast bouncers against Australia in the World Cup quarterfinals and each time I saw the ball pass so close to a batsman I was a bit uncomfortable A cricket ball hurled at 140 kmph is a dangerous weaponAre helmets adequate protection from head injuriesLook the Hughes incident was a freak and very unique case But thereafter the modification of the helmets were discussed and have subsequently been carried out too especially from the back covering the lower part of the head around the neck area I think thats perfectly fine Im not a batsman but Ive heard that there have been some limitations of movement of the head for batsmen with the new helmets But the movement is not very restrictive and its a small price to pay to protect your head and life But more importantly helmets should fit correctly Ive noticed in grounds many a times a team shares just two or three helmets and these dont fit all batsmen correctly since all heads are not the same obviously This must be avoided because first of all a helmet does not ensure zerohead injury A helmet only prevents the focal contact of the ball on a vulnerable area For example the temple area in particular is very vulnerable because theres a blood vessel that runs up on the inner side of the skull bone so if you get a fracture there you can have internal bleeding pretty quickly What a helmet does is it absorbs the contact and spreads it across a larger area of the head reducing the danger Conversely when a ball hits the head directly its a highenergy impact on a small contact area so thats dangerous So even a helmet cannot stop concussion that can occur on impactWhat was your reaction when you saw Phillip Hughes for the first time in hospitalIm a vascular surgeon surgery that deals with the vascular system comprising arteries and veins so I could tell that the artery at the base of the skull neck region just below the skull was damaged I felt very very sad and in a sense I also felt a very strong feeling of helplessness looking at the gravity of the injury As a doctor I had never encountered such a case ever and none of the doctors I know had eitherSouth Australias Phillip Hughes is attended to by NSW players after being stuck on the head by a Sean Abbott bouncer at the Sydney Cricket Ground on November 25 2014 PicGetty ImagesWhat were the initial moments of Phillip Hughes admission likeThe most important component of any neurosurgical therapy is the time taken from the occurrence of injury to the time in reaching the operating theatre and thats the difference between a good outcome and bad oneIn normal emergency cases time is spent in the initial investigative department going in for scans andor getting in surgeons but in this case we had prenotification that such an incident had occurred on the cricket field So my team was ready and everyone was available We went straight to the scanner and from there he was immediately rushed into intensive care Thats where I saw him and at first glance we realised that there was not much we could do as it was a very difficult situation He was not dead but the sheer extent of the injury gave us all a heartsinking feelingHow did your team handle the family crowds and mediaOur team was very professional because we do see a lot of awful things happening around us with emergencies coming in all the time But this was different and completely unexpected in nature We have two teams of social workers who are on call 24 hours mdash one from the nursing department and one in the intensive care department and their job is to primarily counsel the patients close family and relatives There was chaos around the entrance of the hospital but everyone was kept at bay as the familys privacy and protection was our priority It was a story of significant interest for the media but they showed good restraint given the sensitivity of the situationAnd what about the cricketersAbsolutely no one was allowed to come in and I met the cricketers beginning with Michael Clarke and the others only two days later after Hughes had passed awayHow long did the operation last Was there any hope at all after surgeryThe operation lasted for an hour and 40 minutes I was in and out of the theatre repeatedly and was following the entire procedure on the scanners outside the theatre whenever I stepped out But the prognosis was clear right from the start We could feel it We felt that it probably wouldnt helpSo when were you certain that Hughes had passed awayOn the second day November 27 We completed some formal tests and found that he was brain dead There were no reflexes in the body We have to wait for 48 hours before taking a call in such cases because we have to make sure there are no drugs influencing the individual You look at the pupils and there are also a series of subtle tests that we do on scans looking at the blood flow in the brain Some of the scans can tell us that there is no blood flowing in the brain and the reason for this could be due to the pressure on the brain where swelling may have occurredWho relayed the news to the family and what was their initial reactionI didnt do it one of our doctors from the operation theatre did it Its a very tricky situation because you have to constantly keep in mind the sensitivity of the issue and the grace that needs to be maintained right through The family was in deep shock but they were prepared for the worst Cricket Australia decided that they would announce the news to the outside world To be honest I went back and looked at the footage of the match a couple of times and the very instant I saw him stumbling after the impact of the bouncer I could tell that something was terribly wrong As a doctor I felt right then and there that he was not going to do very well after that And the fact is that his heart did stop at the ground itself and he had to be given CPR Cardiopulmonary Resuscitation on the sidelines It was a remarkable effort from the people at the ground to get him to the hospital in the condition that they didHow did the players reactThey were in disbelief I think everyone else outside was in disbelief I have a wife and kids and they too could not believe it But I was very impressed with the way the players conducted themselves not only in the immediate aftermath but even when they went out to play and reached various milestones and dedicated it to HughesBut cant a brain dead person still be kept alive artificiallyInitially its not possible to tell if a person is brain dead We could not assess if Hughes was brain dead on the very first day without going through various tests and scans We dont declare someone brain dead first up because we always have hope for improvement So we give the patient a chance to get better by providing maximum therapy which includes drugs and other methods of treatment Our machines keep him in the best position A brain dead person can be kept alive on machines for long but its not a satisfactory thing to do because the patient cannot move at all and so they get pressure areas and their nutrition is poor anyway so things can only get worse It was a joint decision between the doctors and the family in this contextIs there truth in the reports that there was a delay in the ambulance reaching the spotThere may have been some slight delays but there were doctors on the field who happened to do exactly what an ambulance would have done So there was no delay in treatment to the patientFinally are you following this World Cup closely and who do you think will win tomorrows semifinalIm obviously unable to watch all the matches as Im on medical call most of the time but I did watch a few games on TV Ive watched India play and I think Australia might just end up being in trouble against the Indians at the SCG