Case 87 of The Blue Cliff Record proposes that “Medicine and disease subdue each other.” An athletic proposition, to be sure; it’s much easier to just assign neat roles of the beneficial and toxic. But do so, and very quickly, you leave the world behind, in favor of clean proscription.
In today’s NY Times, an account of the work of neurosurgeons, Dr. Michael Lemole and Martin Weinand on Gabrielle Giffords’s gunshot wound, includes as robust and clear an example of this inextricability of harm and healing as I have ever seen: that the heat of the bullet itself might have sterilized the areas it passed through, thereby reducing the chance of infection.
Here is an excerpt from the article:
Dr. Lemole and Dr. Weinand studied the CT scans, tracked the path of the bullet and decided where to cut. The bullet had passed through her skull. Fortunately, it had not severed arteries or veins. The surgeons plucked out bits of broken skull and dead tissue, and removed part of her skull — less than half on one side — to avoid pressure from swelling. Also to relieve pressure, they expanded the opening that the bullet had made in the dura, the membrane covering the brain. The skull bone, fractured by the bullet, came off in pieces, which are being kept in a freezer and will be put back during reconstructive surgery, probably months away.
A bullet hits the skull like a meteor, Dr. Lemole said. Both start to break up, and shards of bone and metal can be driven into the brain.
“The old thinking was to chase after them and pull them out to reduce the chances of infection,” he said. “But we learned from the military that it can be worse to chase them” than to leave them there. Digging around in the brain can damage it further. In any case, he said, the heat of the bullet may have sterilized the embedded fragments.