Expert surgeons save youngster after rare brain haemorrhage

By JOHN ROBERTSON

A Lerwick boy has survived a rare form of brain haemorrhage and do-or-die operations which taxed the expertise of some of the world’s top surgeons.

Now, after enduring grave threats to his life, Jack Pearson seems to have bounced back to being a normal fit and healthy 14-year-old.

The Pearson family’s experiences of the NHS at its absolute best are an antidote to the grim stories of health care failures which have hit the headlines in Shetland recently. But it has left Jack’s mother, Sandra, concerned that more could be done to prevent islanders dying or suffering serious illness from the undiagnosed cause of recurring headaches. She urges people who suddenly start getting headaches to visit their doctor and ask to be scanned in Shetland’s CAT scanner to pick up potential warning signs of tumours, haemorrhages and other conditions.

She also backs the community’s call for a second emergency ambu­lance, fearing someone will die because of a delay in getting urgent medical care if the only ambulance is elsewhere on a call.

Sandra is not just a concerned mother with an understandable fear of what can happen in the event of accident or life-threatening illness, she has specialist knowledge of how to minimise risk, prevent accidents and avoid unnecessary failures because that is what her job as the council’s safety and risk manager is all about.

When she tells councillors how to save hundreds of thousands on the SIC’s insurance premiums they sit up and listen. “I’m a great believer in prevention rather than cure,” she tells The Shetland Times, and would like to see a bit more of that philosophy adopted by islanders and the NHS.

When she and Jack, her eldest son, recount the drama which began to unfold five months ago it sounds like every parent’s nightmare. Late one Friday in early December she got a call to her home at Murrayston from Jack’s friend, Jack Hardie, saying that her boy was collapsing in a Lerwick lane with the pain of a sudden headache.

The third-year Anderson High School pupil recalls: “I felt a really bad pain like something hit me on the inside of my head. I tried to walk a little bit more but I couldn’t stand up and went down on one knee. That’s really all I remember except a faint memory of going into the ambulance and looking at Jack Hardie.”

Sandra jumped in her car and got to him as quickly as possible. “When I saw him I knew it was something desperately, desperately serious. He was just in a heap on the pavement. There was no recog­nition. He couldn’t speak – it was just like a total stroke victim. His limbs were all locked in position and I couldn’t get anything straightened out.”

His colour had drained deathly white and he was shivering with cold. His mother tried to lift him to get him into her car but was unable to because of his weight and condition. She was also worried about making him worse by man­handling him without knowing what was wrong – something ambu­lance paramedics are trained to deal with.

Two of Lerwick’s community wardens happened to walk past and phoned 999 for an ambulance. A taxi driver also offered to help. “That would have been a godsend if the ambulance had been else­where: Sumburgh or Brae or whatever,” Sandra says.

The ambulance arrived in no time and she reckoned Jack was in hospital within 15 minutes of her getting the call from his friend. She believes speed was vital to his survival, according to information she got from hospital in Aberdeen.

“Spontaneous haemorrhages like that are really rare in anybody under 40. The statistics I was given showed that 50 per cent of young people will die as the haemorrhage happens and another 35 per cent won’t survive long enough to get to hospital. So really the ambulance being available and us getting to hospital so quickly I’m sure played a huge part in his life being saved. The ambulance crew were absolutely brilliant.”

In the hospital Dr Pauline Wilson and the team at accident and emer­gency took over, getting Jack’s body temperature up and giving painkillers. But because it was Friday night they could not get him scanned in the CAT scanner to help diagnose his problem until the next morning as there was nobody on duty in Aberdeen to interpret the results. It also meant they could not give very strong pain relief, such as morphine, despite his severe pain.

“He put in 12 hours of absolute agony on Friday night,” Sandra says. “I’ve never seen anybody in that much pain for that long. It is just as well he can’t remember it because it must have been horrific.”

The next day the CAT scan showed a subarachnoid haemor­rhage, which essentially meant a blood vessel near the surface of his brain had burst, leaking blood into the fluid between the brain and spinal cord. The medical team at the Gilbert Bain Hospital were then able to give him morphine and Jack slept more peacefully, albeit with scary dreams. His younger brother Sam, 10, says he looked dead in the hospital bed.

After being flown by air ambulance to Aberdeen, surgeons decided they could not perform the normal procedure of coiling and tying off the aneurism and he had to be sent to Edinburgh instead where he spent five of the next six weeks.

Sandra said the medical author­ities in Edinburgh described the type of haemorrhage as unique. “As far as I ken there is nobody had that type of aneurism that shape and in that place.” If he had suffered a second one it would have killed him, she was told.

The consultant neuroradiologists who dealt with Jack at the Western General Hospital, Robin Sellar and Phil White, are eminent practitioners in their field, specialising in pioneering treatments for brain aneurysms. “They are worth their weight in gold,” Sandra says. “Those men are just amazing.”

The three procedures, one in December, another in March and an angiogram in between to x-ray blood vessels, were done not by opening up his head but by pushing equipment through an artery in his leg and up to his head to carry out the procedure of sealing off the leak.

Sandra says it was the stuff of science fiction and a procedure which has only been in use around the world for six years. “His brain surgery scar is just a tiny little dot in his leg.”

Each procedure carried massive risks which she had to weigh up. While a more routine operation might have a one in 100,000 chance of the patient not surviving, in Jack’s case it was a staggering one in five chance.

“That, as a parent, just chilled me to the bone. I just couldn’t imagine putting my bairn through surgery that has such bad odds. But without the surgery the odds were even worse – he only had a one in 10 chance of surviving so the odds of surgery suddenly started to look an awful lot better.”

In March Sandra endured the same gamble a second time, the weeks weighing it up beforehand proving to be a real strain. “It was the most hellish four weeks I have ever put in, knowing that for the third time I could be kissing my boy on the operating table and not have him alive in two hours or three hours later.”

It was probably worse for Jack because he had to be briefed about the risks, sign his consent and go into the operation not knowing if he would make it back.

His case benefited from input from brain specialists from around the world who took time out of a conference in England to consider his scans. It has apparently made him something of a celebrity in the world of brain surgery and, such is the uniqueness of his case, it will be referred to in training.

Jack is back to his best now, although he has to avoid violent sports, take a daily aspirin to thin his blood and will have to go to Edinburgh regularly to be scanned. “I’m very lucky to be here,” he says, casually. “The surgery had worse odds than Russian roulette.”

Sandra insists his story and her message about recurring headaches should not be seen as another attack on the NHS or the ambulance ser­vice, two organisations which she holds in the highest esteem after what happened. “What I want folk to take from this is that the NHS is a really good service when it all works well. Like any public sector body, when things go wrong it’s big news and when things go well it’s hardly mentioned, but from the ambulance crew that picked us up in the Hillhead, through to Edinburgh and input from around the world – you just can’t ask for a better service than that. They were all fantastic.

“For us this was the NHS working at its absolute best and I will be eternally grateful and totally indebted to them. The NHS worked perfectly for us and it saved his life.”

Sandra urges anybody suffering recurring headaches to seek help. She does not base her plea on what happened to Jack because prior to the haemorrhage he only had one very painful headache and it may or may not have been connected. She gave him a pain killer and thought no more about it.

“Shetland people are really not very good at making a fuss. They think they will just take a tablet and not bother the doctor or waste an NHS appointment.

“I think maybe it is time as a community we stop thinking like that because prevention has got to be better than trying to cure something after the event. Because we have got the CAT scanner here if we could do more preventative care it’s got to be a good thing. Don’t wait until it is really, really bad. It might be too late then.”