Derek feels a personal connection and feels a great deal of
responsibility for his patient Jen. She's young. She's happily married,
pregnant and cheering for Derek as he decides how to propose to
Meredith. (She's a total MerDer). When her condition goes from bad to
worse to nightmarish, Derek takes extraordinary measures to save her
life, but they go horribly awry.
We first met Jen several weeks back, when she accidentally ran over her
husband with their car. Our doctors found an aneurysm (an abnormal
bulge or ballooning of an artery) in her brain. Derek repaired it.
Though there was a complication during the repair, he was able to fix
it and now she's recovering from surgery. She's been having
mini-strokes cuasing aphasia (difficulty talking and communicating)
indicating there's a decrease in blood flow. Derek decides to do a
Extracranial-Intercranial Bypass or EC-IC.
During the EC-IC bypass, Derek redirected the blood flow in the brain
and cut out the faulty bit of artery that was inhibiting brain
circulation. In this case, he took vessels from her extracranial
vasculature and plugged them into a branch of the larger middle
cerebral artery.
The surgery was extremely successful. The aphasia is gone. Jen is able
to communicate easily and the happy couple rejoices. Addison warns
them, Jen's hypertension has become full-blown pre-eclampsia (high
blood pressure, swelling & protein in the urine). Her pregnancy is
in danger. Derek chastises Addison, saying this is a moment to
celebrate, surgery was successful, the couple's had a difficult week
and needs to focus on the positive for a few minutes.
Their week goes from bad to horrible when Jen screams with pain. Her
head hurts. The bypass hasn't held and blood is gushing into her brain.
Derek rushes Jen into surgery.
Once Jen is under and Derek has her brain open, he sees the terrible
mess the blown bypass has created. Her brain is swollen and filled with
blood. Because the skull is a hard structure, designed to be
impervious, there is nowhere for the blood to escape or the swelling to
expand. So, if Derek wants to save her life, he must remove some of her
brain... the temporal lobe. This is radical, but not unheard of, since
the temporal lobe is sometimes removed to stop severe seizure
disorders. These patients go on to live normal lives, often seizure
free. Removing a lobe will create room for the rest of the brain to
expand without causing irreparable damage. Derek cuts out her temporal
lobe.
But, the hemorrhaging doesn't stop, it gets worse and worse, so does
the swelling. The rest of the brain has already moved into the
additional space and it continues to expand. The pressure is causing
severe damage and every minute, Jen gets closer to death.
Addison fears for the life of her infant. She begs Derek to stop, to
allow her to deliver the baby so at least one of them can have a chance
at life. But, Derek isn't able to give up on Jen's life yet. He decides
to remove another lobe, make more room for the swelling brain, so maybe
Jen can live. He cuts out the frontal lobe. This is radical. Once the
frontal lobe is gone, if Jen lives through the surgery, she'll be a
vegetable. But, Derek is attached to this patient and can't let her go
yet. He cuts out her frontal lobe and waits for the pressure to reduce,
ordering more blood. Richard steps in, asks Derek to stop, to give
Addison a chance to save the baby. Derek relents.
Addison, delivers the baby in record time, giving him a chance at life.
The steroids Jen was given to reduce her brain swelling, actually
helped her son's lungs grow more quickly and will make his survival
more likely. When Arizona holds the premature baby she announces, "He
looks strong and has a definite chance at life." His mother flatlines.
Derek is devastated.
