Warren Krackov, MD, FSIR: I’m sure they told you that they probably had maxed out on what they could give you safely.
the best, because we knew he would be in dire straits and have to have surgery, which we wanted to avoid. That’s why we had the idea of coming from above and working our way down from either a brachial or radial approach. If we could recannulate the celiac and get into the branches, we would have a far better chance of treating the aneurysm, as well as inflow and outflow.
Warren Krackov, MD, FSIR: Have you now done more cases from a transradial approach as a result of this?
Philip Dombrowski, MD: I’ve always been one who likes new ideas and new approaches. So, I think even before Sebastian’s situation, I was very comfortable with performing certain types of procedures from a radial approach.
I mean, if I do a renal artery stenosis, I do that approach routinely. Again, I did a lot of work with interventional cardiologists. So, I use those techniques that I’ve learned through the years. So that’s what we did, and we opened up the celiac to allow us to get into the vessels. And it turned out that it was that dorsal pancreatic branch that comes off the proximal splenic artery that was supplying the aneurysm, which was just beyond the origin of that vessel. So that’s a very uncommon situation. It’s extremely rare.
It’s almost like opening the incision and seeing everything right in front of you. Once we were in that vessel we could see where the pathology was and what we had to do. And Dr. Gorin was working from the groin and was able to detect exactly the vessel that we needed to embolize from the inferior pancreatic
38 IRQ | FALL 2024
branch. And we were able to take care of both ends without much further work.
Michael Hallisey, MD, FSIR: There’s a part in the book where Sebastian describes this exact moment, and it was almost like an epiphany. And it was almost like his amygdala was seeing everything transpire in slow motion.
Sebastian Junger: I remember one of the nurses saying to try to keep my eyes open. Even at that moment, I’m a curious journalist, so I said, “Why? Why do you guys care?” She said it was so they knew I was still with them. That was the first time I had an inkling what the stakes were. And I also started seeing things and faces in the machinery. It was very unnerving. And I also witnessed a shrug by I think Dr. Dombrowski, saying we’ve run out of options here. And then he said, “Why don’t we try his left wrist?” And someone—presumably Dr. Gorin—said, “I like the way you think.”
That was my memory of it. And in my mind, I’m like, “Oh my god, this is complicated enough. They’re having to figure it out as they go.”
I understand my mind was severely compromised. I saw my medical records, and I was on apparently a small amount of fentanyl, or not enough, so I was in a huge amount of pain, and I kept telling the doctors how much my back hurt. And they didn’t really acknowledge me, and part of me is thinking, “What’s a guy got to do to get a drink around here?” But then I realized, oh, it’s a good sign, right? They’re so focused on what they’re doing, me telling them my back hurts is just irrelevant.
Sebastian Junger: If they did, I don’t remember it. But one of the many miracles of this was the power of human touch and breathing to buffer people from pain.
When I was sent through the CAT scan, I was in hemorrhagic shock and was convulsing. I was in incredible pain. They put a warm blanket over me, which just felt like heaven, but I was in a lot of pain, and I think I was asking for painkillers. A nurse came up and held my hand and said to breathe with her. I remember thinking, “What is this Lamaze stuff? That’s not going to work. I want some pills.” But then she held my hand, and I almost immediately calmed down.
I know a pediatric nurse who says that when you put young children in the arms of their parents, the same thing happens—their blood pressure and heart rate regulates. I could feel it immediately. I breathed with her and the pain just subsided. And as deranged as I was, I clocked it.
I think that happened periodically in the IR suite. I remember the nurse telling me to keep my eyes open, and she was very close, holding my hand or touching me. There was a human connection that I think is probably vital in situations like that. We really respond to it.
Want to hear more? Check out the recommended reading below, and don’t miss Junger’s plenary session at SIR 2025!
More reading:
• In My Time of Dying: How I Came Face to Face with the Idea of an Afterlife, Junger’s new book about his near-death experience.
• “A book that features NDE and IR,” Dr. Hallisey’s SIR Connect post about how the new book spotlights IR.
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