I was struck by the news report a few days ago about the man getting a face transplant, particularly the five years the surgeons and medical docs planned such a daunting operation. (Ref. 1) It reminded me about a case I had a while ago, albeit less difficult by comparison, and months of planning not years. Nevertheless, I had that daunting feeling too.
Maurice Desjardins’ face was damaged by a bullet during a hunting accident. He couldn’t close his mouth property and had holes in his face for a nose, and breathed through another hole in his windpipe. Surgeons tried rebuilding his face with conventional plastic surgery over the years without much luck.
Then Dr. Daniel Borsuk came along, “un magician du visage” (a magician of the face), in his mid 30s and full of youthful piss and vinegar, and after five years of planning – Success.
Dr. Borsuk plus 8 other surgeons, 5 anaesthesiologists and 100 other medical, nursing and support staff performed two operations at the same time that had to end within minutes of each other. The one operation removed the face of the brain-dead donor and the other transplanted the face before it died.
The operating rooms were so busy looking in news reports that it seemed no one moved unless they all did. It reminded me of my smallish kitchen when five friends are in it each preparing a different course for dinner. When one has to move to get something from the cupboard; we all have to move.
So, why am I telling you this? How does a face transplant relate to forensic engineering? It relates because some forensic investigations also take a lot of planning to know where you’re going. Not years but sometimes many months and that can be scary because time is money in civil litigation.
The news report made me think of a case I’ve got that contains six different investigation, design and construction specialties. They are as diverse as lifting a structure off its foundations and setting it aside to chasing an elusive material across a site, quite literally.
Where do I start in dealing with such a problem? And how do I estimate the cost of the different specialties to guide the way forward when not a lot of experience exists in the area, certainly not all under one roof. And for the one specialty, the magnitude of the problem is not known until you start chasing it. How do you estimate the cost of something like that?
I’m getting on top of this case as the months go by, fortunately not years but still long and difficult. I had that daunting feeling when I started and was reminded of it when I saw the news report.
I thought of another case involving repair of the old foundations of a structure founded on sloping, filled ground that is still subsiding and shifting after about 40 years – not a sinkhole like in oxford, N.S. but almost equally challenging in the uncertainly that had to be confronted. The main problem was repairing the foundation and supporting the structure safely while accommodating future ground movement and conforming to the standard of care.
Fortunately I remembered a case report from years ago about providing jacking points in the support for a structure underlain by compressible foundation soils. I also conferred with a friend in Australia, Paul Gunson, who dealt with a similar problem beneath a railway line. (Ref. 2) Paul’s innovative solution included grout and rubber blocks for foundations. The way forward was clearer. Still, lots of non-textbook problems to solve and solutions to implement.
Two or three other engineering cases come to mind as i write. It’s interesting, that the difficult, many month-long ones concern the ground and Mother nature, unknown, unforgiving quantities that don’t lend themselves to neat, quick and easy textbook solutions. I’ve known about the tricky ground for decades and the planning that is necessary.
For certain, “the magician of the face” knew about tricky plastic surgery and that he was operating at the cutting edge of face transplanting when he started planning years ago. A friend of mine, a retired ear, nose and throat surgeon, told about repairing a throat one time damaged by a chainsaw – a suicide attempt – and another repair, a windpipe pierced by a 2″ diameter stick. Where do you start?
It’s a good thing that engineers and surgeons like to have a problem to fix and one to look forward to.
- Canadian Broadcasting Corporation, CBC, and other news’ reports, week of September 9, 2018
- Personal communication, Paul Gunson, professional engineer, Adelaide, Australia, July 18, 2018