Moving on, protecting others
This winter, eight years after his near-fatal flight, two years after he came to Stanford for help, after a slew of diagnostic tests and more than a dozen incremental surgeries to fix his injuries, Buchanan qualified to fly again. With that step, he can move toward commanding a squadron of fighter pilots. "That's the pinnacle of an aviator's career," he said.
"This case taught me to never, never take it for granted that you know it all," Damrose said. "The answers aren't always in textbooks." The literature search also revealed other patients suffering from similar symptoms, almost all related to decompression injury, he said. "And Cmdr. Buchanan spurred us to keep going."
"Many of the procedures that we ultimately performed did not have formal names and had not been previously performed," Nayak said, "so we had to be creative about extending principles of surgery and tissue reconstruction to meet this patient’s most unusual predicament." Kossler, earlier in her practice than Damrose and Nayak, also acquired some important takeaways. "When you finish your training, you think you know everything," she said, "but the more you learn, the more you learn that you don't know everything. In this case, we put our minds together and didn't give up."
That will likely make a difference for others. "Through this process, we learned of two other Navy pilots with similar decompression injuries that hadn't been previously reported," Kossler said. Buchanan helped uncover new knowledge about such a decompression injury. "It had never been in the emergency procedures book before, but now it's an action item that pilots have to memorize and are tested on routinely," he said. "The Navy's done a fantastic job of realizing that this is something we can do better, to help aviators as we put them in harm's way."
Those Stanford doctors did have to come up with a name for this now-identified decompression injury. It doesn't exactly roll off the tongue, but it's finally part of medicine's lexicon: a sino-cervical fistula.
Nayak is waiting for one small token of thanks he wants from Buchanan. "I want to him to call me from somewhere higher than 20,000 feet, from the cockpit of his F-18, doing what he does best and what he loves to do."