Self-surgery

Self-surgery is the act of performing a surgical procedure on oneself. It can be an act taken in extreme circumstances out of necessity, an attempt to avoid embarrassment, legal action, or financial costs, or a rare manifestation of a psychological disorder.

Genitals

These surgeries are generally the least life-threatening. Sometimes people resort to self-surgery in the form of castration in an attempt to control their sexual urges, or due to gender dysphoria.^[1]^[2]^[3]

Boston Corbett, the soldier who killed Abraham Lincoln's assassin John Wilkes Booth, had performed self-surgery earlier in life. He castrated himself with a pair of scissors in order to avoid the temptation of prostitutes. Afterwards he went to a prayer meeting and ate a meal before going for medical treatment.^[4]

Abdominal

Abdominal self-surgery is extremely rare. A few well-publicized cases have found their way into the medical literature.

On February 15, 1921, Dr. Evan O'Neill Kane carried out his own appendectomy in an attempt to prove the efficacy of local anaesthesia for such operations. He is believed to have been the first surgeon to have done so.^[5] However, Dr. Wiener previously performed appendectomies (on others) with local anesthetic.^[6] In 1932, he performed an even more risky self-operation of repairing his inguinal hernia at the age of 70.^[7]

On April 30, 1961, Dr. Leonid Rogozov removed his own infected appendix at the Soviet Novolazarevskaja Research Station in Antarctica, as he was the only physician on staff. The operation lasted one hour and 45 minutes.^[8]^[9] Rogozov later reported on the surgery in the Information Bulletin of the Soviet Antarctic Expedition.^[10]

A male student who had already performed a self-castration was the subject of a 1979 case report by Kalin.^[11]^[12] The student, some time after his self-castration, also attempted to reduce the activity of his adrenal glands with an injection of bovine serum albumin, luteinizing hormone-releasing hormone and Freund's adjuvant. When this produced an abscess at the injection site, he resorted to self-surgery. His psychiatrist reported:

At four o'clock on the morning of his surgery, he disinfected his dormitory room with spray disinfectant and alcohol and draped an area with sheets that he had previously sterilized. For anesthesia, he took oral barbiturates. He also took hydrocortisone and prepared a canister of vaporized adrenalin, readying himself for a possible shock syndrome. He performed the procedure wearing sterile gloves and a surgical mask.
Lying supine and looking into strategically placed mirrors to obtain an optimum view, he began by cleansing his abdomen with alcohol. The incision was made with a scalpel, exposure obtained by retractors, and the dissection carried out with surgical instruments. Lidocaine hydrochloride was injected into each successive tissue layer during the opening. He controlled bleeding with locally applied gelatin powder, while sterilized cotton thread ligatures were used for the larger vessels. After eight hours he had had minimal blood loss but was unable to obtain adequate exposure to enter the retroperitoneal space because of the unexpected pain in retracting his liver. Exhausted, he bandaged his wound, cleaned up his room, and called the police for transport to the hospital because of a "rupture".^[11]

In 2000, a Mexican woman, Inés Ramírez, was forced to resort to self-surgery – a Caesarean section – because of lack of medical assistance during a difficult labour: "She took three small glasses of hard liquor and, using a kitchen knife, sliced her abdomen in 3 attempts ... cut the uterus itself longitudinally, and delivered a male infant. Both mother and child reportedly survived and are now well."^[13]

Medically supervised

Dr. Jerri Nielsen was the sole physician on duty at the U.S. National Science Foundation Amundsen–Scott Antarctic research station in 1999 when she found a lump on her breast. She was forced to biopsy the lump herself. Her experience made international news and was the basis for her autobiography, Ice Bound. The lump was found to be cancerous, so she self-administered chemotherapeutic agents. She remained cancer-free for several years but died in 2009 after her cancer reappeared and spread to her brain.

Self-trepanation

Trepanation involves drilling a hole in the skull. The most famous instances of self-trepanation is that of Amanda Feilding, Joey Mellen (Feilding's domestic partner), and Bart Huges (who influenced Mellen and Feilding).

Amputation of trapped limbs

In 1993, Donald Wyman amputated his leg with his pocketknife after it was pinned by a tree .

In 1993, Bill Jeracki was fishing near St. Mary's Glacier in Colorado, when a boulder pinned his left leg. Snow was forecast and without a jacket or pack, Jeracki didn't believe he would survive the night. Fashioning a tourniquet out of his flannel shirt and using his bait knife, he cut his leg off at the knee joint, using hemostats from his fishing kit to clamp the bleeding arteries.

In 2002, Doug Goodale cut off his own arm at the elbow in order to survive an accident at sea.

Aron Ralston, a former student at Carnegie Mellon University was on a canyoneering trip in 2003 in Blue John Canyon (near Moab, Utah), when a boulder fell and pinned his right forearm down, crushing it. First he tried to chip away the rock around his hand with his pocket knife, but gave up the attempt after two days. Next he tried to lift and move the boulder with a simple pulley system made with rope and gear, but that failed too. On the sixth day, which he did not expect to live to see upon falling asleep the night earlier, a dehydrated and delirious Ralston had a vision of himself as a one-armed man playing with his future son. Upon a subsequent fit of rage he discovered that he could bow his arm against the chockstone far enough to snap the radius and ulna bones. Using the dull blade on his multi-use tool, he cut the soft tissue around the break. He then used the tool's pliers to tear at the tougher tendons. He was careful not to sever the arteries before attaching an improvised tourniquet. After he cut the main bundle of nerves, leading to agonizing pain, he cut through the last piece of skin and was free. In bad physical shape, and having lost more than a litre of blood, he managed to rappel 60 yards down and hike another 8 miles, when he ran into a Dutch family who offered help and guided him to a rescue helicopter which happened to be nearby looking for Ralston and took him to a hospital. His story was dramatized in the film 127 Hours (2010).

In 2003, an Australian coal miner trapped three kilometres underground by an overturned tractor cut off his own arm with a box-cutting knife. The 44-year-old man, who was not identified by police, was working late at the Hunter Valley mine when the tractor tipped over, crushing his arm and trapping him.

In fiction

In the 1982 film First Blood, the main character (played by Sylvester Stallone) stitches closed an open wound in his own arm using a needle and thread taken from the hollow handle of his survival knife.
In the 1987 Peter Jackson film, Bad Taste, one of the characters injures his head from a fall and then keeps his brains from leaking out by wearing a hat, and later a belt. Realizing that he is losing too much brain matter, he replaces the missing parts of his own brain with some from the head of an alien he kills.
In the 1990 film Predator 2, the extraterrestrial Predator is injured in a shootout and breaks into an apartment, where it smashes a hole in the a wall and uses the crumbled plaster mixed with an advanced medical substance to doctor the stump left when Harrigan severs part of its forearm with the throwing disc (to stop the self-destruct device). This species's highly developed ability to mend itself is mentioned in the original Predator, although briefly.
In the 1991 film version of The Story of Ricky, the protagonist ties together a tendon in his arm after it's cut by someone else with a knife.
In 1994 film Léon, the title character removes a bullet and stitches the wound in the shower.
In the 1998 film Ronin, Robert De Niro's character, who had past surgical experience, directs the removal of a bullet from his abdomen.
In the 1998 film Pi, Max Cohen (played by Sean Gullette) is tortured by dementia. In an effort to relieve his psychotic episodes, he trepans himself by drilling a hole in his head with a power drill.
In the 1999 manga series "Shaman King", Faust VIII performs surgery on himself when protagonist Yoh Asakura breaks his tibia. He hooks himself up to morphine and then has his dead wife retrieve a tibia of matching proportions. He rips the bone out and performs the surgery, much to Yoh's horror.
In 2000's manga Battle Royale, the main antagonist Kazuo Kiriyama finds that he is unable to properly flex his trigger finger, and cuts his upper arm open to tape damaged muscles back into place.
In the 2004 film Master and Commander: The Far Side of the World, Dr. Stephen Maturin (played by Paul Bettany) is forced to perform emergency surgery on himself to remove a bullet and torn piece of clothing from his abdomen, as there are no other trained medical professionals onboard his ship.
In the seven Saw movies, of which the first was released in 2004, a central theme is the idea of injuring oneself to survive, including amputations and self-surgeries.
In the 2004 Television Series LOST, Jack Sheppard attempts to take out his own appendix with the aid of Juliet Burke while Kate Austen holds a mirror to allow Jack to see.
In the 2004 video game Metal Gear Solid 3: Snake Eater, becoming injured often requires self-surgery via the Survival Viewer menu to splint broken bones, remove bullets or arrows from the body and various other treatments using rudimentary field medical techniques to avoid a drain in stamina or health.
In the 2006 Spanish film Pan's Labyrinth (El laberinto del fauno), Captain Vidal (played by Sergi López) has his cheek cut open from the corner of his mouth almost to his ear by Mercedes (played by Maribel Verdú). In front of a mirror, he neatly stitches the wound shut with needle and thread, and though in great pain, does not use any kind of anesthetic (though he does have a stiff drink afterwards).
In the 2006 novel A Spot of Bother by Mark Haddon, protagonist George Hall, who is undergoing a mental breakdown, becomes convinced that a strange growth on his body is cancer. He disregards his doctor's diagnosis of eczema, and removes it with a pair of scissors.
In the 2007 film No Country for Old Men, Anton Chigurh (played by Javier Bardem) cleans and stitches his own wounds with stolen supplies, after his leg is badly injured by a shotgun blast. He first disinfects the site of the injury with a solution of iodine, then injects an anesthetic (lidocaine) before suturing the wound.
In the 2007 film Shooter, Bob Lee Swagger (played by Mark Wahlberg) is forced to use self surgery when shot twice by a policeman. He makes a homemade IV solution by mixing salt and sugar with water, and injects it into his arm with a meat injector.
Stephen King's short story "Survivor Type" is about a surgeon trapped on a small island who is forced to operate on himself. He anaesthetises himself with the drugs he was attempting to smuggle.
In the episode "After Hours" of the medical drama House, the protagonist attempts with little success to excise a cluster of leg tumours in his bathtub brought on by his use of an experimental muscle strengthener.
In episode 28 of the 2004 adaptation of Osamu Tezuka's manga Black Jack, the protagonist successfully performs open body surgery on himself to remove a parasite while in the middle of the Australian outback.
In the 2012 sci-fi horror film Prometheus, protagonist Elizabeth Shaw (played by Noomi Rapace) self-performs a Caesarian to remove an alien growing inside her.
In the 2013 movie The Wolverine, the titular hero's healing factor is significantly weakened for much of the movie. After using a medical scanner to find that a robotic parasite attached to his heart is responsible, he uses his adamantium claws to cut open his own chest and pulls out the parasite.

References

Morton WA (1991). Scrotum self-repair. Med Aspects Human Sexuality Jul 1991:15.

↑ Lowy, FH.; Kolivakis, TL. (Oct 1971). "Autocastration by a male transsexual.". Can Psychiatr Assoc J 16 (5): 399–405. PMID 5151637.
↑ Money, J.; De Priest, M. (Nov 1976). "Three cases of genital self-surgery and their relationship to transexualism.". J Sex Res 12 (4): 283–94. doi:10.1080/00224497609550947. PMID 1018488.
↑ Money, J. (Aug 1980). "Genital self-surgery.". J Urol 124 (2): 210. PMID 7401235.
↑ Swanson, James L. (2007). Manhunt: The 12-Day Chase for Lincoln's Killer. pg. 329 HarperCollins. ISBN 978-0-06-051850-9.
↑ "Dr. Evan Kane dies of pneumonia at 71". New York Times. April 2, 1932. p. 23.
↑ JAMA1916, .
↑ Arsen P. Fiks, Paul A. Buelow, Self-experimenters: sources for study, page 125, Greenwood Publishing Group, 2003 ISBN 0-313-32348-8.
↑ Jeff Rubin, Antarctica, page 260, Lonely Planet, 2005 ISBN 1-74059-094-5.
↑ Rogozov, V.; Bermel, N.; Rogozov, LI. (2009). "Auto-appendectomy in the Antarctic: case report.". BMJ 339: b4965. doi:10.1136/bmj.b4965. PMID 20008968.
↑ L.I. Rogozov (1964), "Self-operation" (PDF), Soviet Antarctic Expedition Information Bulletin: 223–224
↑ 11.0 11.1 Kalin, NH. (May 1979). "Genital and abdominal self-surgery. A case report.". JAMA 241 (20): 2188–9. doi:10.1001/jama.241.20.2188. PMID 430820.
↑ Callan, JP. (May 1979). "Surgical decisions.". JAMA 241 (20): 2193. doi:10.1001/jama.1979.03290460057024. PMID 430822.
↑ Molina-Sosa, A.; Galvan-Espinosa, H.; Gabriel-Guzman, J.; Valle, RF. (Mar 2004). "Self-inflicted cesarean section with maternal and fetal survival.". Int J Gynaecol Obstet 84 (3): 287–90. doi:10.1016/j.ijgo.2003.08.018. PMID 15001385.