Medical Miracle #8
Problem: Thirteen-year-old boy shooting pool. Cue smashes light ﬁxture, glass cuts off part of his nose. Without surgery, he’ll lose the severed portion. No time for anesthesia.
Doctor: Robert Guida
Patient: David Silberberg
On a Friday afternoon in January 2003, 13-year-old David Silberberg was shooting pool after school with some friends in the basement of his parents’ home in Forest Hills. David casually raised his cue over his head after a shot, and it hit a light fixture. “The glass came crashing down,” he says. “I put my hand to my nose—I was bleeding, but my friends wouldn’t tell me what I looked like. I think they didn’t want me to get upset.”
At first, David was worried about bleeding on his parents’ floor. It turned out he had a much more serious concern: The glass had severed a half-inch chunk off the end of his nose.
One of the boys called an ambulance; David’s friend Ben called his mother, Yael, a nurse, who rushed to the Silberbergs’ house and put the piece of nose on ice to preserve it. David’s father, Steve, who had been out picking up movie tickets for the family and didn’t have his cell phone with him, arrived a few minutes before the ambulance (David’s mother was at work and met them later at the hospital). “I came in and saw David lying on the floor, his friends surrounding him, with his face covered,” says Steve. “I realized it was serious and immediately started thinking about getting him to a plastic surgeon.”
The ambulance took David to Forest Hills Hospital. “The attending ER physician looked at him and said he’d never seen anything like this,” says Steve. “That’s not something you want to hear from a doctor treating your son.” Eager to get David the best possible care, Steve had called his brother, a Beverly Hills plastic surgeon, who directed him to Robert Guida, a Manhattan plastic surgeon specializing in facial plastic and reconstructive surgery. Guida had been packing his car for a family getaway in Connecticut, but he told Steve to bring David to his Manhattan office right away. “When I first saw David, I knew that had he waited around at the ER, he would have certainly lost his nose,” says Guida. “He needed to be operated on quickly, or the blood vessels in his nose would have become necrotic.”
The Silberbergs arrived at Guida’s office at about 9 P.M.—three and a half hours after the accident. Calling around to local hospitals, Guida found it impossible to secure an operating room until early the next morning—too late for any chance of a successful reattachment.
Guida decided to operate in his office, without general anesthesia. “I told David that he’d have to be very, very brave,” he says. Guida numbed the area around David’s nose as much as he could with Novocaine and started working. “I just listened to my MP3 player and tried not to think about it,” says David.
The first and most difficult part of the operation was to reconstruct the lining. “The lining provides most of the blood supply to the nose,” says Guida. “It’s the foundation, and without a properly reconstructed lining, the nose will eventually collapse.” Guida next focused on the cartilage in the tip of the nose, which had been sliced through entirely. “The cartilage gives the nose its shape and definition,” he says. “Without it, the nose would basically be an amorphous blob.” Guida finished by reattaching the skin—all told, the procedure took two painstaking hours.
Many reattachment surgeries fail, regardless of how expertly or quickly they’re done. Happily, the circumstances surrounding David’s injury were fortuitous. “That one of the boys’ mothers was a nurse, that Steve’s brother recommended he call me, that I was able to operate in my office—if just one event had been off, he would have been disfigured for the rest of his life, had severe breathing problems, and needed numerous nasal reconstructive surgeries.”
In David’s case, virtually all of his nose was saved. Now all that remains of the ordeal is a thin white scar. “It doesn’t even bother me,” says David, now a sophomore at Stuyvesant High School. He’s back to playing pool. “I don’t really think about it,” he says of the accident. There is one change, however: “My dad replaced the light fixture. The new one is higher.”