Roadside Surgery

aka: Operate In The ER

We have to operate — but we're IN SPACE!

Dr. Edwards: We almost did a thoracotomy in the ER.
Dr. Grey: Yeah, this bought us some time.
Dr. Edwards: No, I mean we almost got to do a thoracotomy, in the ER. Which, you know, would have been amazing. [...] 'Cos, I mean, how many times do you get to operate outside the operating room?
Dr. Webber: Okay, for the record, it sounds fun, until you do it.

— Grey's Anatomy, "There's a Fine, Fine Line"

Your standard Medical Drama will have a lot of emergency surgeries, most of which take place in an OR (the cooler-sounding name for a simple operating room). But then, not all medical dramas focus on a surgical team. And let's not forget about the Rule of Drama. One way to get the right pulses racing is to have a Matter of Life and Death time-sensitive surgery and no place to operate... except where you are right now.

The most common perpetrators are in an ambulance or ER/trauma center (A&E/Casualty in the UK), but occasionally doctors in a disaster zone or those responding to a distress call will have to operate in an Abandoned Warehouse, in the back of a taxi, or stranded in a forest.

It is also done in non-medical shows such as police shows, or by characters other than the doctors in the medical show if necessary. For example, in a big car crash, a nurse on the scene might have to do an emergency surgery to save a victim's life, with the emergency situation causing them to bend procedures. This usually leads to a big story about surgeons having to fix the roadside stitch-up job. Often, a Back-Alley Doctor will have to operate in a grungy No-Tell Motel or an empty apartment.

This focuses on the story element of an unconventional surgery location and the associated drama, this drama constituting the danger of a necessary and immediate surgery; not having a suitable place and having to do the surgery out-of-OR; not having the regular hospital equipment for disinfecting and lighting, and the risks from performing surgery at on the roadside.

See also Meatgrinder Surgery, a similar trope about operating without proper surgical tools, and Open Heart Dentistry, for when you can't find an appropriate physician for the surgery but get someone else with advanced medical or health training (possibly at gunpoint).

Super-Trope to Instant Drama, Just Add Tracheotomy, when the specific surgery in this situation is a tracheotomy, and Self-Surgery, when the specific surgeon in this situation is the wounded person.

In some cases, this might overlap with After-Action Healing Drama if the rush to get to medical personnel is forgone for a rush to just heal.

And PSA: No matter how many episodes of Grey's you've seen, please Don't Try This at Home.

---

Examples:

Advertising

• Hindsight being 20/20, it probably wasn't a good idea for the guy in the SmartAsset commercial to try taking out his own appendix.

Fan Works

• In the humanised My Little Pony: Friendship Is Magic fanfic Guppy Love, Applejack finds the mermaid Rarity on the beach with a tail injury from an orca and looks after her with Fluttershy and Rainbow Dash. To keep Rarity and her sister-like companion Sweetie Belle from being discovered by other humans, Fluttershy performs the surgery on her injured tail with Rarity laying on a rock near the lake the two mermaids hide in.

Film — Live Action

• 13 Sins: One of Elliot's challenges involves him amputating the arm of a former classmate in a seedy motel.
• Black Hawk Down: An Army Ranger medic tries to save a fellow Ranger with a horrific leg wound. The medic needs to install a bridging shunt in the patient's femoral artery to keep him from bleeding to death. The surgery has to be performed on a rickety table in a derelict building while the local warlord's mooks are searching for them.
• The Cider House Rules: Homer Wells grew up in an orphanage, and was being groomed to follow in the footsteps of Doctor Larch. While earning a living on an apple farm, Homer discovers young Rose is pregnant with her father's child. Because Rose is black, getting a proper medical abortion is highly unlikely. Therefore, Homer agrees to perform the procedure in the pickers' shack (the cider house), using the skills and training gleaned from Doctor Larch.
• Circus of Horrors: Dr. Rossiter insists he can perform delicate facial surgery on the kitchen table of a circus caravan. As it turns out, he's right. Much later, he guides Angela and Martin through performing a similar procedure on his own face in a similar location.
• Deadtime Stories: Volume 2: In "The Gorge", three spelunkers are trapped in a cave by a cave-in. Gary's leg is injured and eventually goes gangrenous and Donna and Craig are forced to amputate it: without anaesthetic and using the only viable tool they have for the job, an ice axe. Craig hold Gary still while Donna hacks the leg off with the axe.
• Iron Man: Tony is almost killed when an explosion blasts shrapnel through his heart. He wakes to meet Yinsen, a doctor who saved his life by grafting an electromagnet to his chest. Yinsen knows it's comically crude, but considering they have both been kidnapped it was the best he could manage.
• Master and Commander: The Far Side of the World:
  • One sailor receives a serious head wound during the first battle against the Acheron. The ship's physician performs open cranial surgery on the man on the main deck in broad daylight because operating lamps haven't been invented yet. This includes using a silver coin to patch the hole in the man's skull.
  • Junior officer Blakeley suffers severe damage to his right arm after the third skirmish against the Acheron, which necessitates amputation at the mid-humerus without anesthetic, just a shot of whiskey. Blakeley is awake and aware of the procedure, including the dreaded bone saw. Hospital escort ships hadn't been invented yet, and a sick bay was a rare luxury too good for the Surprise.

Literature

• In the 29th Animorphs novel The Sickness, Cassie has to perform brain surgery on Ax in her barn in order to remove his Tria gland, as he's an Andalite and thus it would be impossible to get a surgeon to operate without causing a lot of problems.
• The Executioner. In Texas Storm, Mack Bolan intercepts a doctor in the hospital parking lot and walks him over to a van where he's got a Damsel in Distress he found drugged in a Mafia hardsite. When the doctor says he needs more light, he turns on a lamp, saying he's seen battlefield surgeons take a man apart and put him back together in worse light that this. The doctor replies, "Yes, so have I."
• In The Impossible Virgin, a Modesty Blaise novel, Modesty and Dr Giles Pennyfeather have to perform an emergency appendectomy in a cave where they and the patient are hiding from the villains. Giles has to talk Modesty through the surgery because the villains tortured him and his dominant hand is too injured to use. Modesty does note that there is one up-side to the situation: Giles got most of his surgical experience as a mission doctor in a remote African village, so he's used to working in primitive conditions; she jokes that he'd probably be more out of his element if they did have access to a proper operating theater with all the modern equipment.

Live-Action TV

• In the Russian Sci-Fi series Better Than Us, Georgiy has to preform this on Zhanna after she gets shot in the leg. Deconstructed, as despite all the necessary medical supplies having been gathered and Georgiy (who is a former surgeon) doing everything possible to sterilize the environment, the wound still gets infected and Zhanna has to be taken to the hospital anyway (despite it being against her wishes) since she will die of sepsis otherwise.
• CASUAL+Y is set in an accident and emergency department, but the resuscitation room may as well be made an OR with how often it gets used for this. As the world's longest-running medical show, it's hard to list instances, but one of the best has to be in the 2009/10 run when Sean and Nick have to operate on Adam, Jessica, and their kids after getting in a car crash that results in spinning off the road into a frozen lake. The hospital they work at does have an OR, but apparently emergent trauma has to go through the casualty before anything else.
• Shows up a couple of times in Doc Martin, most notably in Martin and Louisa's honeymoon, when they wind up wandering through the countryside, lost, and stumble upon a paranoid farmer who manages to impale himself in the neck while trying to drive them off his land (It Makes Sense in Context). Martin is forced to perform surgery in the farmer's non-too-clean farmhouse using nothing but fishing line, a fish hook, and a bottle of whiskey to sterilize his hands as best he can.
• One Emergency! episode had the surgery done in a outdoor area because the guy had a live mortar embedded in him and the ride to the hospital could have made it explode. Another episode narrowly averted it, with Roy managing to save the patient’s leg and extract him from a work site collapse just before Brackett arrived to amputate the leg.
• The Good Doctor: In the first episode, Shaun has to perform surgery using a bottle of whiskey in an airport. In the third episode, he operates on an ex vivo transplant liver on the trunk of a cop car.
• Grey's Anatomy: At last count, over a dozen cases.
  • Most of the time Grey's is focused on the ORs, but kudos go to the time that a man had to amputate his wife's leg down a sinkhole with Callie giving him directions.
  • And let's not forget Meredith having to operate on Mark and Arizona in the forest after the plane crash.
  • There's also a storyline where they have to train general practitioners from Syria to be able to operate in a war zone without proper tools — the trifecta.
  • In season 12, there's an episode all about this. After a Code Pink is called and the hospital put on lockdown, the residents all get stranded with patients. Ben performs an unnecessary emergency caesarean in the hallway, while Steph laments that she almost got to do a thoracotomy in the ER — asking how often people get to operate outside of an OR, with Webber telling her it's not as fun when you have to do it.
  • Honorable mention to Meredith draining a brain bleed while airborne and in heavy turbulence, a full six seasons after the last time she did any Neuro work.
  • This is arguably Ben Warren's specialty. Aside from the aforementioned c-section, he has opened a psych patient with a clipboard and done a second, more successful, caesarean on April. Even his switch to firefighter didn't stop this, preforming an amputation at the end of Season 2.
• One episode of House involved the medical staff at the hospital being called to the scene of a disastrous building collapse. One woman is trapped underground with heavy debris trapping her leg. The only way to save her life is to amputate her leg, which House volunteers to do and does successfully with minimal tools.
• Pretty common in M*A*S*H, but given they're in a war zone, it's probably not unlikely.
  • "Goodbye, Radar" features the O.R. losing lighting and Radar improvising the solution of lining up jeeps outside with their headlights on, so that the medics can work.
  • In "Mulcahey's War", Catholic priest Father Mulcahy must perform an emergency tracheotomy by the side of the road in Korea using improvised equipment. He's given instructions over the radio by the doctors back at the 4077th.
  • "They Call the Wind Korea" has Charles and Klinger trapped in an overturned truck during a windstorm with a bunch of injured Greeks. Charles is forced to perform surgery with whatever happens to be in his medical bag. Being Charles, he gripes the entire time about the improvised tools despite performing the procedures flawlessly.
  • In "Best of Enemies", a North Korean soldier takes Hawkeye hostage, ordering him at gunpoint to save his wounded friend. Hawkeye does his best, even attempting an emergency tracheotomy when the patient struggles to breathe, but unfortunately the damage is too severe and Hawkeye isn't able to save him.

Video Games

• Almost every level in the Amateur Surgeon games takes place in an unconventional location to do surgery. Only a minority of them do take place in risky places to say the least.
• Surgeon Simulator 2013 plays this for laughs, by having Nigel — the highly inept surgeon you're playing as — performing surgery in various, less-than-ideal situations. This includes an ambulance with a crazy driver, him running down a corridor, or operating while in space with zero gravity.
• Trauma Center (Atlus):
  • The chapter "Caduceus on a Plane" has you doing surgery on a plane. That sometimes experiences turbulence.
  • Another level exclusive to the Wii version has you doing emergency surgery at a car crash. Where the lights are failing.
  • The sequel also has a level where you're forced to operate in a moving car. You get a warning before a sharp turn is about to happen. The level also has the additional challenge of having most of the operating area blacked out, with you having to move a light to see a limited area.
  • In Trauma Team, first response is all about this, light surgery to deal with problems on site ASAP and buying time for proper care.
  • A few coleoscopy levels in Trauma Team are set outside of the hospital, including one where you navigate through rubble at a disaster site.

Western Animation

• Futurama: After Fry and Amy (and Dr. Zoidberg) are in a hovercar wreck, Zoidberg attaches Fry's head to Amy's body to keep him alive, working in the middle of nowhere without any tools. No one seems the least bit amazed he succeeded, despite his otherwise horrible track record at treating human patients.
• The Simpsons: In one episode, Bart is bitter because Mr. Flanders wouldn't let him have a knife. He walks past several other characters using knives in various ways. Dr. Hibbert uses a pocket knife to remove a man's appendix right on the sidewalk before throwing said organ away to explode like a grenade. The patient gets up and thanks him, like nothing out of the ordinary happened.

Real Life

• In 1995, orthopedic surgeon Angus Wallace and Doctor Tom Wong made news for treating a woman for Pnuemothorax (air inside the chest but outside the lungs) while in flight. Fearing that landing the plane would kill the patient due to changes in air pressure, the two used whatever equipment they could find or improvise, such as Cognac being used to sterilize a coat hanger. The treatment was a success, and the trip went without further incident. Reportedly, after it was all over Wallace celebrated his success with a sip of the cognac.
• In 2014 a London Air Ambulance crew used a new method (Reboa) of preventing blood loss on a patient involved in a large RTI. The method involves open-heart surgery, and the patient survived.
• In 2016, an Australian doctor took a wrong turn and discovered a catastrophic truck collision in the middle of nowhere, and called for emergency services. When they arrived, they asked the doctor to stay in case they needed help and firefighters freed the truck drivers. A paramedic attempted to decompress the chest, without luck, and called the doctor over. He then cut open the man's chest cavity, called his attending, and continued surgery to relieve it. The doctor says that, really, anyone with the same skill in the same circumstances would have done the same.

---