Surgeon’s persistence, prowess saves fisherman’s hand

Christopher Got, MD, turns to rare procedure in effort to avoid amputation

Orthopedic surgeon Christopher Got, MD, had just come home for dinner when a text arrived from the emergency department at Rhode Island Hospital. It contained a photo of a severely mutilated hand.

“Your thoughts?” a resident asked.

The gruesome photo captured what remained of skipper David Tyrrell’s hand after a horrific accident aboard his charter sportfishing boat, the Narragansett-based Mako II. Even Dr. Got had never seen anything like it.

“The image was of a basically degloved hand, which is when all the skin and soft tissues are avulsed from the bone and tendons,” he recalls. 

When he presented the case to colleagues, most recommended amputation and a permanent prosthesis.  Since each of Tyrrell’s fingers was essentially lost, trying to save the hand could be a long, grueling, and painful process –- with no guarantees. 

But Dr. Got wasn’t ready to give up just yet -- not when he knew how much his patient was counting on returning to fishing for his livelihood.

Many wonderful years, one tragic day

Fishing is all Tyrrell, 56, has ever known.

He was just 16 and on summer vacation in Narragansett when a charter boat skipper spotted the brawny teenager on the dock and asked him to fill in for a deck hand. A fishing enthusiaist since he was a young child, Tyrrell jumped at the chance. He was immediately hooked. 

Fisherman sails in a sea of gratitude, lands new and lasting friendship

On a brisk autumn day, Dave Tyrrell spots a familiar face on the dock and then warmly welcomes aboard Christopher Got, MD. It’s not the first time the surgeon who saved his hand has been on his boat.

The pair share two things in common: a remarkable limb-preserving procedure and a love of angling. Ever since the many hours they spent together as doctor-and-patient, the two have enjoyed occasional fishing trips together.

When he arrived in the Emergency Department, Tyrrell maintained his composure, even his wry sense of humor, and assured Dr. Got and the staff that “he could take a punch.” But the ensuing weeks and months proved anguishing. Dr. Got, he says, helped him get through it.

“Every day, I cried on his shoulder, I said, ‘What am I going to do? This is all I know. Fishing. I'm never going to be able to do it again,’ ” Tyrrell says. “He just kept telling me. ‘You'll get through it. Remember, you can take a punch.’” 

The first time Dr. Got went aboard Mako II, he saw his former patient do something that filled him with hope.

“Dave’s not a small guy and there’s this small ladder up to the elevated wheelhouse,” he recalls. “I was like, ‘How is he going to make it up there?’ He grabs a hold of the ladder and shoots up like it was nothing. It was a proud moment for me to know he had gained enough function to do that.”

On this morning, the two tease each other and catch up on how their families are doing. Tyrrell talks about how his daughter became inspired by Dr. Got’s care for her father to pursue a career in medicine.

“He was my doctor,” Tyrrell says. “Now he’s my friend.”
 

By the time high school graduation rolled around, there was nothing the Pawtucket native wanted to do more than go to work full-time on charter boats. Within a few years, he went into business for himself as the owner of Mako II. He would spend the next 30 or so years taking passengers out to sea to catch prized sportfish.

“It's something that gets into your blood. I like the freedom of it,” he says. “It was like an aquarium out here 30 years ago. Whales, tuna and swordfish – it's unbelievable the stuff I've seen.”

It’s what he didn’t see one day that nearly cost him his hand: The drawstring of his hoodie.

In the winter of 2016, while preparing to haul out Mako II for maintenance, Tyrrell was below deck checking for leaks around the propeller shaft seal. As he bent over, the rapidly spinning shaft snared the dangling drawstring. The results were sudden and violent.

“It grabbed and pulled my head down,” says Tyrrell, who would later learn that the blow fractured his eye sockets and jaw. “My sweatshirt and shirt were right up to my throat. It was trying to decapitate me.  I thought, ‘This is how I’m going to die.’”

Out of desperation, Tyrrell attempted the unthinkable.

“I hugged the shaft to try and stop it,” he says. “That’s when my whole arm got wrapped around in it like a wet noodle.”

When his crewmate realized what was happening, he cut the engine. Tyrrelll was then rushed to Rhode Island Hospital.

“That night,” says Dr. Got, “amputation seemed imminent.”

A rare technique attempted

Dr. Got understood why the consensus of a group of orthopedic and plastic surgeons was not to try and save the hand. 

“How are you going to come up with soft tissue to get coverage and if you don’t have the coverage how are you going to get function?” he says. “And if you have some motion and no sensation, you are very prone to injuries down the road.”

Still, Dr. Got kept searching for options. When he reached out to a colleague at Stanford, a bizarre solution emerged:  surgically implanting the injured hand into a pocket carved out of the captain’s chest wall. And leaving it there for close to a month. 

During that time, the flap of skin over his hand would begin to draw blood from the back of the hand and become attached to it. That would allow Dr. Got to deepen the pocket and cultivate the chest skin as a graft to cover the degloved hand, much like a mitten. Tyrrell wouldn’t have fingers, but the fisherman would retain the critical use of his thumb and hand.

"I didn't think I could ever tie knots again,” says skipper David Tyrrell.

Dr. Got had created similar flaps elsewhere on the body, but nothing to this extent. Nearly nine inches of skin would have to be grafted from Tyrrell’s chest. Additional grafts for his forearm would have to come from his thigh.

“I wouldn’t have faulted him for picking amputation. He would have been out of the hospital faster,” Dr. Got says, but Tyrrell “wanted at all costs to try and keep whatever length and function of his hand and arm that he could.”

Back on the water

Amazingly, Tyrrell was back to fishing in just three months. He’s been working ever since. 

Nearly two years later, after finishing an early morning charter, Tyrrell secures Mako II to the dock at the state pier in Galilee. The right-handed fisherman acknowledges he’s had to adjust to not having a fully functioning left hand.  But he’s just as quick to show how far he’s come. To demonstrate, he uses both hands to thread fishing line through a lure and tie it to a rig.

“I didn’t think I could ever tie knots again,” he says.

Tyrrell still thinks back to the day Dr. Got offered him an option to save his hand – and his way of life.

“I’m glad I listened to him,” he says.