Woodland Brain Surgery

Magazine Layout, Illustrations

This is my entry to the Society of Publication Design's annual student competition. The category I entered required students to write and layout an article describing how to do something like a pro. Drawing on my dad's experience as a neurosurgeon, I wrote an article on how to perform a simple trephination procedure, sans ER. On seeing the illustrations, my professor told me I was, in the very best way, "a sick bastard." For the morbidly curious, I've included the full text below the images.

Professor: Jeffrey Conger

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Any outdoorsman worth his salt knows that the most annoying, inconvenient scenario is a comatose partner. If you hate having to hightail it out of your woodland sanctuary to find suitable medical assistance for your fallen comrade, this is the article for you.


Let’s start with the basics: your partner is non-responsive, but is still breathing and has a weirdly big pupil. How has your partner arrived at their current state? If they have suffered some sort of head trauma, like a haymaker from a rogue grizzly, they are an ideal candidate for surgery. If, on the other hand, they are suffering from hypothermia, snakebite, or are simply a deep sleeper, brain surgery will probably not alleviate their problems. At least not the first two.

The surgery you’ll be doing is relatively simple, and is called a trephination. To understand why you’ll be digging around in your partner’s head we’ll go back to the aforementioned bear situation. About the time that paw connected with their dome, a blood vessel inside the skull burst and did its best imitation of a BP oil rig. Unfortunately for your partner, the skull is a pretty tight place, and the brain does not appreciate sharing it with an ever-growing puddle of blood. Your mission is to poke a hole in the skull, and relocate the blood (called a haematoma) to a less lethal location.

At this point, we feel it is wise to note that it in today’s litigious climate, even trained professionals risk a lawsuit every time they put someone under the knife. Performing an unsolicited, improv surgery may be a sure way to end up in court, but hey, your partner was stupid enough to go backpacking with someone willing to perform brain surgery after reading a two-page a magazine article, so they kind of brought it on themselves.

But now that we’ve got that out of the way, let’s move on to the fun stuff. We’ll assume that despite letting your partner suffer a severe injury, you’re still a relativley competent backpacker, and brought fishhooks, tent-stakes, a pocket knife, and bandanas. Get some water boiling while you gather them, and then sterilize all of it by cooking for a bit.

You’ll also want to clean the incision site, as best you can (hand sanitizer works great if you’ve got it). Now release your inner Vidal Sassoon and cut off any hair near the site. Finally, prep your fish hooks by tying about two feet of fishing line or string to the end of each.

Once you’ve got that done, your pre-op procedures are complete, and you’re now ready to be the doctor you always dreamed of!


1. Using your knife, make an incision where shown, about 2-3 fingerwidths in length.

2. Now the bleeding starts, but if you watch The Walking Dead, you’ve probably seen worse. Dab at the blood with your cloth, and keep cutting down through the muscle until you’ve hit bone.

3. Using your knife, scrape the layers of muscle away from the bone. Get the cloth in there and press hard.

4. This is when it really starts to get fun. Hook a fish hook under the muscle, then tie the string to something that will hold. Do this on each side of the incision as necessary to expose the bone.

5. If you don’t have fish-hooks (You’re not catching your own food? Pansy!) bend a fork in half and use it to wedge open the incision.

6. Using a wet cloth, put heavy pressure on the incision for 5 minutes. While you are doing this, take one of your metal tools and get it red hot over the camp stove. At the end of five minutes, slowly release the pressure, and use your metal tool to cauterize any areas still bleeding. This may fail miserably. If that’s the case, just carry on.

7. Now comes the moment you’ve been waiting for. Grab your tent stake and a rock. Hold the stake perpendicular to the skull, and tap with the rock. The key here is gentleness. If you get too excited, you’ll end performing a lobotomy, which is great for dealing with ornery partners, but won’t fix your current problem.

8. Use the same procedure to make a series of holes in a circle with a one inch diameter.

9. Now you should be able to dislodge a section of bone. Use a spoon to detach anything stuck to the bottom of it, and then discard, or keep as a souvenir.

10. If the haematoma is epidural, you’ll see blood now. Wash it away with cool water and spoon it out. If you see gray underneath you’re looking at the dura. If you see pink or white tissue, the dura is torn, and you’re looking straight at brains. Neat!

11. If you don’t see any blood, you’re dealing with a subdural haematoma, which means a little more work on your part. Make a small cut in the dura (remember, there’s brains under there) and retract the flap using one of your fishhooks. Keep cutting until you’ve made an x from one bone to the other. Use cool water and a spoon to remove as much blood as possible.

12. Remove your fishooks, and sew the incision shut. If you learned a locking stitch in your home-ec class, you can now put it to good use! If you didn’t, your partner may look like Chucky for the time being, but hey, you can’t win ‘em all.

13. Put a bandage on the incision, and then wrap gauze or fabric around the head. If you happened to bring a Sharpie, now is the time to draw something embarassing on your partner’s face.

14. You’re done! You’ve either just saved your partner’s life, or royally screwed them. Either way, it’s probably time to start preparing a speech for the reporters.

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