Email Surgery Saves Sailor's Life

A Boston doctor used email to tell a solo sailor thousand of miles away how to operate on himself, probably saving the sailor's arm and possibly his life.

The sailor not only arrived safely in Cape Town at the tip of Africa on Monday, he got there ahead of four of the other 14 sailors in the race around the world that started in Charleston, S.C.

"In terms of administering medicine by remote control, this one has got to be right up there as one to remember," Dr. Daniel Carlin told The Boston Globe.

An infectious disease specialist at the New England Medical Center, Dr. Carlin, 39, founded World Clinic Inc., which practices long distance medicine by computer.

He also is physician on call for the Around Alone Race for solo yachtsmen.

One week ago Tuesday, Dr. Carlin got an email from Viktor Yazykov, a Russian competing in the race.

"My right elbow does not look good. Some yellow spot in the middle of red and it feels dead," Yazykov wrote. "Waiting for your help."

He was 400 miles from Cape Town, the end of the first leg of the race.

Many of his competitors had sophisticated satellite communication systems, but for financial reasons, Yazykov had the minimal system issued by race officials.

It uses solar power for emergency email transmissions, making it useless at night, and its keyboard has English letters.

Yazykov injured his elbow at the beginning of the race, which he started Sept. 23, four days after others, but had managed to pull ahead of four competitors.

Dr. Carlin messaged back that it probably was an infection, but he needed more information.

"All skin is glossy and shiny white," Yazykov messaged back the next morning. "It is like a pillow with some liquid inside," he said, but he was not in pain.

Knowing Yazykov was a former member of the Russian Special Forces, Dr. Carlin figured the sailor probably was downplaying his pain.

If the abscess Yazykov described burst under the skin, the infection could kill him.

With four hours until sunset would black out Yazykov's communication system for the day, Dr. Carlin messaged him 13 steps to take in cutting into and draining the abscess with medical instruments World Clinic had provided all those in the race.

Last Thursday morning, Yazykov emailed that he had punctured the abscess but could not stop the bleeding and could not move the fingers of his right hand.

"Have been sitting on the bloody cabin floor almost completely naked ... watching as my life drop by drop leaving me," Yazykov wrote.

He had not told Dr. Carlin that in the previous day or two, he had taken about eight aspirins to numb the pain.

Aspirin thins blood, making it harder to clot, and the bandaging Dr. Carlin had told him to use had not worked.

So, with his teeth and good left arm, Yazykov had wrapped elastic cord around the arm to stop the bleding and had paralyzed it from the elbow down.

Dr. Carlin emailed him to remove the cord and apply pressure directly to the wound.

The bleeding stopped and by last weekend, Yazykov had some movement back in his hand. He is expected to recover fully.

"The arm getting better. Very grateful to doctor," Yaykov said Sunday in his last email to Dr. Carlin.