Inside, emergency-room physician Edward Heneveld looked at the nail head in Spaulding’s chest and grimaced. Pressing on the neck artery, he could barely feel a pulse. The man’s pale, sweaty appearance and deteriorating vital signs were evidence of severe shock.
The trauma team cut off Mike Spaulding’s clothes, inserted I.V. lines into his arms and placed an oxygen mask over his nose and mouth. X rays and a sonogram confirmed Heneveld’s worst fears: that the nail had driven straight into Spaulding’s heart, allowing blood to leak into the space between the organ and its surrounding membrane, the pericardium. Each time the heart beat, more blood spurted into the space. The growing pressure of blood in the pericardium was literally strangling Spaulding’s heart.
His lips were blue from lack of oxygen.
Tahoe Forest, a 72-bed district hospital, boasted a large emergency room for its size. It was not equipped for heart surgery, however. Normally, a patient with the type of injury that Spaulding had would be moved to a trauma center in Reno, 35 miles away. He’ll never make it, Heneveld realized.
“Get Boone in here quick,” he said. “We’re going to lose this guy unless we open him up fast.”
* * *
Across the corridor in the physicians’ lounge, Dr. Howard Boone was unwinding after assisting at a hernia operation. The bearded, six-foot-four-inch surgeon favored blue jeans and cowboy boots and was a popular figure both at the hospital and in town.
Boone’s patients liked him for his gentle and confident manner, as well as his skill and compassion. A colleague tells of the time Boone performed emergency stomach surgery on a 76-year-old cancer patient. “We couldn’t help you,” Boone told her when she came out of anesthesia. “But I promise to make you as comfortable as possible.” He remained at the woman’s bedside all that night and into the next afternoon, personally nursing her until she passed away.
“Dr. Boone, ER stat,” the loudspeaker in the doctors’ lounge crackled—hospitalese for “to the emergency room, immediately.” Boone loped across the corridor and shouldered his way past the nurses and physicians surrounding Spaulding’s gurney.
* * *
After a glance at the man’s X rays and heart sonogram, the surgeon knew they were in deep trouble. Spaulding needed open-chest surgery immediately. The last time Boone had performed such an operation was 16 years earlier during his residency in San Francisco. Boone knew Tahoe Forest was not equipped for this type of surgery: the hospital had no heart-lung machine and no chest saw.
Without a sternal saw, he’d have to use an old Lebsche knife. This is a ten-inch-long stainless-steel bar with a handle at one end and a sharpened wedge at the other. On the back side of the wedge is a flat surface that can be banged with a mallet to drive the wedge into the bone. Before orthopedic saws, the Lebsche knife had been the standard tool that thoracic surgeons used to crack breastbones open for access to the heart and lungs.
Boone knew the hospital had one left over from earlier years. “Prepare for an open chest,” Boone directed. “We need all the usual stuff, plus the Lebsche knife, a chest jack and a blood recycler.”
Travis McMaster rushed into the emergency room with Judi Schorr. After pleading to be allowed to see Spaulding, Schorr was shown into the area where he was being examined. Recognizing her, he lifted off his oxygen mask and whispered, “I love you.”
A nurse steered Schorr away. “I’m afraid you have to leave,” she said. Trying to prepare her for the worst, the nurse added quietly, “You might want to say good-bye. He may not make it.”
Boone and Dr. Jacinto “Butch” Orozco, the general surgeon who had performed the hernia operation Boone had assisted with, were already suited up and scrubbed. Nurses rolled Spaulding, still conscious, into the operating room. They moved as rapidly as possible, for they could see the patient was dying before their eyes.
Spaulding looked up at nurse Suzanne Achey and asked weakly, “Am I going to die?”
“Not if we can help it,” she answered with her most reassuring smile. “We’re a very determined bunch.”
Boone wanted to hold off until the last moment before giving anesthesia. He couldn’t risk the patient’s blood pressure plummeting further.
* * *
Now, scalpel poised, Boone nodded to the anesthetist. “Aren’t you going to knock me out first?” asked a frightened Spaulding.
“Put him out,” Boone said as he began the chest incision. Spaulding felt a sharp sting down the center of his breastbone. As the anesthesia kicked in, a black curtain descended. Incredibly, only 20 minutes had passed since the spike had been driven into his chest.
“Lebsche knife,” Boone called. The scrub nurse placed the gleaming instrument into his gloved, outstretched hand. Boone put the sharpened wedge of the Lebsche knife against the top of Spaulding’s sternum. “Go ahead,” he said to Orozco. “Slam it.”
Orozco struck the knife’s flat surface forcefully with a small stainless-steel mallet. He had expected a few whacks to drive the wedge into the patient’s sternum and split it cleanly in half. But Spaulding was an athlete with stone-hard bone. Although Orozco pounded again and again, the wedge didn’t move. “This guy’s built like a rock,” he muttered.
Anticipating the next move, the scrub nurse asked for an orthopedic tray, which would have a bigger hammer. When it arrived, she said, “Try this, Butch,” and handed him a three-pound hammer.
This time, after only three blows, Spaulding’s breastbone split open. Boone exhaled with relief. “Rib retractor,” he ordered.
The nurse handed him a steel device like a small tire jack. Slowly, Boone cranked the chest open, careful not to dislodge the nail. He probed inside with a gloved finger. The spike had entered Spaulding’s chest just off center of the breastbone. It had angled to the left before perforating the right lung; then it penetrated the right chamber of the heart. Finally, it had punctured the aorta, the garden-hose-size main artery that leads from the heart to the rest of the body. The pericardial sac around Spaulding’s heart ballooned with dark, oxygen-poor blood. Equally ominous, with each feeble beat of the heart, the nail again poked at the aorta like woodpecker pounding a tree.
Boone was amazed that his patient had survived this long. It’s a one-in-a-million chance to get this kind of injury, he thought, and not have it be fatal.
With surgical scissors, Boone carefully cut open the pericardium to relieve the pressure on the heart, suctioning and sponging out the pooled blood. If they could stop the heart for a few minutes, it would be much easier to work on. But for that they needed a heart-lung bypass machine. The surgeons would have to make their repairs while the heart was still beating. Working on a moving target, they would need every ounce of skill they could bring to the table.
By now Spaulding had lost perhaps a quarter of his body’s blood. They didn’t want to transfuse him because there hadn’t been time to determine his blood type before rushing him to surgery. To compensate, three large-bore I.V.s poured more than a gallon of clear fluids into his veins. An autotransfuser recycled the blood spilling into his chest cavity and returned it to his veins.
While Boone pulled the nail back bit by bit, Orozco put his fingers over the holes it had made. At last, Boone held the nail in the air. Then he handed his trophy to a nurse. “l want to save it,” he explained. “I’ll probably never see a case like this again.”
Over the next two hours, Boone worked to suture each hole that the nail had made. First he repaired Spaulding’s damaged lung. Next, with tiny stitches, he attached a Teflon patch to seal the hole in the upper-right chamber of the heart.
He watched the patch pulsate. “This guy’s strong as an ox,” Boone said as he worked.
Finally he tackled what he knew would be the trickiest part of the surgery—repairing the aorta. The staff fell silent as Boone gingerly peeled back a clot covering the puncture wound. A geyser of blood spurted across the room. My God, we could still lose him, Boone thought. Orozco immediately put a finger over the wound.
>
Boone was now working blind, the hands of both surgeons deep inside Spaulding’s chest. Then, while Orozco kept his finger firmly in place, Boone prepared needles for suturing. Because the puncture was located deep in a crevice where the heart and aorta meet, each surgeon placed half the suture in the part of the wound he could best reach. “I think I’ve got it,” Boone finally announced.
To help seal the hole, Orozco held a gauze sponge in place for five more minutes. An audible sigh went up in the operating room when he slowly removed it and not a drop of blood appeared.
Between his cap and mask, Boone’s eyes registered relief as they met Orozco’s. “Let’s close him up,” Boone said. “This just wasn’t his day to die.”
Mike Spaulding recovered with surprising speed. Only three days after surgery, he was begging so hard to go home that Boone finally granted permission—with a warning.
“If you try anything strenuous during the next two months,” the surgeon said, “your blood pressure could rise enough to blow a hole in one of our sutures. If that happens, you’ll be dead. It’s that simple.”
Judi Schorr and Travis McMaster got Spaulding home and made sure he was comfortable. After nearly losing her man, Judi found that her thoughts about marriage had changed. Just nine days after the accident, Mike and Judi were married. By mid-March 1992, Spaulding was back at work—careful to keep his finger off the trigger of his nail gun until he was ready to fire it.
Spaulding changed in other ways. Formerly hard-driving, competitive and sometimes argumentative, he became more relaxed. “I’ve found I’m not as invincible as I’d thought,” he says. “And I can’t always do everything by myself.”
Still, some of his renegade spirit remains intact. After receiving a clean bill of health from Boone, he asked if he could jump the freight train again.
Boone smiled. “Sure,” he said. “Just tell me when. It’s an event I wouldn’t want to miss.”
The nail that almost took Spaulding’s life nestles in a box on Boone’s desk at his office. Every once in a while, the surgeon twirls it in his fingers and marvels at the gleaming 3¼-inch-long sliver of galvanized stud. He says, “Mike definitely had an angel on his shoulder that day.”
Originally published in the June 1993 issue of Reader’s Digest magazine.
Mike Spaulding died of cancer on July 10, 2013. Dr. Howard Boone is still practicing at Tahoe Forest Hospital. Dr. Jacinto Orozco is a general surgeon in Goldendale, Washington.
• YOUR TRUE STORIES •
WORST ENEMY
Looking across the crowd at my 40th high-school reunion, I spotted walking my way one of the persons I really had not looked forward to seeing. He had been a tormenter, a teaser, a prankster who had made me feel miserable. He grinned, called out my name, and started talking about himself and asking questions of me as warmly as the exchanges with long-lost best friends. That’s when I realized he really hadn’t been among my worst enemies. For the teasing and taunting had prepared me for the rough patches in life that always arise. Without him, I would not have been as prepared for adversity. He was really among my best friends. I can’t wait to see him again.
—Greg Rohloff Amarillo, Texas
GRANDDAD’S TRUCK
I was four, out back playing in the humid Kentucky air. I saw my grandfather’s truck and thought, Granddad shouldn’t have to drive such an ugly truck. Then I spied a gallon of paint. Idea! I got a brush and painted white polka dots all over the truck. I was on the roof finishing the job when he walked up, looking as if he were in a trance. “Angela, that’s the prettiest truck I’ve ever seen!” Sometimes I think adults don’t stop to see things through a child’s eyes. He could have crushed me. Instead, he lifted my little soul.
—Angela Bradley-Autrey Deer Park, Washington
PHOTO OF LASTING INTEREST
Space Equation
American scientists pose for Life magazine on October 10, 1957, alongside satellite orbit equations drawn up by astronomer Samuel Herrick. The photo was taken just six days after the Soviet Union had launched Sputnik 1—the world’s first human-made satellite and a win in the earliest round of the space race. NASA was created the following October, and within months, the United States was also in orbit: On January 31, 1958, NASA launched the Explorer 1 satellite from Cape Canaveral, Florida. Photograph by J.R. Eyeman/Getty Images
Raising Alexander
by Chris Turner
Alexander was a strangely motionless and silent baby, and doctors knew of fewer than 100 cases like his in the world.
For the first six months of Alexander’s life, I wanted to believe he might get well on his own. I would often lie down on the floor and make faces at him, trying to tease out a smile. Sometimes, after lots of effort, it worked. But mostly, my son was motionless and silent, his eyes focused on nothing in particular.
It was fall 2009, and my wife, Ashley, and I had only just moved into a new home in downtown Calgary, Alberta. We had a vivacious four-year-old daughter named Sloane, a grouchy Siamese cat, and an infant son who was a mystery. Alexander had been born hypotonic—floppy, basically—with an abdominal hernia, a heart murmur, strange folds on his ears, and a V-shaped birthmark in the center of his forehead. The geneticist assigned to us in intensive care, Micheil Innes, knew these were markers of a genetic disorder, but he couldn’t identify which one it was.
Even after Alexander was healthy enough to come home, he was undersized and underweight, hardly able to hold up his head. Amid the rush of feeding and diapers and getting Sloane to school, I could pretend he was just a little quiet and weak for his age. But the truth is, we often wondered if there was any awareness inside him at all.
The first tentative answer arrived on a dark afternoon in December. We were called to a small room at the Alberta Children’s Hospital, where Innes explained that a piece of our son’s genetic coding simply wasn’t there. He showed us Alexander’s lab results: rows of striped squiggles like some ancient alphabet and a red dot indicating the location of the missing material, near the end of the “q” branch of the ninth pair of chromosomes. The precise spot, in technical terms, was 9q34.3.
Innes then handed us a pamphlet that had been printed from a website. The document explained that “9q34.3 subtelomeric deletion syndrome” was usually an uninherited, spontaneous mutation, likely occurring at conception. The condition is also called Kleefstra syndrome, after a Dutch researcher who studies it. Innes believed there were fewer than 100 verified diagnoses worldwide at the time. Alexander’s developmental problems were born of a single cause—the tiniest of wounds, duplicated in every single cell in his body, forever. Because there were so few cases, the pamphlet provided anecdotes rather than a prognosis: a series of expected obstacles—to speech, mobility, learning—that our son might overcome, if lucky, after a lifetime of hard work.
Ashley and I drove home from the hospital in devastated silence, as if some vital swatch of our family’s fabric had been ripped away. We were terrified that our mute child would never walk or talk, let alone run across a playground or march up the aisle at his wedding. Later, as I watched Alexander in bed, I was too numb even to cry. I started to indulge in wishful thinking. Maybe he’ll simply catch up to his peers, I thought. Maybe someone will figure out how to fix this. I was convinced, in any case, that I couldn’t.
A few days after meeting the geneticist, we were having dinner when Sloane left her seat and skipped to her brother in his high chair at the other end of the table. We hadn’t discussed Alexander’s diagnosis with her, but Sloane’s internal radar for her parents’ moods had always been impeccable, and we were both far too shaken to hide it very well. My wife, usually a boisterous, no-holds-barred play fighter, had already stopped the roughhousing as the house filled with a formless, boundless anxiety.
Sloane set herself up behind Alexander, hands clutching either side of his chair, and flung herself from one side of his head to the other. With each swing, she bellowed, “Hello, Mr. Chubby Cheeks!” Alexand
er began to swing his head back and forth in time with her. His face erupted in a gap-mouthed grin. And then, for the first time in his life, Alexander laughed. Hard. A sudden gurgling, exuberant laugh. And then we all did.
Somewhere on the other side of the diagnosis was a boy who could feel joy. It was our job to find him.
* * *
We began where almost all parents with a special-needs child begin: monthly visits to an overworked early intervention clinic that recommended rudimentary physical therapy—exercises to encourage rolling over and sitting up, for example. The workouts seemed arbitrary and totally out of proportion to Alexander’s need, like Band-Aids on broken limbs.
My wife pushed the therapists at the clinic for better ways to address Alexander’s disorder. They were kind and competent, but Kleefstra syndrome was a question mark for them too. The message was to wait and see, to react once Alexander’s symptoms were clearer. Had we acquiesced, the “intensive” part of my son’s therapy would’ve started around the age of three, at the earliest.
Ashley has never accepted the default position on anything, and when it came to her fear of her son’s diminished prospects, she was relentless. She used her background as a research editor and radio producer to dig deeper. Books on disability and the brain piled up on her bedside table. One title was Glenn Doman’s What to Do About Your Brain-Injured Child. Doman—who died in 2013, at 93—was the founder of the Institutes for the Achievement of Human Potential, an unconventional teaching institute in Philadelphia. Using its methods, neurologically impaired kids learn not only to walk and talk but to read and count—often well ahead of unimpaired peers. Ashley had been begging me to look at Alexander’s condition as a crisis that, though it could never be eradicated, could be treated. Here, finally, was corroborating evidence.
The Best of Reader's Digest Page 25
