June 8th, 2005
Elanger Hospital was a bustling modern hospital with four branches spread out on each side of the city of Chattanooga; north, south, east, west, and one at the center of the city, accounting for five in total. Regarded as a teaching hospital, they developed and performed the latest cutting-edge medical techniques, producing some of the finest medical staff in the country; although all too often the advancements came as a result of the gang-related violence that erupted within the inner city, many times catching the innocent in its crossfire.
Dr. David Warner burst through the swinging wooden double-doors and headed to the scrub station.
"Ok, what do we have?" he asked as he turned on the water and pulled on the soap dispenser, releasing a large dollop into his hands. Vigorously he scrubbed from his fingertips to his elbows as he listened to his supporting staff inform him of the emergency.
"Doctor, we have a gunshot victim with an entry and exit wound between the seventh and eighth rib, entry through the abdomen. Her belly's distended, must be filling up with blood. Her vitals are low, about eighty-five over sixty. Her Foley output is bright red and she’s hypovolemic from the blood loss. Triage has intubated her and already infused 2 liters of plasma," replied surgical resident Kerry Stadler, as he too scrubbed in for emergency surgery.
"So she's prepped?" Dr. Warner asked.
"Yes, doctor. Prepped and ready," Dr Stadler replied.
"Films?" Dr. Warner asked in abbreviated speech, a function of his occupation.
Before he could receive an answer, surgical nurse Jill Edwards burst through the door. Pulling her mask from her face, she anxiously reported, "Doctors, you'd better hurry. Her vitals are dropping fast. BP is eighty over fifty-five, pulse ox is eighty-five."
Without hesitation, Dr. Warner quickly responded, "Gloves and gown, now! And set up a thoracotomy tray, along with a laporatomy just in case."
Both doctors washed the soap from their hands and arms quickly as the pressure and anxiety of the situation worsened.
“Should we get an ultrasound in here?” Dr. Stadler asked as he started to tie his gown.
“Yes, STAT!” Dr. Warner replied urgently.
As the two doctors quickly donned their attire, Nurse Edwards pulled on her protective mask and rushed back into the OR to prep the ultrasound equipment and set up the thoracotomy tray.
Moving through the double doors, Dr Warner heard the sounds of alarms as the medical equipment coldly reported a patient in crisis. He scanned the various devices as the patient’s levels continued to drop into the danger zone.
As he rushed to the patient’s side, Dr. Warner's eyes widen in disbelief as he realized the age of the tiny victim. "My god, she’s just a baby. How old is she?"
"Eight years," Nurse Edwards replied, her voice sadly exposing what her mask disguised.
“What’s her name?” Dr. Warner asked.
“The chart says Lena Williams,” Nurse Edwards replied.
Shaking his head in disgust, he listened as the cardiac monitor sounded slower beats and become erratic. Immediately, he reacted out of instinct.
“She needs volume NOW. Hang another two on the rapid infuser,” He said, his voice showing the strain as the youth of his patient weighed heavy in his mind.
“BP's seventy over fifty and dropping, pulse ox is eighty-two,” Dr. Stadler informed his mentor and colleague.
“I just lost her pulse,” nurse Edwards cried out as the cardiac monitor sounded the unmistakable tone of ‘flat line’.
“Push an amp of atropine. Charge the paddles to fifty,” Dr. Warner retorted back.
Nurse Edwards quickly wheeled over the defibrillator and programmed the setting to Pediatric, while charging the external paddles to fifty joules. She quickly handed them to Dr. Warner, then injected an amp of atropine into the patient’s IV.
As Dr. Warner prepared paddles, Dr. Stadler scanned the young patient’s belly with ultrasound. Rotating the small metallic wand at various angles, images showed on the monitor, confirming their suspicions of the hidden trauma.
Having applied conductive gel, Dr. Warner placed one of the paddles to the upper right clavicle, and one just below and to the left of the young patient’s left nipple.
“Clear,” Dr. Warner called out.
Dr. Stadler broke off his examination just as Dr Warner depressed the buttons on the paddles, delivering a charge to the heart as well as other nearby organs.
The patient’s body convulsed from the current coursing through her. Her chest heaved and expanded, then fell and contracted back onto the table. The three medical personnel focused on the cardiac monitor for signs of activity. They held their breath in vain: the monitor continued to report a single monotone sound of flat line.
“Still in V-fib,” Dr. Stadler cried out. Desperation could be heard as he spoke.
“Fifty again,” Dr. Warner called out once more. He replaced the paddles in the previous locations and delivered a second charge. Again the tiny patient's body convulsed. As the three waited for the electrical shock to dissipate and reset the heart, the cardiac monitor registered a single ‘beep’, then another and still another as the young patient's heart began to return to its singular function, pumping life's blood once again through her tiny body.
“Sinus tach,” Dr. Stadler cried out in relief.
Dr. Warner roughly placed paddles back on tray. “Ultrasound?” he asked Dr. Stadler, who had now resumed his examination, nervous sweat beading up on his brow.
“Belly's full of blood. Looks like some major hemorrhaging where the bullet hit the spleen, pancreas and kidney. Eighth rib is broken too.” replied the Dr. Stadler, now regaining his composure.
“OK, eight blade,” Dr. Warner requested.
Instantly, Nurse Edwards handed him a scalpel from the tray of stainless steel instruments, butt end first, taking care not to slice her own hand as she pulled away.
Even with years of experience, the thought of slicing into the poor little girl that lay in front of him felt offensive. Dr. Warner strengthened his resolve and made his incision, cutting through the various layers of tissue as blood flowed freely from the opening. Immediately the unmistakable stench of blood and fecal matter wafted through their protective masks.
He finished the incision and called, “Clamp.”
Nurse Edwards placed the clamp in his hand. Dr Warner positioned the clamp, holding open the incision as he tried to examine the damage through the draining blood.
“Suction,” Dr. Warner called out.
Dr. Stadler inserted the probe into the incision and began to suck out the excess blood.
“Careful; watch the trauma. Work around the transverse colon. Clean out as much of that fecal matter as possible,” Dr. Warner cautioned as Dr. Stadler worked.
“Got it,” Dr. Stadler replied, carefully sucking up the blood and debris from the abdominal cavity.
With a better view, Dr. Warner could now see the damaged organs more clearly. It was apparent the spleen, pancreas and colon, as well as the left kidney had some form of trauma.
“I need a 4-0 prolene and an R.B.-1 needle, now. Anyone know the caliber of bullet?” Dr Warner asked, as Nurse Edwards handed him the needle and suture.
“Doesn't look small, that's all I know,” replied Dr. Stadler, still suctioning the colon.
“Looks like about a .22,” Dr. Warner informed. “Small entry wound, but heavy internal trauma from the shockwave as it passed through at the high velocity.”
“Shockwave?” asked Nurse Edwards.
While Dr. Warner worked to repair the damaged spleen, Dr. Stadler answered Nurse Edward's question.
“As a bullet travels, it pushes the air out of the way, creating a field of turbulent air around the bullet. That air around the bullet, the shockwave, has almost as much destructive force as the bullet itself: so instead of a quarter of an inch bullet causing damage, you have to add the inch of shockwave to the problem too,” Dr. Stadler said.
“Awful, just awful,” Nur
se Edwards replied sadly.
“Stats!” Dr. Warner called out as he quickly worked.
“BP seventy-five over fifty, pulse ox eighty,” replied Nurse Edwards
“She's bleeding everywhere,” Dr. Warner complained. He turned to Dr. Stadler and instructed him to repair the transverse colon. “Looks like we have a small puncture in the transverse colon. Can you repair it while I attend to the spleen?”
“I'm on it. Eight blade with suction, and a 4-0 and an R.B.-1 standing by,” Dr. Stadler rattled off in quick succession to Nurse Edwards.
Like a gentle father teaching his son, Dr. Warner delicately cautioned Dr. Stadler, “One thing at a time,” he said, then added, “Work frantically in control.”
“Gotcha,” Dr. Stadler replied, slightly embarrassed by his over zealousness.
As they both worked frantically to repair the damaged organs, the flow of blood went on nearly unabated. Nurse Edwards kept a careful eye trained on the monitors as well as the doctors, anticipating their needs before their requests.
“Doctors, BP is dropping again, sixty-five over forty-eight. Pulse ox is very low: seventy-seven,” Nurse Edwards announced.
“Dammit, where is she bleeding from?” Dr. Warner asked rhetorically.
“We're working the areas now, Dr. Warner,” Dr. Stadler replied.
“No, no, with this much blood loss there has to be a much larger source, like the vena cava or the aorta,” Dr. Warner speculated.
“We're nowhere near those areas. The bullet exited out her back, through the kidneys,” Dr. Stadler replied.
“I know, but this much blood loss isn't adding up. The bullet missed the renal and spleenic veins and arteries. This can't be from just the organs,” Dr. Warner replied.
The two doctors worked feverishly to repair the damaged and bleeding organs as the patient’s vitals continued to fall. Having repaired the spleen and the transverse colon, the two moved onto the pancreas and left kidney.
“More suction, Kerry,” Dr. Warner instructed Dr. Stadler. He then glanced up and asked Nurse Edwards, “How's our supply?”
“She taking blood faster than we can give it,” she retorted back instantly.
“Hang another two units,” Dr. Warner requested anxiously.
“Dr. Warner, do you see this?” asked Dr. Stadler. “Would you agree that the bullet entered the abdomen, broke the rib and continued through the spleen, pancreas and out the kidney?”
“It appears that way, why?” Dr. Warner asked as he worked on the kidney.
“There seems to be an abrasion heading up into the upper posterior peritoneum,” Dr. Stadler said, as he lifted the pancreas slightly and pointed to an abrasion that angled up toward the middle of the patient’s body instead of down and through it.
“Dammit, you know what that is? That's another entry wound,” Dr. Warner replied. “Eight blade and sternal saw, STAT!” he said to Nurse Edwards.
“Two bullets? But there’s only one entry wound,” Dr. Stadler replied in disbelief.
“I know. Two bullets entered through the same location,” Dr. Warner responded as he accepted the scalpel from Nurse Edwards and began to make a long incision down the patient’s breastbone. “I knew something wasn't right. A .22 caliber can't break a rib, then have enough energy remaining to tear through all these organs. There had to be more than one bullet, and I'm betting it’s also the cause for the massive blood loss,” he explained as he finished his incision.
“What are the odds of that happening? I mean, two bullets with the same entry wound?” Dr. Stadler asked rhetorically, shaking his head now in further disbelief.
“Stenal saw,” Dr. Warner asked next, then added, “I never would have guessed it if I hadn’t seen it with my own eyes.”
Quickly, Nurse Edwards handed Dr. Warner the saw. Placing it at the base of the sternum, he began to cut through the breastbone, the smell of bone and blood penetrating through their masks and into their nostrils. Moments later, he was done.
“Rib spreader,” Dr. Warner requested.
Anticipating his request, Nurse Edwards handed him the instrument immediately. Inserting it directly into the incision, he turned the lever and separated the ribs enough to view the upper chest cavity.
“Probe,” Dr. Warner requested from Nurse Edwards. He then called to Dr. Stadler to begin suctioning the open areas. As he did, Dr. Warner examined the cleaned areas.
“More suction. I need more suction,” Dr. Warner asked with frustration. “Oh man, we have trauma to the inferior vena cava. I need a 4-0 and an R.B.-1, STAT!”
Working feverishly to repair the profuse bleeding, the needle contacted something hard. At first he thought it was a rib fragment, but upon closer inspection Dr. Warner realized it was the second bullet.
“There it is. Forceps,” Dr. Warner requested with an almost frantic tone.
He inserted the forceps into the cavity, gently pushing aside the still-bleeding vena cava and gently extracted the deformed and mangled bullet.
“Wow. The edges are like tiny razor blades. They sliced through the veins on contact,” he announced. “There must be a dozen fissures to repair.”
As he unceremoniously tossed the clamped bullet and forceps into a stainless steel container, he continued to suture the tears to the damaged vein and surrounding organs.
Moments later, Dr. Warner watched as the heart began to slow. Just then, the cardiac monitor sounded. He quickly placed his gloved fingers around the heart and began to squeeze, attempting manual heart compressions even before Nurse Edwards could speak.
“Doctor, she's in PEA,” Nurse Edwards announced.
“Push another amp of Epi and charge the internal paddles to fifteen,” Dr. Warner demanded.
Handing him the paddles, they watch as he inserted them into her chest cavity and placed them on the still heart.
“Clear,” Dr. Warner called out he depressed the button and sent the shock directly into the young patient’s heart.As they listened for signs of life from the cardiac monitor, reality set in. There were none to be heard.
“Charge to twenty. Another 6 milligrams now. Clear!” Dr. Warner frantically called again.
He shocked the heart, sending the current deep within, but to no effect. The cardiac monitor continued to report its menacing tone – flat line.
“Asystole… God dammit.” Dr. Warner shouted out loud.
As he continued with manual compressions he called out once more, “Charge to thirty.”
Inserting the internal paddles again, he delivered a massive jolt to the patient's heart. In horror and sadness, they watched the monitor register no change.
Dr. Warner frantically searched his mind for a solution as he continued manual compressions. Even with his years of education and training, the damage was too extensive for him to overcome. He pulled his hands from her chest and stood back. With his gloved hands dripping fresh blood onto the floor, he hung his head low.
“Call it,” he mumbled quietly.
As Nurse Edwards called the time of death, he stood motionless as he watched the lifeless body of the young girl. His mind raced as he stared at the carnage in front of him. He thought about the smiles she must have displayed just a few hours before. He thought about the hugs her mom must have given her that morning, and the pain the parents would be feeling forever. He thought about her violent death and the injustice of it all. Deeply saddened and sickened by the grievous sight, he could stand no more. He turned and walked out the OR doors, oblivious to all, in a state of shock and disbelief. With his gown soaked in blood and his gloves dripping a red path behind him, he made his way down the corridor toward the elevator. In a blurred and confused state, he was unable to hear his name being called as he walked.
Standing in front of the elevator, he pushed the button. Instantly, the doors sprung open. He looked back up the hallway to Nurse Edwards, who was calling his name, but heard nothing. As if in slow motion, he stepped in and the doors slowly closed behind him.
??
?Dr. Warner! Dr. Warner, stop!” Nurse Edwards called as she ran down the corridor toward the elevator.
Too late. She watched as the doors closed behind him. As she stared at the bloody footprints that seemed to vanish through the elevator doors, she caught a slight movement with her peripheral vision. Looking up, she watched with sadness as a droplet of blood pooled, then slide down from the elevator button. Reaching into her pocket, she pulled out a tissue and reverently wiped off the sad remains of the young victim, imprinting in her memory, forever the pain of the senseless tragedy.
In a daze, Dr. David Warner stood in the middle elevator and stared through an old photo hanging on the back wall. As the metal doors closed behind him, he felt a small shudder, then a slight drop as he momentarily became weightless as the elevator began to descend. Ignoring the fact that he had not pressed a floor to descend to, he felt any place but the OR was a good place. He just wanted to forget.
Slowly the elevator descended. As David struggled to free his mind of tragedy, his eyes began to focus on the picture in front of him. Slowly at first, then more detailed as he descended, the photo came into focus. He was no longer staring through the photo, but directly at it. Somehow it helped to soothe the pain that gnawed away at his soul.
The photo was an antique, a reflection of the past; a unique display of history that showed how Elanger Hospital came to pass. The photo was of a group of civil war doctors standing over a patient after a recent amputation. At its center was the patient, laying on a makeshift gurney built from an old wooden wagon, sedated and bandaged, with his lower right leg, a stump, resting and on display as a testimony to the doctors’ abilities. Standing behind the patient, dressed in uniform with their bloody smocks still fastened to them, several military doctors stood proudly for the photo. Hardened and determined, their faces were devoid of all expression, save for one - pride.
At the left side of the photo sat an old man on a rickety stool. With his white flowing beard and hair, he looked much older than his more distinguished-looking colleagues. He too wore a bloody smock, and his face also carried the expression of pride. Yet something else shone through in the old man’s eyes – wisdom. While the others looked into the camera, he looked beyond it, as if deep in thought and oblivious to its presence. He appeared somewhat accidental to the photo’s purpose. At the bottom of the photo, David read the inscription: Original site of Elanger Hospital, 1862.
David gazed upon the doctors in the photo. He looked at the bandage, bulbous and barbaric on the poor soldier’s leg. A feeling of contempt swept over his body.
“Huh. A hundred and fifty years of progress and we still can’t save ’em,” he shouted out irrationally, his fists clenched in anger and still encased in bloody gloves.
Then, in a fit of rage, he punched the picture on the wall, the glass shattering and dropping to the floor of the elevator, cracking the cheap plastic frame. The sound of shattering glass and cracking plastic snapped him back to reality. He bent over and picked up the old photo, leaving the broken shards of glass still at the floor of the elevator. He began to replace the picture on the bent hook when he felt his knees begin to buckle slightly as the elevator began to slow to a stop.
A moment later, David heard the sound of a bell as the elevator settled into its floor. Suddenly, he saw his gloved hands, sticky with drying blood, holding the framed picture held out in front of him. He looked down at his gown and realized he was covered in blood, a fact that had escaped his attention moments before.
As the mechanized sound of the heavy metal doors signaled their opening, he felt a light balmy breeze brush by his neck. The air suddenly felt dense, as if the relative humidity dramatically increased. A strange yet familiar odor drifted from behind him and penetrated his nostrils. Turning around to investigate, he stiffened and froze in place.
As his eyes took in the sight before him, his mind struggled to make sense of the scene beyond the doors of the elevator. His heart began to pump wildly and his whole body shook. He felt he was dreaming: but never before had a dream felt so real.
“Hey, you. Come here. I need you to hold his leg,” David heard just outside the door of the elevator.
David squinted at first, then rubbed his eyes and refocused on the vision before him. There, several yards away, he watched as a man dressed in a blue military uniform stood over another man laying on a wooden gurney. The man standing looked familiar to him, and he searched his mind to make the connection.
“Hey, come here. I need your help now. I’m almost finished,” the voice called again from beyond the elevator door.
David looked around inside the elevator, then over to the control panel. At the bottom of the panel, a circular button labeled “G” was highlighted. He thought it strange that he ended up at the ground floor, as he had not pushed any of the buttons on the panel. He turned back to the scene that was unfolding in front of him. The light, balmy breeze was still blowing in his face, and the strange odor, now foul and offensive, still penetrated his nostrils.
David watched in fascination as he realized the military man beckoning him was, in fact, a doctor performing crude surgery on the other man laying unconscious on the wooden gurney. Suddenly it dawned on him. The man standing before him was the same man in the picture. David looked at the picture in his hands, then back at the man beyond the elevator. He was indeed the doctor; the older-looking man with a white flowing beard and hair.
“Wow. This is one strange dream,” David said out loud.
He felt confused by the vision.
“Whoa, I’m seeing color in this dream. How is this possible?” he asked of no one in particular.
“Are you just going to stand there or are you going to help me?” the old doctor called out to David in frustration.
David thought about answering him, but thought it to be silly. ‘It’s just a dream,’ he thought to himself. Then, reconsidering, he rationalized to himself, ‘What would be the harm?’
David called to the old man, “What do you want me to do?”
“Tear that cloth into strips,” the old doctor responded immediately, pointing to a mound of cloth on the grass at the foot of the wagon.
At first, David hesitated. Something in his gut was telling him not to go. He felt paralyzed with indecision, but then, throwing caution to the wind, he stepped forward. As he passed through the doorway of the elevator and stepped out onto the grass, time seemed to slow for a moment. He heard voices and sounds as if they were being played to him at half speed. He turned and looked back into the elevator, but strangely, he saw only its interior: the hospital he expected to see housing it was not there.
David turned and took a step onto the grass. Time seemed to resume its normal speed. He suddenly heard the deafening sounds of thunder and recognized the foul stench of rotting flesh. He turned to look back at the elevator, but it was no longer there: only grass and birch trees, which partially obstructed the war that raged off in the distant valley.
“What the hell?” David said out loud, as a wave of fear and confusion spread through his body.
“Son, I really need your help here,” David heard, as the old voice shouted from behind him.
David turned and looked at the old doctor, then back at the spot of grass that used to be the elevator. Suddenly, a loud clap of thunder sounded just beyond the birch trees, shaking the ground under his feet. He heard screams of agony and realized that the sounds he’d been hearing were not thunder after all, but were in fact artillery explosions.
Instinctively, David ran toward the old doctor, frantically searching for cover as he closed the distance. The old doctor, seeing the intense fear in David’s eyes, quickly recognized the developing problem. He pulled away from his patient and moved quickly to intercept David in flight.
“Whoa, son! Steady. You’re in no danger,” the old doctor called to David as he ran to him and grabbed his arms, reassuring him of his safety.
“Those are bombs. They’re trying to kill us,” David replied,
almost hysterical.
The doctor casually looked beyond David at the raging war, then back into his eyes, and replied, "Well, I suppose they are, but we're out of range of their artillery."
He scratched the top of his head with his bloody fingernails and continued, "I guess a wild bullet could accidentally find us up here, but it's not likely,"
He then took a long look at David's clothes. A confused expression crossed his face as he spoke. "That is quite an unusual uniform you have on. What outfit are you from?"
"Outfit?" David replied, still in a deep state of shock.
"Outfit, lad. What outfit are you from? Who's your commanding officer?" the old doc questioned with a bit of suspicion, then added, "Don't tell me you're gray?"
David was about to speak when another shell hit a bank just beyond the birch trees, startling both he and the old doctor. With a quick look over David's shoulder, then back to his patient on the wooden wagon, the doctor refocused on his duty.
"This way, lad. We have work to do," the old doctor said, as he extended his hand in the direction of the patient as an invitation for David to follow him.
Quickly, they walked back to the wagon, with the doctor leading the way. Once at the patient’s side, the old doctor instructed, "I need you to tear those rags into thin strips so I can finish bandaging this poor lad’s stump before he comes to. Lord knows he'll be suffering enough when he wakes without us fidgeting with his bandage, so be quick with your work."
David pulled off his rubber gloves and tucked them into his pocket. With his mind struggling to make sense of the situation, he reached down and begin to tear the cloth into strips in an effort to buy himself time to sort through the complexities of his dream. His mind raced from one topic to the next, never answering his questions as each problem became a Pandora’s Box of other unanswerable questions, distracting and derailing him from solving anything. As he looked around, he could hear the cries of agony, the sounds of war, the smell of death, and suddenly he realized that this was no dream. This was real. He was now existing in another era in time: the Civil War – the 1860s.
As he tore off each strip of cloth, he handed it to the old doctor, who used it to secure the amputee's bandages in place. As he worked, the old doctor began to interrogate his new assistant.
"I see you've been in surgery already. I don't recall another medical unit around here. Where did you come from?" the old doctor asked casually as he worked.
David searched his mind for an answer that would be suitable for the old man. He knew he couldn't say he was from the future. Quickly he devised a cover story until he could make sense of his dilemma.
"I have medical training and thought I could be of use,” David replied, hoping his answer would suffice.
“Uh huh, and where did you come from? Allow me to be more direct. Are you gray or blue?” the old doctor asked without breaking his concentration.
“Doctor, I am neither. I am just a medically trained individual who wants to lend a hand to these poor boys,” David replied.
“Young man, are you a deserter?” the old doctor asked bluntly.
“No, sir. I am not in the military,” David responded.
He knew the questions would keep coming and that he needed to find a better reason for his presence. He then had an idea.
“Doctor, the truth is I need a job. I’d like to join the military to in order to practice medicine. I am a very skilled practitioner and feel I can be of real use here,” David finished, hoping he hadn’t overplayed his abilities.
“Hmm, skilled practitioner you say? Where were you trained? Are you a doctor?” the old doctor said, continuing his interrogation.
“Yes, I am a doctor. I was trained in New England at Harvard University. Have you heard of it?” David asked, unsure if his Ivy League alma mater wouldn’t raise even more suspicion.
“Harvard you say? Hmm. We are short-staffed here, to be sure. My assistants mean well but are bumbling country boys, if you understand my inference,” the old doctor said as he winked at David.
“Completely, doctor,” David replied back with a smile of understanding.
“Well, doctor, do you have a name?” the old doctor asked, now warming to David a bit.
“Yes sir. My name is Dr. David Warner. May I ask what your name is?” David responded in kind.
“Certainly. My name is Jebadiah Morgan,” Dr. Morgan replied, his modesty eliminating fancy titles from his name.
He tied the last bandage and lifted his head. With piercing eyes, he stared directly into David’s. Slowly, he extended his hand in greeting.
“I’m pleased to make your acquaintance, David. Now, if you will indulge me a while, I’d like to see your abilities. I have a young man waiting amputation I’d like you to attend to. If you prove your skill, I will consult with Gen. Negley regarding employment. Is this accord satisfactory?” Dr. Morgan asked with blunt sincerity.
“Where's the patient?” David replied, trying to contain his confidence.
Dr. Morgan signaled to the private to bring up the next patient. As they waited, he showed David to his station, pointing out the instruments he'd be operating with, as well as suturing materials and bandaging. David viewed his crude operating environment with shock. He hadn't thought about it until that moment, but he was trained to operate in a highly technical environment. This was as primitive as he could imagine. He wasn't sure he could do it.
Dr. Morgan sensed David’s apprehension and said, “Son, are you sure you're up for this?”
“It's a bit more primitive than I'm used to, but I can manage,” David replied.
“Son, I don't want you to manage. I want you to perform as a trained operator. These young men deserve more than a butcher or a charlatan. If you are either, please speak the truth,” Dr. Morgan stated boldly and with conviction.
“Doctor, I can assure you my skills as a surgeon are more than adequate. I just need a moment to acclimate myself to an environment I'm not accustomed to,” David replied with a bold and confident tone, in an effort to reassure Dr. Morgan.
As the assistants laid the next patient on the wooden wagon, David could see the agony of the young soldier and immediately began his assessment.
Without the basic equipment to understand the patient’s vital signs, David could only make limited observations. He quickly took the patient’s pulse and determined it to be weaker than normal. Next, he checked pupil dilation and reaction with a match. Satisfied, he then examined the patient's mouth, tongue and skin for dehydration and color. He observed that his skin color was pale and felt clammy. In addition, the young man seemed somewhat withdrawn and lethargic. Trying not to move the traumatized leg too much, he moved it only slightly, cutting away the pant leg. He observed that a large caliber bullet had indeed passed through the calf, but had left a gaping wound upon exiting. David determined that with careful cleaning and repair, the leg could be saved, although without antibiotics, the post treatment would be problematic.
David immediately bent the young man's undamaged leg at the knee, leaving the traumatized leg laying flat. He then moved to the front of the wagon, grabbed a blanket, and draped it over the patient.
"Dr. Warner, what is your assessment?" Dr. Morgan questioned with concern.
"The patient is suffering from mild hypovolemic shock. I am making some effort to stabilize him before invasive surgery. The large bore bullet has indeed left a great deal of trauma to the calf, but I believe I can save the leg."
David recalled from his courses in school that the anesthesia of choice during this period was chloroform.
He continued, "Do we have the chloroform ready?" David asked.
"Doctor, I must protest. His leg is too badly damaged. We must remove it before gangrene develops," Dr. Morgan said.
"I've examined the wound and feel it is relatively clean, thanks to his pant leg protecting the trauma. After a proper cleaning, I can repair the muscle, veins and arteries, but will need a strong cleansing solution and fres
hly boiled water. I believe he will have some degree of infection, but the chance of gangrene is much lower than you might think," David replied.
"Repair the veins and arteries? Is this possible?" Dr. Morgan asked incredulously, then added with great concern, "And what if the infection spreads and gangrene develops?"
"We'd amputate, but then he'd be no worse off than if we had amputated now. At least we give him a chance to save the leg," David reasoned.
"Hmm. You really think you can do this? Save his leg?" Dr. Morgan asked, now intrigued by David's plan.
"I can only assure you he won't die under my care, though saving his leg under these conditions isn't going to be easy," David responded.
Dr. Morgan coifed his long white beard as he contemplated the procedure. He looked over at the patient, then back at David, deep in worry as he struggled to trust this mysterious doctor who appeared just minutes before. David could see the old man's forehead furrow as he thought. A moment later, David saw the worried expression leave the old man's face. He now began to smile a bit as he came to grips with his decision.
"Ok, son. Tell me exactly what you need," Dr. Morgan finally replied.
"Two pots of boiling water, distilled or grain alcohol, soap, and clean dressings," David replied.
"It's going to take some time to collect these things. Is every operation like this?" Dr. Morgan asked.
"Keeping the water boiling is the only time consuming consideration," David responded.
A fire had already been smoldering from early morning usage, so Dr. Morgan tossed more wood on the coals. Twenty minutes later, two pots of water boiled wildly as David sorted through Dr. Morgan's limited instruments required to perform the surgery. Resigned to his selection, David placed the instruments into the boiling water for sterilization. He then poured off some of the boiling water into third pot and began to scrub his hands and arms with the soap, as well as the rubber gloves he had in his pocket. Satisfied with his cleansing, he slowly washed away the soap.
Dr. Morgan looked on ill-amused with the display by this strange doctor. A man of medicine for more than thirty-five years, he regarded the prep work as shenanigans reserved for roadside carpetbaggers as a means to disguise their lack of content. David looked over and could see the contempt in Dr. Morgan’s eyes. He knew the old doctor was losing his patience, and with that lost, he too was losing what little credibility he might have had.
Quickly, David set up next to the young soldier. With the help of the old doctor, the patient was anesthetized in a matter of minutes. With the patient out, Dr. Morgan looked on closely. David put on his now-sterilized gloves, and then applied a generous amount of the ‘moonshine’ he obtained from the old doctor to the area around the wound in an effort to sterilize it.
“Ok, doctor: as you can see, the patient’s leg is torn up pretty badly. I’m going to make an incision through the back of the calf to inspect and then repair any damage I might find,” David started.
With the patient’s legs bent at the knees and rolled to one side so he had a clear view, he made an incision across the entry wound large enough to view inside when spread apart. As if on cue, Dr. Morgan moved in for a closer look.
David then brought out a pair of retractors used to hold open an incision. He delicately placed the instrument in the incision and expanded it, giving him a good view of the wound. Next, he rinsed out the incision with a salted water solution he had prepared before the surgery. Dabbing the excess blood, he was able to see the damaged muscle tissue and a torn vein. Using his scalpel, he cut away the torn and mangled muscle tissue. Again, he rinsed out the interior of the wound with ‘moonshine’ and his makeshift saline solution. With the smallest needle from the old doctor’s bag of instruments, David began to sew the reconstructed muscles as well as the arteries, using very few sutures to accomplish his task.
“Now, the sutures will remain there forever, but the body will adapt to them. I believe this should take care of this side of the wound,” David replied softly, completely engrossed in his work.
He closed the entry wound and move onto the more extensive damage on the other side of the calf.
Dr. Morgan looked on in total fascination. Never before had he seen or even heard of surgery so delicate and so complicated performed with such ease and skill. Eagerly, he waited for David to attempt the more difficult area of the operation. After watching the first phase of the operation, David had indeed proven himself to be a quite gifted surgeon. Dr. Morgan now watched as any spectator would watch a professional in his element. He was in awe and excited to observe even greater feats of medicine.
Once again, David did his best to rinse and clean the wound with the salted water solution, and then sterilize it with the distilled alcohol. Pulling the scalpel from the hot water, he began to work the damaged muscle tissue on the exit wound. The damage was much more extensive, but manageable. As he removed tissue, he would temporarily close the wound to ensure the proper shape of the reconstruction. Working quickly, he then began to suture the arteries and muscle as he had done on the previous side, using very few stitches to accomplish the task. He then closed the wound as he had done on the other side. When completed, he rinsed again and sterilized the entire area with the alcohol.
With the operation over, he began to bandage the wound. A few minutes later, as the patient was gaining consciousness, David had tied the last bandage. The operation was now over and David felt confident he had done his best to inhibit infection. In a day’s time, the results of his work would be evident. All he could do now was to wait.
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