Tear In Time (6 page)

  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,” Nurse 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 slid 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.