Part I: The Farmer and the Corn Picker
My training and early experience after medical school entailed an internship at a large university medical center followed by five years of residency at an even larger university medical center. I then served as an orthopaedic surgeon at a referral hospital in the U.S. Air Force. Although I knew better, you might have thought that I’d “seen it all” by the time I joined the Wilmington Orthopaedic Group in 1975. I hadn’t.
My first weekend on call was not memorable other than being so easy. I guess that I “rounded” on the patients of our group who were in the hospital and took care of some relatively minor injuries, but that would have been it. “Ah ha”, I remember. This is going to be easy: Work during the day; get an afternoon off every week. Take emergency call only a fourth of the nights and a fourth of the weekends. Before it had been every second. Wow!
“Wow!” was right. That party ended my second weekend on call. Friday after evening rounds I was walking through the physicians’ lounge on my way home and almost passed by general and thoracic surgeon Dr. Ellis Tinsley who had one hand on the telephone and one held out for me to stop. He had been talking to someone in the emergency department (ED) in Burgaw who had just sent a man who had fallen into a corn picker our way.
Now I’ve never seen a corn picker up close, but it was described as a large farm machine that is driven through cornfields pulling up corn stalks and feeding them into an auger. The auger is a screw-like device used to pull through the stalks leaving behind the ears of corn. It hurts to imagine what it would do to a human leg.
Imagine the unimaginable. A highway patrolman was cruising a backcountry road and saw a man in distress. He turned off the machine and called for help. The rescue squad took the man to the ED in Burgaw where he was stabilized and transported to the New Hanover Regional Medical Center in Wilmington.
Ellis alerted the operating room staff to be prepared; no way could we have managed something of this magnitude in the ED. Then we changed into our green “scrubs” and went to the ED to meet the ambulance.
The patient arrived in fairly good condition and was taken directly to the operating room (OR) where an anesthesiologist put him to sleep and began pushing intravenous fluids and blood (O-negative until we could determine a blood type) as samples were being taken for a variety of lab studies.
We found that the area of trauma was “limited” to his lower extremities and pelvic area. One lower extremity was absent as were his genitalia. The lower half of his bladder was exposed and distended. Much of the buttocks on the other side had been chewed away exposing but not injuring the sciatic nerve. Altogether he had a huge open wound involving about two-thirds of the bottom of his trunk.
Because we could not find the urethra (opening in the bladder through which urine normally drains and through which to insert a catheter), we called in urologist Dr. John Cashman. He couldn’t find it either, so he had to make an incision in the bladder through which to insert a catheter. Although he had no other choice that proved troublesome in that there was constant urinary leakage around the catheter thereafter, not helpful in trying to develop a clean and dry wound. Later we needed a plastic surgeon to cover the wounds and called in Dr. Ed Wells who did wonderful work as well.
Ellis had taken charge of the patient from the beginning and did a masterful job of pulling him through. There were many days in the ICU managing pain, electrolytes, blood counts, and infection but ultimately the patient survived and healed his wounds. My role after many hours that Friday night was joining Ellis and the other surgeons in the OR to debride dead tissues and clean the wound which we did on that Saturday and Sunday and many days after. John diverted the urine and Ed grafted skin and ultimately all of the wounds healed.
The patient learned to walk on crutches and could even drive his pickup truck so we felt like we had done a pretty good job. Sadly, however, he reportedly committed suicide a couple of years later.
Memory of that suicide brings to mind Ellis’ response to someone who asked why we would work so hard to save someone so badly mangled. Ellis’ replied, “It’s up to us to do what we can. It’s up to God to decide who lives and dies.”
That pretty much filled up the Friday night of my second weekend on call in Wilmington. I breathed a sigh of relief when I finally got home and went to bed. Based on my prior experience, the hard part was over.
Part II: The Murdercyclist and “Honey, There’s been a plane crash! They want you back at the hospital.”
Saturday morning, the next day of my second call weekend in Wilmington, was uneventful. I had a leisurely breakfast and visited with my wife Linda who was eight months pregnant at the time and our two young children. Then I headed over to the hospital for rounds. About mid-morning I was called to the ED for a young man who had crashed his motorcycle.
Many who treat trauma patients call motorcycles “murdercycles” because of what happens to their riders. Murdercyclists don’t seem too concerned, however, and even insist that they are safe to ride even without helmets. They blame accidents on automobile drivers who fail to see motorcycles. This fellow was in a single vehicle crash of his own causing. Sorry about digressing. I can’t help it.
At any rate, he had three open wounds involving fractures and joints, all requiring hours in the OR cleaning up and fixing things. Fortunately I had my friend and outstanding Orthopaedic Physician Assistant Deak Walden by my side, and we finished about suppertime. I guess that fellow did OK as I remember little else about the case. That’s typical, by the way. When people do well you typically forget the case and move on unless something like writing this story triggers a memory.
I went home. As I was getting out of my car, my five-year old son was so excited to tell me that his beloved grandparents had come to see us that he tried to pop open our storm door by running into the glass panel. The door didn’t open and his hands went through the glass cutting one of them, fortunately not too badly. That was managed with first aid by my neighbor and partner Dr. Charlie Nance, but the vision of those little hands going through that glass window still shocks my psyche. I guess I emotionally settled for a few seconds and started over to see how badly he was hurt.
Before I had taken a couple of steps Linda came out with the phone in her hand saying, “Honey, There has been a plane crash! They want you back at the hospital.”
“Very funny”, I responded. She wasn’t joking.
Professional wrestling was just becoming popular in 1975. Wrestlers traveled together and performed in the smaller markets. Charlotte, Charleston, Raleigh, and Wilmington come to mind. This group was flying a small charter up from Charleston for a Saturday night performance at Legion Stadium.
The emergency call schedule for orthopaedic and neurological surgeons in 1975 worked like this: If a patient in the ED needed a specialist and knew which doctor he/she wanted, the ED would call that specialist. If the patient did not know whom to call, the ED would call whoever was on “unassigned call” (ortho for ortho; neuro for neuro). In our group, we took turns covering the weekends Friday through Sunday, which included some days and nights of responsibility for “unassigned” patients.
There was a lot of crossover among specialists. Orthopaedic surgeons, plastic surgeons and some general surgeons treated hand injuries, for example. In the case of spine injuries without neurologic impairment, orthopaedic surgeons took them. If there were neurologic impairment, the neurosurgeon would be the primary physician. We consulted back and forth but that was how the “admitting physician” for that patient was determined. I was on unassigned call that Saturday.
When I walked into the New Hanover ED, there was more commotion than I had seen before. Lying on gurneys were the three largest men I had ever seen. One had a compressed fracture of the seventh thoracic vertebra (T7) with no neurologic deficit. One had an “explosion” fracture of the second lumbar vertebra (L2) with no neurologic deficit; one had an “explosion” fracture of the first lumbar vertebra (L1) and was paraplegic (“paralyzed from the waist down”). They had no other serious injuries.
The neurosurgeon on unassigned call and I arrived about the same time. He made it clear that he did not want to be the primary physician for any, and for reasons I’ve never understood tried very hard to convince me to perform a decompression laminectomy on the one who was paralyzed. Fortunately I had been trained too well to be so inclined, and my resolve had been reinforced by a recent authoritative review of the treatment of spine injuries by Howorth in The Journal of Bone and Joint Surgery. Dr. Howorth made it clear that emergency decompression surgery for fractures had no favorable effect on paralysis. The damage to the spinal cord had been done. Emergency surgery could make the patient’s condition worse but not better. I agreed to manage the patient but not to operate.
As those were the days before much surgical stabilization of spinal fractures, the treatment was keeping the patient horizontal and trying to avoid or worsen injury to the spinal cord. The next biggest worry was bedsores from lying on their backs and a turning bed was available to strap the patient between two frames and allow the nursing staff to flip him from supine to prone every two hours. When the flip had been accomplished, the then top frame was removed to allow the tissues on the top to be decompressed, inspected, and cleansed.
Guess what? These guys were way too big for this frame. Now what?
By then, Deak had arrived and we decided that the patients needed plaster “turtle” shells for turning while protecting their spines. Deak made interlocking half-shells that would protect the spine when strapped together for each patient. Once the patient had been logrolled from front to back and so on, the top shell could be removed for the purposes noted above.
The next challenge was how to perform 180-degree turns on men weighing 240+ pounds. The solution came from the hospital maintenance staff who used plywood boards to widen the single sized hospital beds and placed double sized mattresses on them. Then the nursing staff could logroll the patients from prone to supine and back again without having to lift them. That worked and they got no pressure sores. We were not much attuned to DVT (deep vein thrombosis) during those days, but fortunately they had no apparent DVT’s or pulmonary emboli.
So how did they do?
Patient 1: L1 fracture with paralysis. He and his family were obviously distraught about his condition and concerned that the neurosurgeon was not board certified. They requested consultation from Dr. Guy Odom, Chairman of the Duke Department of Neurosurgery. Dr. Odom chartered a twin-engine airplane with two pilots at the patient’s expense and came for a visit. He reviewed the x-rays and examined the patient and told him that his treatment was appropriate. I don’t know how the patient felt, but I felt both relief and validation. Dr. Odom returned to Durham.
After about a week the patient was flown to Houston by charter airplane for continued treatment. I heard through the grapevine that he had surgery there and was told that had they gotten to him sooner they could have helped his paralysis. My take is that they felt badly about doing surgery not likely to help him and used that as an excuse. At any rate, I never heard from him again.
Patient 2: L2 fracture with no neurologic deficit and who was a former professional football lineman. He had no complications and he flew home to San Diego. I heard that he did well, but do not think that he returned to wrestling.
Patient 3: Thoracic compression fracture; interesting fellow who was loaded with personality. He fully recovered, became a World Champion professional wrestler, and remains famous to this day.
A few months after he was discharged, he called to say that he was coming to Wilmington and asked if he could come see me at home. We welcomed him and he and an even larger fellow arrived that evening in a Buick Rivera bristling with antennas. They came into our home, and he lay down on the floor and played with our young children, an action distinct from his professional persona. He sent greetings through our mayor a year ago and just recently a friend showed me a photo that he had taken of him taken sometime in November.
Other recollections about this case:
- Professional wrestling was much bigger than I realized, and these men were celebrities. Hospital staff were often admonished for trying to sneak peeks through slightly opened doors, and we were often asked how they were doing.
- When other professional wrestlers came to visit them in the hospital they, too, were treated as celebrities.
- The pilot was killed in the crash ostensibly because the seat of the passenger behind him was torn from the floor of the plane and the wrestler’s body slammed the pilot’s head into the dashboard of the plane.
- The pilot’s family sued the airplane manufacturer because the seats were torn loose in the crash.
- Want to know why the plane crashed? It was reported that when they loaded the plane in Charleston, the load was above the regulatory maximum. The pilot had a simple solution. He drained enough fuel from the plane’s tanks to get below the maximum allowable takeoff weight. They ran out of fuel within sight of the airport and crashed into a pine forest.
Dr. Hundley is a retired orthopaedic surgeon and a founder and the president of OrthopaedicLIST.com.