{"id":101,"date":"2014-12-13T21:42:28","date_gmt":"2014-12-14T02:42:28","guid":{"rendered":"http:\/\/www.orthopaediclist.com\/blog\/?p=101"},"modified":"2014-12-18T17:15:37","modified_gmt":"2014-12-18T22:15:37","slug":"corn-pickers-murdercycles-and-plane-crashes","status":"publish","type":"post","link":"https:\/\/www.orthopaediclist.com\/blog\/corn-pickers-murdercycles-and-plane-crashes\/","title":{"rendered":"Corn Pickers, Murdercycles, and Plane Crashes"},"content":{"rendered":"
\n

by James D. Hundley, MD<\/p>\n<\/div>\n

Part I:\u00a0 The Farmer and the Corn Picker<\/h1>\n

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.\u00a0 I then served as an orthopaedic surgeon at a referral hospital in the U.S. Air Force.\u00a0 Although I knew better, you might have thought that I\u2019d \u201cseen it all\u201d by the time I joined the Wilmington Orthopaedic Group in 1975.\u00a0 I hadn\u2019t.<\/p>\n

My first weekend on call was not memorable other than being so easy.\u00a0 I guess that I \u201crounded\u201d 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.\u00a0 \u201cAh ha\u201d, I remember.\u00a0 This is going to be easy:\u00a0 Work during the day; get an afternoon off every week.\u00a0 Take emergency call only a fourth of the nights and a fourth of the weekends.\u00a0 Before it had been every second. \u00a0Wow!<\/p>\n

\u201cWow!\u201d was right.\u00a0 That party ended my second weekend on call. Friday after evening rounds I was walking through the physicians\u2019 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.\u00a0 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.<\/p>\n

Now I\u2019ve 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.\u00a0 The auger is a screw-like device used to pull through the stalks leaving behind the ears of corn.\u00a0 It hurts to imagine what it would do to a human leg.<\/p>\n

Imagine the unimaginable.\u00a0 A highway patrolman was cruising a backcountry road and saw a man in distress.\u00a0 He turned off the machine and called for help.\u00a0 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.<\/p>\n

Ellis alerted the operating room staff to be prepared; no way could we have managed something of this magnitude in the ED.\u00a0 Then we changed into our green \u201cscrubs\u201d and went to the ED to meet the ambulance.<\/p>\n

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.<\/p>\n

We found that the area of trauma was \u201climited\u201d to his lower extremities and pelvic area.\u00a0 One lower extremity was absent as were his genitalia.\u00a0\u00a0 The lower half of his bladder was exposed and distended.\u00a0 Much of the buttocks on the other side had been chewed away exposing but not injuring the sciatic nerve.\u00a0 Altogether he had a huge open wound involving about two-thirds of the bottom of his trunk.<\/p>\n

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.\u00a0 He couldn\u2019t find it either, so he had to make an incision in the bladder through which to insert a catheter.\u00a0 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.<\/p>\n

Ellis had taken charge of the patient from the beginning and did a masterful job of pulling him through.\u00a0 There were many days in the ICU managing pain, electrolytes, blood counts, and infection but ultimately the patient survived and healed his wounds.\u00a0 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.\u00a0 John diverted the urine and Ed grafted skin and ultimately all of the wounds healed.<\/p>\n

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.\u00a0 Sadly, however, he reportedly committed suicide a couple of years later.<\/p>\n

Memory of that suicide brings to mind Ellis\u2019 response to someone who asked why we would work so hard to save someone so badly mangled.\u00a0 Ellis\u2019 replied, \u201cIt\u2019s up to us to do what we can.\u00a0 It\u2019s up to God to decide who lives and dies.\u201d<\/p>\n

That pretty much filled up the Friday night of my second weekend on call in Wilmington.\u00a0 I breathed a sigh of relief when I finally got home and went to bed.\u00a0 Based on my prior experience, the hard part was over.<\/p>\n

Part II:\u00a0 The Murdercyclist and \u201cHoney, There\u2019s been a plane crash!\u00a0 They want you back at the hospital.\u201d<\/h1>\n

Saturday morning, the next day of my second call weekend in Wilmington, was uneventful.\u00a0 I had a leisurely breakfast and visited with my wife Linda who was eight months pregnant at the time and our two young children.\u00a0 Then I headed over to the hospital for rounds.\u00a0 About mid-morning I was called to the ED for a young man who had crashed his motorcycle.<\/p>\n

Many who treat trauma patients call motorcycles \u201cmurdercycles\u201d because of what happens to their riders.\u00a0 Murdercyclists don\u2019t seem too concerned, however, and even insist that they are safe to ride even without helmets.\u00a0 They blame accidents on automobile drivers who fail to see motorcycles.\u00a0 This fellow was in a single vehicle crash of his own causing.\u00a0 Sorry about digressing.\u00a0 I can\u2019t help it.<\/p>\n

At any rate, he had three open wounds involving fractures and joints, all requiring hours in the OR cleaning up and fixing things.\u00a0 Fortunately I had my friend and outstanding Orthopaedic Physician Assistant Deak Walden by my side, and we finished about suppertime.\u00a0 I guess that fellow did OK as I remember little else about the case.\u00a0 That\u2019s typical, by the way.\u00a0 When people do well you typically forget the case and move on unless something like writing this story triggers a memory.<\/p>\n

I went home.\u00a0 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.\u00a0 The door didn\u2019t open and his hands went through the glass cutting one of them, fortunately not too badly.\u00a0 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.\u00a0 I guess I emotionally settled for a few seconds and started over to see how badly he was hurt.<\/p>\n

Before I had taken a couple of steps Linda came out with the phone in her hand saying, \u201cHoney, There has been a plane crash!\u00a0 They want you back at the hospital.\u201d<\/p>\n

\u201cVery funny\u201d, I responded.\u00a0 She wasn\u2019t joking.<\/p>\n

Professional wrestling was just becoming popular in 1975.\u00a0 Wrestlers traveled together and performed in the smaller markets.\u00a0 Charlotte, Charleston, Raleigh, and Wilmington come to mind.\u00a0 This group was flying a small charter up from Charleston for a Saturday night performance at Legion Stadium.<\/p>\n

The emergency call schedule for orthopaedic and neurological surgeons in 1975 worked like this:\u00a0 If a patient in the ED needed a specialist and knew which doctor he\/she wanted, the ED would call that specialist.\u00a0 If the patient did not know whom to call, the ED would call whoever was on \u201cunassigned call\u201d (ortho for ortho; neuro for neuro).\u00a0 In our group, we took turns covering the weekends Friday through Sunday, which included some days and nights of responsibility for \u201cunassigned\u201d patients.<\/p>\n

There was a lot of crossover among specialists.\u00a0 Orthopaedic surgeons, plastic surgeons and some general surgeons treated hand injuries, for example.\u00a0 In the case of spine injuries without neurologic impairment, orthopaedic surgeons took them.\u00a0 If there were neurologic impairment, the neurosurgeon would be the primary physician.\u00a0 We consulted back and forth but that was how the \u201cadmitting physician\u201d for that patient was determined.\u00a0 I was on unassigned call that Saturday.<\/p>\n

When I walked into the New Hanover ED, there was more commotion than I had seen before.\u00a0 Lying on gurneys were the three largest men I had ever seen.\u00a0 One had a compressed fracture of the seventh thoracic vertebra (T7) with no neurologic deficit.\u00a0 One had an \u201cexplosion\u201d fracture of the second lumbar vertebra (L2) with no neurologic deficit; one had an \u201cexplosion\u201d fracture of the first lumbar vertebra \u00a0(L1) and was paraplegic (\u201cparalyzed from the waist down\u201d).\u00a0 They had no other serious injuries.<\/p>\n

The neurosurgeon on unassigned call and I arrived about the same time.\u00a0 He made it clear that he did not want to be the primary physician for any, and for reasons I\u2019ve never understood tried very hard to convince me to perform a decompression laminectomy on the one who was paralyzed.\u00a0 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<\/i> Journal of Bone and Joint Surgery<\/i>.\u00a0 Dr. Howorth made it clear that emergency decompression surgery for fractures had no favorable effect on paralysis.\u00a0 The damage to the spinal cord had been done.\u00a0 Emergency surgery could make the patient\u2019s condition worse but not better.\u00a0 I agreed to manage the patient but not to operate.<\/p>\n

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.\u00a0 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.\u00a0 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.<\/p>\n

Guess what?\u00a0 These guys were way too big for this frame.\u00a0 Now what?<\/p>\n

By then, Deak had arrived and we decided that the patients needed plaster \u201cturtle\u201d shells for turning while protecting their spines.\u00a0 Deak made interlocking half-shells that would protect the spine when strapped together for each patient.\u00a0 Once the patient had been logrolled from front to back and so on, the top shell could be removed for the purposes noted above.<\/p>\n

The next challenge was how to perform 180-degree turns on men weighing 240+ pounds.\u00a0 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.\u00a0 Then the nursing staff could logroll the patients from prone to supine and back again without having to lift them.\u00a0 That worked and they got no pressure sores.\u00a0 We were not much attuned to DVT (deep vein thrombosis) during those days, but fortunately they had no apparent DVT\u2019s or pulmonary emboli.<\/p>\n

So how did they do?<\/p>\n

Patient 1:\u00a0 L1 fracture with paralysis.\u00a0 He and his family were obviously distraught about his condition and concerned that the neurosurgeon was not board certified.\u00a0 They requested consultation from Dr. Guy Odom, Chairman of the Duke Department of Neurosurgery.\u00a0 Dr. Odom chartered a twin-engine airplane with two pilots at the patient\u2019s expense and came for a visit.\u00a0 He reviewed the x-rays and examined the patient and told him that his treatment was appropriate.\u00a0 I don\u2019t know how the patient felt, but I felt both relief and validation.\u00a0 Dr. Odom returned to Durham.<\/p>\n

After about a week the patient was flown to Houston by charter airplane for continued treatment.\u00a0 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.\u00a0 My take is that they felt badly about doing surgery not likely to help him and used that as an excuse.\u00a0 At any rate, I never heard from him again.<\/p>\n

Patient 2:\u00a0 L2 fracture with no neurologic deficit and who was a former professional football lineman.\u00a0 He had no complications and he flew home to San Diego.\u00a0 I heard that he did well, but do not think that he returned to wrestling.<\/p>\n

Patient 3:\u00a0 Thoracic compression fracture; interesting fellow who was loaded with personality. \u00a0He fully recovered, became a World Champion professional wrestler, and remains famous to this day.<\/p>\n

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.\u00a0 We welcomed him and he and an even larger fellow arrived that evening in a Buick Rivera bristling with antennas.\u00a0 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.\u00a0 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.<\/p>\n

Other recollections about this case:<\/p>\n

    \n
  1. Professional wrestling was much bigger than I realized, and these men were celebrities.\u00a0 Hospital staff were often admonished for trying to sneak peeks through slightly opened doors, and we were often asked how they were doing.<\/li>\n
  2. When other professional wrestlers came to visit them in the hospital they, too, were treated as celebrities.<\/li>\n
  3. 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\u2019s body slammed the pilot\u2019s head into the dashboard of the plane.<\/li>\n
  4. The pilot\u2019s family sued the airplane manufacturer because the seats were torn loose in the crash.<\/li>\n
  5. Want to know why the plane crashed?\u00a0 It was reported that when they loaded the plane in Charleston, the load was above the regulatory maximum.\u00a0 The pilot had a simple solution.\u00a0 He drained enough fuel from the plane\u2019s tanks to get below the maximum allowable takeoff weight.\u00a0 They ran out of fuel within sight of the airport and crashed into a pine forest.<\/li>\n<\/ol>\n

    Dr. Hundley is a retired orthopaedic surgeon and a founder and the president of OrthopaedicLIST.com.<\/em><\/p>\n

    \u00a0<\/em><\/h1>\n","protected":false},"excerpt":{"rendered":"

    by James D. 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