Small Sacrifices (3 page)

There's a third one! What are we going to do?

Mackey was sure Shelby Day had seen the third child a

moment after he had. But in the shadows, in her shock, she hadn't.

The quick look he'd had at the first two injured youngsters

^old Mackey they were dealing with chest wounds. Short of a lrect head shot, there is nothing more cataclysmic than gunshot founds into the chests of little children. Mackey too shouted at

""y Patterson. The command was short, but Judy understood.

• "Find Wilhite!"

br ^v' <)teven Wilhite is a thoracic surgeon. To crack a chest, to

^k the sternum and reach with gloved, artist's hands into the 16 ANN RULE

heart and lungs of a human being, takes skill that few surgeons possess. Wilhite is one of the few board-certified thoracic surgeons in the Springfield-Eugene area. His presence in the ER was something devoutly to be wished.

Wilhite was just pulling into his own driveway when his

beeper picked up the code call at the hospital, followed by a specific request for his presence. Children had been shot. He shifted into reverse and turned back toward McKenzieWillamette. The drive normally took him twenty minutes. Driving eighty miles an hour, he cut his time to eight minutes. |

Shelby Day turned to follow Mackey into the ER.

"No--" the blonde woman said urgently. "Cher . . . Cheri!" Shelby stopped, puzzled. "What?"

The woman pointed toward the floor area of the passenger seat in front. "Cheryl's on the floor. She hasn't moved at all." Shelby peered into the shadowy car. There was another child! A dark sweater had been draped over a little girl who lay face

down on the carpet. The slender nurse had to sit the youngster up to get a good grip on her. Then, with one fluid movement, she had her free of the car and was running toward the ER. This child was as heavy as a stone in her arms. When she felt not even a faint independent support of muscle from her burden, Shelby feared that this victim was gone. Still, she ran. Shelby felt a heartbeat bumping crazily, but it was only her own.

She laid her burden gently on the bed at the left rear of the trauma room. She could see doctors and nurses working frantically on the other two youngsters. She could hear the hospital's PA system droning out the Code 4 over and over. Already, the ER was beginning to fill with personnel, all of them working

efficiently with at least surface calm.

Jan Goldberg Temple, a registered nurse assigned to the

intensive care unit, hurried to the ER. She joined Shelby Day at the bedside of the third child. Carleen Elbridge, an X-ray techniM cian, was there and Ruth Freeman, the supervising nurse on duty.* and Sue Sogn, an RN from the third floor. Two respiratory

therapists--Bob Gulley and Demetria "D.J." Forester--rushed in. Joe "Tony" Curtis, the maintenance man, worked along with the medical team, running for blood units, propping doors open'^ doing whatever was needed. "

It was sheer luck that so many physicians were available to help this late on a weekday evening.

I

,1

I fan

Dr. David Scott Miller is a pediatrician, a fine-boned man with a moustache and glasses, a gentle man meant to be a children's specialist. Ordinarily, his hospital rounds would have ended hours before, but on this night one delay after another had kept him at McKenzie-Willamette Hospital. He was walking toward the hospital parking lot when he heard a commotion and deciphered electrifying phrases in the words cutting through the night air. He heard "children" and "shooting."

He turned and sprinted for the ER, all his fatigue forgotten. Judy Patterson reached Dr. George Foster, a pediatric surgeon on staff at Sacred Heart Hospital in Eugene, and he too

raced to McKenzieWillamette.

Four of them had arrived in the red Nissan Pulsar. Shelby Day had noted how the young woman--the mother?--had stood so woodenly next to the car. Shock. The layman is never prepared for the gore and suddenness of traumatic injury. Shelby turned to see that the blonde woman had followed her into the trauma room. Stark white but dry-eyed, she stood mutely and glanced from bed to bed to bed.

She shouldn't be here, Shelby thought. No mother could deal with such a sight. All three of her children were probably dying. Shelby spotted Judy Patterson standing quietly outside the doorway to the treatment room and called softly, "Judy! Take her out of here!"

The woman went obediently with Judy. "OK. I'll just sit here on the stretcher." She waited there, perched on the wheeled gurney across from Judy's desk.

Shelby Day forgot about the blonde woman as she fought to save ^e child she'd found crumpled on the front floor boards. She

suctioned the youngster's throat to clear blood clots that were blocking air. But the clots were as thick as liver, hemorrhagic blood in the throat so long that it had coagulated. Odd. It was rare w the ER crew to see coagulated blood. Patients were usually

brought in while they were still actively bleeding. Each time Shelby removed a blood clot, she found another beneath it.

As Shelby struggled with her hopeless task, Jan Temple s npped off the child's clothing, leaving her naked save for a pair

I 'f8^0" snorts sne wore m place of panties. Jan attached the ^"e-Pak leads to the patient's chest. The heart monitor required man ^ectrical impulses to react. There was nothing there. Only

18 ANN RULE

a straight line; she might as well have hool

the bed or a chair.

Dr. Mackey broke off for a moment frc

the two children who still breathed, howe1 attempted to intubate the last victim discov blood. Puzzled, he lifted the child gently

holes in the little girl's back--one over the

and one just below the left shoulder blade.

monitor and slowly shook his head.

"There's nothing we can do for this ct

Shelby was angry, unwilling to accept

whose butterscotch hair lay so brilliantly i

sheet. "What do you mean you're not go

her?" she demanded of Mackey.

"Shelby," Mackey said gently. "She's we can do. She was dead when you carriei She knew he was right; she put aside 1

stared down at the little girl, her skin as w;

cent as a crushed gardenia. So young-seven. She'd worn a pair of brown cord . belt, and a faded purple and white stripe' that had hidden the youngster from the vi far too big for a child. It was blue gray, U.!

postal workers. There was a U.S. Mail pi Shelby folded the clothing and put the g basket at the end of the bed.

The other two children were barely

whimpered softly, panicked by his inabili

lungs. Jan Temple moved away from the di

to help with the boy.

The other girl was motionless. Davi

ishly over her. She looked to be a year or

child. She had two small-caliber bullet w

One slug had entered near the left nippi

through her chest, exiting at the scapula i

bullet had entered two or three centimeter a much larger wound, and was still in her through-and-through wound near the base

She was as close to death as a hurnai

beginning processes of dying. She regist

and she was not breathing beyond a few a

pupils had reacted to light when she arri

ked up the monitor to

)m his ministrations to ver tenuously. He too

ered, but only elicited

and found two bullet ; right shoulder blade,

He stared at the heart

lild," he said flatly.

the death of this child,

alive against the white

ing to do anything for

> gone. There's nothing

d her in. I'm sorry."

the suction device, and

ixy yellow and translunot more than six or

jeans with a blue Levi

d T-shirt. The sweater

ew of the rescuers was "I . government issue for

atch on the left sleeve.

arments in the clothes

alive. The blonde boy ity to draw air into his

ead child and pitched in

d Miller worked fever

so older than the dead

ounds in the left chest,

e, traveling completely^ n her back. The second^

s from the first, leaving fe

body. There was a third

of her left thumb. i can be, actually in the

ered no blood pressure

igonal gasps for air. Her

ved, but even as David

Miller watchel, he could see the life fading from her eyes. Damn it' They wouk not lose this child too.

On Miller's orders, respiratory therapist Gulley inserted an endotracheal lube into her throat, and tried to force air into her lungs. There was some blockage preventing the oxygen from expanding her chest. A portable chest X ray pinpointed the problem. In the lefi lung a massive hemorrhage left no room for air. Moreover, the patient's right lung was collapsing. She was rapidly bleeding out, in imminent danger of dying from exsanguination. Her bbod tests indicated barely enough oxygen-carrying

hemoglobin to sustain life.

She was crifting away from them. Her skin was cold, shaded the dread blue of cyanosis, and her heartbeat was faltering and sporadic on the monitor. All signs were incompatible with life. She had nothing going for her beyond the adamant refusal of her physicians to let her slip away.

The patient's heart stopped beating.

Miller "pushed" (rapid, forceful injection) thirty milligrams of sodium bicarb to urge it to beat, then glanced up to see Steve Wilhite rush into the room.

The chest surgeon looked at the patient. She looked dead and he cursed himself for being too late. There was no blood pressure now. No pulse. Her pupils were fixed and dilated.

Wilhite and Miller simply refused to give up.

Steve Wihite grabbed a chest tube and plunged it directly through her skin and chest well into the left lung. There was no need for anesthetic; the child could feel nothing. He recovered 300 ccs of bright red blood. Swiftly, he plunged another chest tube into her right lung. No blood appeared in the tube and there was very little, if any, air. That lung had folded in on itself, flat as an empty bellows. In the other lung, she was drowning in her own blood.

Wilhite rapidly inserted a CVP line and hit an artery with the irst try--the first bit of good news: the patient's veins and arteres had not collapsed. 0Negative blood was rapidly infused. fli ^nt^ ^len miraculously, the heartbeat, tentative as the

"UtteriTID r>f Q hntt^^fl,,'^ „,;„„„ K^^^^ r,^^;^ C^^a,,,hoyo ol/^nn nenng of a butterfly's wings, began again. Somewhere along e sure passage toward death, this little girl had turned around.

co mte' Miller, and Mackey dared to hope that she might

beo au the way back to them when ^y saw that her P"?^ had

„ ° u to react, and that she nnw had a cvstniir hinnd nrpsoirp nf

^iXtyi

react, and that she now had a systolic blood pressure of 20 ANN RULE

New chest X rays showed that her right lung had expanded, but the left lung was still filling relentlessly with fresh blood. Her chance for survival remained as frail as a strand of spider web. bing. As rapidly as blood was infused into her veins, it leaked away through her left lung.

It would be 11:45 p.m., before she was stable enough to beg transported to surgery. Even then Bob Gulley would still have to I

breathe for her through the trache tube, as her stretcher was walked to the operating room with Drs. Wilhite and Miller trotting alongside. j

Dr. Mackey and Dr. Foster stayed with the little boy. Jan Temple worked beside them, trying to comfort the toddler. She removed his clothing--a green and white Hockey Puck shirt with the number forty on the front, a pair of faded OshKosh-By-Gosh jeans, and size two jockey shorts--and put them in the clothing basket attached to the gurney.

He looked to be about three. John Mackey had begun resuscitation from the moment he'd first carried him into the trauma

room. He'd inserted a CVP line into the right jugular vein and started the flow of a solution to keep the veins open and ready for medication or a transfusion.

There was a small bullet wound of entry a fraction of an inch to the right of the spinal column. It was a near-contact wound. Mackey could see black powder from a gun's barrel around the bullet hole.

The tiny boy was washed of color and terrified, his heart racing one hundred and fifty beats a minute. He couldn't draw a good breath. Mackey found markedly diminished breath sounds in his left lung. He inserted a chest tube; blood and trapped air

gushed out. The small lung expanded, and the tow-headed boy began to breathe easily, but he continued to sob, a steady keening wail.

He was out of immediate danger, but the bullet had come soJ close to his spinal cord. Injuries to this vital nerve center are

unpredictable. If all went well, he might recover completely. ^ the spinal cord, insulted, should swell ....

The bullet had slammed into his back close to T-6 and T7. His arms would be all right. Everything below midchest was threatened; there was a possibility that he might never walk again.

* *

<,teve Wilhite performed an exploratory thoracotomy on the suriving giri-He found the ragged exit wound in the upper lobe of the left l"^' cut awav the ravaged tissue that was steadily oozing blood, and joined the now-clean edges with sutures. There was no more seepage, but so much of her blood had had to be replaced. vyith complete blood replacement, there can be a profound loss in clotting capability, as well as diminished hemoglobin. Blood chemistry, out of balance, may behave chaotically.

But she lived.

At the completion of surgery, she had a normal blood pressure reading. She woke up quickly, fighting the endotracheal

tube, pulling at the proliferation of tubes that were connected to her body. She was very, very, frightened, but she responded to the nurses' voices.

One child was dead. One child had defied the odds and lived through profound blood loss, heart stoppage, and delicate surgery. One child seemed stable, but was at risk of paralysis. Who in the name of God could have aimed a pistol at three small children and pulled the trigger five times?