With the permission of my publisher, for the month of March, I’m giving you a SNEAK PEEK of the first four chapters of my latest book on my family medicine years in the then-small-town of Kissimmee, Florida. Here’s Chapter ONE of The Best Gift: Tales of a Small-Town Doctor Learning Life’s Greatest Lessons.
I was in scrubs, driving the few minutes from home to the hospital in my old “trusty and dusty” pickup truck. It was the middle of a chilly, moonless night. Dr. Ken Byerly from the ER had paged me to come to see a patient complaining of chest pain. As I skidded around a corner, I saw scores of flashing lights a few blocks ahead. I drove up to see if I might be able to help and parked behind two fire trucks, several police cars, and an ambulance.
On the other side of a deeply gouged residential front lawn, a police cruiser had crashed into an oak tree. Its front end was wrapped around the massive trunk, and the dashboard thrust back, trapping the motionless driver in a cab filled with smoke. A burning stench permeated the scene while steam hissed from the engine compartment, but there was no visible fire. The remnants of fire-suppressing foam covered the front of the car and the surrounding lawn. The noxious scent of burned rubber and oil contaminated the scene.
I walked over and recognized Kissimmee Police Chief Frank Ross standing close to the vehicle. “What in the world happened?” I asked.
“One of my men was on patrol. He must have fallen asleep. He’s not in good shape and is pinned in.”
“In North Carolina, I had medical rescue and extraction training. Happy to help.”
“Just might need you.”
Firefighters with hoses were at the front and back of the car, while two were positioning their Jaws of Life—a hydraulic tool used by emergency rescue personnel to assist in the extrication of a crash victim from their vehicle.
Frank commented, “Because the doors are jammed, the EMTs had to break the door window for access to stop the bleeding from an ugly head wound and splint what they think is a broken wrist. The wreckage has crushed and pinned his leg. They’ll use the Jaws to open ’em. Dr. Pete Gonzales, who serves as the police department surgeon, is on his way. Y’all may have to amputate my officer’s lower leg to get him out.”
The metal squealed and creaked as the Jaws pried open the driver’s door. The firefighters backed away, indicating to the chief it was safe. “You mind checking him out?” Frank asked me.
“Not at all. Who is it?”
“Gib. Gib Michaels.”
We had frequently worked together. I rushed to the cruiser, crouched next to my friend, and found him unresponsive. His still-buckled seat belt held him upright. He had a cervical collar on his neck and a bloodied bandage around his forehead and scalp. Dried blood stained the front of his face and neck, while still-moist blood discolored the front of his uniform and pooled in his lap. I tried rousing him with no luck.
“Doc, when we checked a few minutes ago, his heart rate was 124, respirations 24, systolic 160,” an EMT said from behind me. “Nasty forehead laceration—to the bone—but the bleeding stopped with direct pressure.”
These numbers were elevated, likely due to pain. At least Gib’s blood pressure wasn’t low, which would indicate shock. “Got a bright light?”
The EMT handed me a small flashlight, which I used to check Gib’s eyes. “Pupils equal and respond briskly. But he’s unresponsive. Severe concussion, at the very least—maybe worse.” Gib had a wrist splint on his left arm, which I lifted to examine.
“Still got a pulse?” the EMT asked.
I unhooked the Velcro and took off the brace. Gib’s left wrist cocked up at a hideous angle. It was a fracture I had seen many times in folks who fall and land on the heel of their palm with the wrist extended. It’s called a FOOSH—a Fall On Outstretched Hand–type fracture. Here, it was most likely from his extended hand hitting the steering wheel or dashboard during the crash. His palm and fingers were ice-cold. I tried to find an arterial pulse on either side of the wrist, but to my dismay there was none, meaning that there was no circulation going to his hand. I knew I had no choice but to reduce the fracture as quickly as possible. Otherwise, Gib could lose his hand. I had done these quite a few times in my brief career but never in this scenario.
The Jaws of Life fired up and pried the passenger side door open. Dr. Pete Gonzales, who also served as chief of staff at the hospital, crawled in. I explained my assessment and plan. “Do it!” he instructed. “By the way, I just came from the ER. Dr. Byerly said your patient with chest pain is stable and in the ICU. No rush to go see him.”
I chuckled. “Well, that’s good news!” I grasped Gib’s left forearm with my right hand and then grabbed his left hand with my left hand as if we were shaking hands. I then pulled my hands apart while extending his wrist to unlock the compressed ends of the large forearm bone—the radius. Then, while pulling as hard as I could, I flexed the wrist while everting it outward. The bones crunched against each other as Gib yelled in pain, but the reduction worked and the deformity disappeared. “His pulse is back!” I exclaimed to Pete. “His hand is warming up.”
“Outstanding job!” Pete said as Gib moaned. “That may have been what we needed to wake up our officer.”
I replaced the wrist splint. “Gib!” I yelled, gently slapping his cheek. “Officer Michaels!”
“Quit yelling at me!” he responded. “I can hear you. What happened?”
He had no recollection of the entire evening. It’s what we call retrograde amnesia, a sure sign of a traumatic brain injury in which one loses short-term but usually not long-term memory—as was evident with his next statement. “Are you the doctor with the ugly truck?”
“Guilty,” I said, as Pete and I both chuckled. “It’s not fifty feet from us now.”
“Better watch out, Doc,” Gib said, “Chief Ross is likely to have that fool thing towed off!” He chuckled and groaned at the same time. It was great to see him try to smile.
“Let’s see if we can get him out,” Pete said. “I’ve done more than my share of these types of extractions on the highways around here.” He shined a flashlight into the mangled wreckage at Gib’s feet. “Looks like the wreckage has crushed and lacerated his right lower leg.”
Pete turned to the EMTs outside the car and requested leather gloves for each of us. With them on, we contorted ourselves into position to explore the twisted metal, rubber, and interior upholstery that had trapped Gib’s leg. To our surprise, I was able to squeeze my hands down and around his lower leg and foot and protect it as Pete pulled back enough debris to free the leg. Unfortunately, it began hemorrhaging.
“Hold direct pressure!” Pete ordered. As I did, my stomach sickened when I felt the splintered ends of Gib’s tibia and fibula sticking out through the skin.
Pete turned and yelled, “Tourniquet! Stat!” An EMT handed him one, and he placed it below Gib’s knee and cinched it up. “Let go of the pressure, Walt.” I did, and the bleeding did not start back up.
“Walt, you secure the leg. I will let the boys get in here and cut him out of his seat belt. Then we’ll extract him from this side, and you follow. But keep pulling to distract the bones. That will help pull them back and set them.”
“I suspect this will hurt!” Gib predicted.
“Like the dickens!” I said.
“Can I get a pain shot before you do anymore?”
“I’d love to, Officer,” Pete answered, “but we have to have you awake. We may need your help.”
Just then someone outside yelled, “Fire!” I looked up to see flames in the engine compartment. I barely had time to clench my eyes shut and duck my head as a fireball rocked the car.
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