A Trauma Surgeon’s Experience With AIDS
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After the nurse finished prepping the patient’s chest and upper abdomen, Dr. Dearborn and Dr. Stone draped the operative field with sterile towels followed by sterile sheets. At 7:45AM, Dr. Stone drew a curvilinear line with his gloved finger on the man’s prepped, left chest. The curved line started just below the tip of the man’s breast bone and then curved below the nipple and ended in the front of the armpit. “That’s where I want you to cut,” Dr. Stone instructed the Resident. “Once you’re through the skin, take the heavy scissors and cut his chest muscles open along the same line, exposing his chest cavity. After that, put the rib spreader (A device with two, short, vertical arms that hooks under the ribs above and below the incision). Then, crank it open pulling the ribs apart and exposing the contents of the left chest cavity, i.e., the lungs, pericardium and heart so we can get our hands inside the man’s left chest cavity.” At 0748, Dearborn took the scalpel and rapidly made an incision about ten to fifteen inches long along the line Dr. Hansen had drawn on the chest wall. Next, Dr. Dearborn cut through the chest muscles holding the patient’s fourth and fifth ribs together with the scissors. “Good job, Dr. Dearborn,” Dr. Stone said. “Now, put the rib spreader between the fourth and fifth ribs and crank his ribs apart.” Dr. Stone calmly instructed the nervous resident as he handed him the rib spreader. Dr. Dearborn inserted the rib spreader and slowly cranked it open with a mild tremor in his hands. As he was spreading the ribs apart, one of them cracked, causing the two jagged ends of the broken rib to partially protrude out from under the rib spreader into the wound. “Now, be careful, Dr. Dearbor. Don’t cut yourself on that broken rib,” quickly warned Dr. Stone. “If this guy’s a ‘druggy’, there’s a good chance he’s HIV positive or has hepatitis.” “I’ll be careful,” responded Dr. Dearborn, as he stared into the wound at the two sharp ends of the broken ribs, realizing that if one of the sharp bones pierced his skin and the patient was HIV positive, he would seroconvert; get an HIV infection; and die in less than two years.an untimely death. At 0748 AM, Dr. Stone said, “Okay. Let’s get this guy fixed.” Dr. Stone carefully pushed the lung out of the way, revealing the Pericardium (The sac around the heart.) bulging with blood. “Now, Dr. Stone instructed Dr. Dearborn, “take your scissors; cut the pericardium open; and carefully pull the blood clots out from around the heart. Once the Pericardium is decompressed, we can sew up the hole in his heart and get him up to the ICU.” Dr. Dearborn cut the pericardium open and removed several large clots. Once the pericardium was decompressed, bright red blood began to pulsate out of the heart into the opened pericardial sac and the chest cavity, preventing them from visualizing the injury to the left side of the heart. Dr. Dearborn carefully put his hand in the wound and tried to palpate the left side of the heart. “He’s got a big adhesion (scar tissue) between the left side of his heart and the pericardium. I can feel blood pulsating out from behind the adhesion, but I can’t get to the hole because of the adhesion.” “No problem,” confidently responded Dr. Stone, “I’ll just slide my hand behind the adhesion; tent it up between two of my fingers; and then you can cut the damn adhesion.” Dr. Dearborn nodded in agreement. “After you cut the adhesion, I’ll try to plug the hole up with one of my fingers,” Dr. Stone confidently said. He paused for a moment and then added, “Trust me. It’ll be a piece of cake.” The man’s heart and Dr. Stone’s hand were submerged in a pool of bright red blood. As discussed, Dr. Stone blindly maneuvered his right hand between the left side of the pericardium and the band of scar tissue adherent to it. A few seconds later, he happily said “I’ve got the adhesion between my fingers, but there’s not enough room down there to cut the adhesion with the scissors so you’ll have to do it with a scalpel.” “No problem,” replied Dr. Dearborn. “Get the suction catheter in your left hand and the scalpel in your right hand. When I say go, quickly aspirate the blood so you can see the adhesion tented up between my fingers and carefully cut it,” instructed Dr. Stone. He paused briefly and then asked Dr. Dearborn, “Are you good to go?” “Yes, sir,” replied Dr. Dearborn, as he picked up the sucker and the scalpel. “Any questions?” calmly asked Dr. Stone. “No,” replied the nervous Resident. Dr. Stone put his hand into the bloody wound again; located the adhesion; and tented it up. Unfortunately, blood kept spurting out the hole, covering up Dr. Stones hand, despite Dr. Dearborn aggressively suctioning out the pericardium and the chest. Dr. Dearborn saw the adhesion tented up and stretched out between Dr. Stone’s two fingers. Dr. Dearborn immediately slid his hand holding the scalpel deep into the wound to cut the adhesion. But just as he was about to cut the adhesion, the sharp point of one of the broken ribs ripped through his right glove at the level of his palm. Already in sensory overdrive due to sleep deprivation and all the other stresses of the ER, Dr. Dearborn instinctively jerked his hand back, fearing the bone was going to puncture his skin. But just as he yanked his hand out of the patient’s chest at 0800 AM, Dr. Dearborn accidently cut a four-inch-long, deep, gaping cut in the palm of Dr. Stone’s right hand that was soaked with the patient’s blood. “Shit,” Dr. Stone suddenly screamed in pain. “I don’t remember telling you to do that.” “Oh God, I’m so sorry!” Dr. Dearborn exclaimed with a horrified look on his face. “That broken rib stuck into my hand so I jerked my hand back. I didn’t think. It was simply a reflex response.” Dr. Stone looked over at the terrified Resident and briefly stared at him. Dr. Stone was obviously in pain and shocked that he had just sustained a potentially, lethal cut of his right palm. Dr. Stone remained silent for a few seconds and then firmly said, “Just calm down. It’ll be okay.” Dr. Stone paused briefly so he and Dr. Dearborn could both regain their composure. Then, Dr. Stone nervously said, “Let’s just get this damned adhesion cut so we stop the bleeding and I can get my hand out of the pool of blood in this man’s chest.” What happened?” Catherine yelled out at 0800 hours as she ran over to the operating room table. “I’ve got a cut in the palm of my right hand and my hand is submerged in a pool of the patient’s blood.” Dr. Stone painfully replied at 0800 AM. “Call Dr. Kurly STAT and tell her to emergently come to the ER and help Dr. Dearborn close the hole in this man’s heart and his thoracotomy incision.” “Now, let’s try again to cut this damned adhesion,” Dr. Stone agonizingly said with his open cut bathed in the victim’s blood. A few seconds later, Dr. Dearborn successfully aspirated the most of the blood in the pericardial sac and chest cavity; cut the adhesion; exposed the hole in the man’s left atrium; and put his finger into the hole, stopping the massive blood loss from the gunshot wound.
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About the Book
The book deals with a Trauma Surgeon, Dr. Stone, who sustains a 5cm, deep laceration of his right palm while helping a Surgical Resident open the chest of a dying patient with a gunshot wound to the heart. Dr. Stone’s injured hand is submerged in the patient’s blood for nearly 30minutes while he waits to be relieved by another Trauma Surgeon. The patient dies 30min later and Dr. Stone discovers that the patient was dying of AIDS. Six weeks later, Dr. Stone discovers that he has AIDS. Subsequently, his wife divorces him; she cleans him out financially; he loses his job; he is forced to file bankruptcy; his home undergoes foreclosure; rumors of him being a “closet gay” circulate around the hospital; several attorneys file lawsuits against him; and the State Medical Board investigates him while Dr. Stone waits to die a hideous, painful death in less than 2 years. The exposes the psychological, personal, marital, financial, professional and familial challenges that confront Dr. Stone while he is waiting to die.
About the Author
Michael Hickey is a board-certified General surgeon and a Fellow in the American College of Surgeons. He graduated from Tulane University and Tulane School of Medicine. Dr. Hickey was an Associate Clinical Professor of Surgery at the University of California San Francisco from 1985-1999, specializing in Trauma Surgery. Between 1999 and 2017, Dr. Hickey practiced Trauma Surgery at a Level II trauma center in Fort Worth, Texas. He has published 59 peer review articles, including several surgical textbook chapters; lectured extensively on the nutritional management of critically ill trauma and AIDS patients both nationally and internationally; and has participated in the training of hundreds of Surgical Residents, Interns, medical students and healthcare providers. Dr. Hickey retired in 2017 after practicing Trauma Surgery for nearly 40 years. He now lives in Fort Worth, Texas and spends his time writing, lecturing, visiting with his grandchildren and playing with his English bulldog, LuLu. Dr. Hickey’s Grandson, William, pitched a no hitter in the 2018 Little League World Series. Two of his Granddaughters are accomplished softball players. And, his youngest Granddaughter, is an excellent dancer, swimmer and student. All of his Grand kids make the old Surgeon very proud and happy.