Beyond the Bear
Authors: Dan Bigley,Debra McKinney
Tags: #Animals, #Bears, #Medical, #Personal Memoirs, #Nonfiction, #Biography & Autobiography, #Retail
BEYOND THE BEAR
How I Learned to Live and Love Again
after Being Blinded by a Bear
DAN BIGLEY AND DEBRA MCKINNEY
LYONS PRESS
Guilford, Connecticut
An imprint of Globe Pequot Press
Copyright © 2013 Dan Bigley and Debra McKinney.
ALL RIGHTS RESERVED. No part of this book may be reproduced or transmitted in any form by any means, electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system, except as may be expressly permitted in writing from the publisher. Requests for permission should be addressed to Globe Pequot Press, Attn: Rights and Permissions Department, PO Box 480, Guilford, CT 06437.
Lyons Press is an imprint of Globe Pequot Press.
Project Editor: David Legere
Text Design: Sheryl P. Kober
Layout Artist: Justin Marciano
Library of Congress Cataloging-in-Publication Data is available on file.
ISBN 978-0-7627-8455-4
Printed in the United States of America
E-ISBN 978-0-7627-9311-2
PROLOGUE: “IT'S TERRIBLE, JUST HORRIBLE”
The beeper on Dr. James Kallman’s bedside table went off
brutally early that midsummer morning in 2003, jolting him from sleep like an elbow to the skull. His head sprang off his pillow. His eyes shot open, then narrowed.
The dark-haired, dark-eyed, thirty-nine-year-old surgeon with a J.Crew look about him was a gifted sleeper, and not easily distracted from it. When his first daughter was born while he was still in residency, he slept right through a raucous bout of colic even after his wife placed their wailing newborn upon his chest. But his pager was fail pr
oof. He propped himself up on an elbow and fumbled for it. Recognizing the number illuminated on screen, he swung his legs out from under the covers, sat up, and, hunched over the edge of his bed, called the emergency room at Providence Alaska Medical Center.
Normally, he’d shuffle off to the bathroom to make the call so he wouldn’t disturb his wife. But Sara and the girls were away, gone to Philadelphia to visit her folks. She’d been through enough of these on-call weeks to know how disruptive they could be. So her trip and his rotation were well timed. For Dr. Kallman, being on call often meant running ragged, bad food on the fly, and way too much coffee in Styrofoam cups. Toss in whitener and a packet of sugar and call it lunch. It could be that bad. And so he braced himself.
It was 4:30 a.m., and Kallman, a plastic surgeon and ear, nose, and throat specialist, had a day packed with patients ahead of him. Although frivolous wake-up calls made him crazy, he hoped this was one of them, a problem quickly resolved over the phone so he could go back to sleep. Like the classic: “The patient’s IV fell out. Should I put it back in?”
This was not one of those. Dr. Kathleen McCue was on the line. He’d never heard an ER doctor sound so rattled. Something about a fisherman being attacked by a grizzly on the Russian River. Multiple claw and bite wounds. And the guy’s face . . .
“Massive facial trauma,” Kallman remembers her saying. “It’s terrible, just horrible.”
He waited for her to describe the injuries, and when she didn’t, he pressed for details. Was the brain involved? If so, a neurosurgeon would need to be called in, too. The young man’s face was so mangled she couldn’t tell what was what. McCue was rarely at loss for words, but what she was seeing made no sense; it was “not compatible with life.”
“We can’t see anything,” she told him. “Please, we just need you to come.”
Specialists tend to get snappy with ER docs who roust them from bed. Kallman knew that and didn’t want to be one of them but couldn’t help thinking,
Get your wits about you.
They went around a couple more times, and then he gave up. Annoyed, he hung up the phone and sighed.
On autopilot, still too groggy to think much, he plodded over to his closet, threw on a sweatshirt and a pair of blue jeans, grabbed his shoulder bag and a banana from the kitchen counter, and went out the door. He backed his Toyota Highlander out of the garage and headed out of his hillside neighborhood, an enclave of stately houses, matching mailboxes, and perfectly manicured yards. Given the time of day, he had the road practically to himself as he drove down the Chugach Mountain foothills toward Providence hospital in midtown Anchorage, a gritty city of 296,000, sprawled between a blockade of skyscraper mountains and the tide-sculpted mudflats of Cook Inlet. Normally he’d use his drive time to get a game plan going in his head. But he had no idea what he’d be dealing with, other than it was going to be bad, bad enough to unravel an experienced trauma doctor. So he allowed his mind to wander.
Because Alaska is both beautiful and mean, doctors dread being on call on sunny summer days like the one July 14, 2003, turned out to be. Not only do planes crash, boats sink, and mountaineers vanish, but after a long, oppressive winter, the reprieve from light deprivation has an amphetamine effect. In their manic states of mind, people blast off for the great outdoors without seatbelts or helmets or common sense, bringing surgeons like Kallman some of their grimmest business. But being mauled by a bear, with the exception of the occasional bonehead who practically asks for it, that’s just plain bad luck.
Although this would be his first bear-attack patient, Kallman had dealt with massive trauma, the kind so complicated it takes a team of specialists to sort out. His most recent case came after a semi-trailer truck crossed the centerline of a slushy highway and slammed into a prison van, killing four inmates and a corrections officer. Handcuffed and not wearing a seatbelt, the injured prisoner Kallman worked on looked like he’d slammed headfirst into a machete.
A Dartmouth grad and Fulbright Scholar, Kallman had become a surgeon relatively late in life, after becoming disillusioned with his first career. Although his degree was in chemistry, he’d been hired straight out of college by Bain & Company, a leading global business and strategy consulting firm, a major score for a twenty-one-year-old. Bain even held the job for him for a year while he completed his Fulbright program in Freiburg, Germany. He soon realized that working with data more than people left him feeling flat. So he got his midlife crisis out of the way early, at twenty-five, when it became obvious that financial management, though lucrative, was not fulfilling. Living in San Francisco at the time, he did a lot of soul searching before his epiphany moment. He remembers the exact corner, the exact spot, halfway through a run in the Marina District:
BING. You could be a doctor.
That option had been off the table since a field trip to Stanford University School of Medicine as a teenager when the sight of a refrigerator full of blood bags almost made him lose his lunch. So beginning at twenty-eight, an age most medical students are about to head out into the world, he was just getting started.
He spent eleven grueling years on that treadmill—five at the University of Pennsylvania School of Medicine, followed by a five-year residency, followed by a yearlong fellowship in facial reconstruction. Since he’d been practicing in what he considered “the real world” for only a year, he still felt pretty green. He felt even greener when it came to fixing the kinds of trouble Alaskans get themselves into. Like flying off four-wheelers and into trees. Like hitting moose at highway speed, sending a thousand pounds of muscle and bone
crashing through windshields and into drivers’ laps. Like crossing paths with rogue bears. He wasn’t even supposed to be on call that night. It was his well-seasoned colleague Dr. Dwight Ellerbe’s turn and they’d switched.
By the time he pulled into physicians’ parking at Providence, adrenaline had kicked in. He walked up to the side entrance, dug his security badge out of his bag, got through one set of double doors and then another, and walked at a steady clip down a long, windowless corridor bathed in beige light.
A detour to the radiology reading room gave him a look at what lay beneath his patient’s skin. In the room alone, he called up the CT scan. A three-dimensional skull glowed green on a computer screen, teeth bared, mouth open in a silent scream. The anterior skull base was shattered, and the entire midsection of the face, from the bottom of the nose to the middle of the forehead, was confetti.
Ho-ly shit
, Kallman thought as he slumped back in his chair.
How the hell am I supposed to fix that?
Heart thumping, he stood, then steeled himself and walked out, closing the door behind him. He
backtracked to the hallway leading to the emergency department, stopped at the security doors, and swiped his badge. The double doors swung open. He walked through, took a turn at the nurses’ station, then another into the biggest and best-equipped trauma bay at Providence, a room of harsh light and gleaming stainless steel. With the patient stabilized, the ER team was going over him head to toe to make sure nothing had been missed—an easy mistake when the main injury is a catastrophic. Everyone looked up as Kallman entered the room.
Before handing the patient over to the critical care team aboard a LifeGuard helicopter, the emergency medical technicians who’d hauled the young man out of the woods had stopped the worst of the bleeding, put in two IVs, and fixed a cervical collar around his neck. He’d been coherent enough to tell them his name was Dan Bigley, that he was twenty-five, and that he was allergic to penicillin. He’d started vomiting in the ambulance, and continued after the medevac crew took over and got him into the air
.
By the time he got to the emergency room, he was gagging on blood. His skin was cold to the touch. His speech was clear one moment, unintelligible the next, and he was fading in and out. When cognizant, he appeared to be in severe pain, and kept trying to touch his face. Yet unlike many trauma patients, who scream, cuss, and thrash about, he had remained calm and thanked Dr. McCue for helping him. She then sedated him and worked a breathing tube down his throat so he wouldn’t drown.
Other than that, he looked just as the bear had left him, stashed in tall grass below the Kenai Peninsula’s Russian River Campground just off a trail traveled day and night by thousands of anglers each summer. One look and Kallman got it, why McCue had sounded so unnerved. In addition to deep, dirty puncture wounds on his extremities, as if he’d been hit by shrapnel, he seemed to be missing the upper half of his face. The closest Kallman had seen to anything like it was the botched suicide attempt of a man who’d tipped his head back, put a shotgun in his mouth, and pulled the trigger.
“Upper nose, eyes, forehead anatomy unrecognizable,” is how the medevac report had put it.
Covered in dried blood, with shreds of skin and forest debris all mashed together, the top half of Bigley’s head was skewed to the left. His scalp was split open at the forehead, and on the left side a flap of skin was peeled back, exposing a jumble of tissue, shards, and bone. Kallman knew from the CT scan that the dura mater—a membrane protecting the brain—was probably torn. He could see exposed brain tissue behind the ruins of the nose.
Then there were the eyes. At first, Dr. McCue had been unable to find them amid the blood and grime. The force of the bear’s jaws had popped them from their sockets, snapping the optic nerves, leaving one hanging by a thread of conjunctiva, and the other by just a few threads more. Both were intact but were on the same side of Bigley’s shattered nose. It was obvious one was hopeless. The other had just enough connective tissue to possibly survive, although with the optic nerve severed it would never see. If Bigley lived, there was no doubt at all that he would be blind.
Of all his injuries, his shattered anterior skull base was the one most likely to kill him. With nothing to hold it up, the bottom of his brain had herniated down into his nose, exposing it to the world.
Bigley was conscious, but with a tube down his throat, he was unable to speak. Kallman leaned in close: “Can you hear me?”
Bigley gave a slight nod. Dr. Kallman introduced himself.
“Listen, you’ve got some pretty bad injuries to your face. Do you understand?”
He nodded.
“I’ll be taking you into the operating room to take care of you.”
Bigley squeezed his hand to show he understood.
Sometime around 6:30 a.m., Kallman woke up Sandy Glaspell, office manager of the private practice where he worked, calling her at home to give her a heads up.
“I’m going to need you to reschedule my patients,” he told her. “I won’t be making it into the office today. I got called in on a bear mauling. The guy’s whole face is chewed up.”
Later that morning, with an operating room team mobilized and an anesthesiologist in place, everything was ready to go. Dressed in blue scrubs, hands scoured and snapped into Latex gloves, Kallman walked into the operating room and up to the stainless steel table where Bigley lay on his back, prepped and draped, his ravaged body covered by a warming blanket. He stared down at the chaos before him and froze.
There was no manual for this one. Bear maulings were hardly on any East Coast medical school’s checklist of commonly encountered traumas for residents to master. Where to begin? Kallman figured he must have looked pretty lost, because one of the senior operating room nurses walked up, put a hand on his shoulder, and asked, “Doctor, would you like to shave the hair?”
Kallman turned to her. “Right. That’s where we’ll start; we’ll start with shaving the hair.”
DAN'S MEDICAL RECORDS
Dan Bigley’s CT scan after his medevac to Anchorage.