Miracles in the ER (2 page)

Let It Be

The helicopter blades thumped in the dark, cold night—barely seventy-five yards from the closed ambulance-entrance doors. Ricky Adler was being flown to the trauma center in Charlotte and to a waiting neurosurgeon.

Ricky was lucky. He had been working the graveyard shift at a local manufacturing company and had fallen twenty feet from a platform. His right wrist had been fractured, but more significantly, so had his neck. EMS 1 brought him to the ER, where we stabilized him and arranged for his transfer.

The collective adrenaline rush was subsiding, and several of us were standing and sitting around the nurses’ station.

The thumping outside slowly faded into a welcomed silence, all too soon broken by Joel Carver, the young paramedic from EMS 1. “I don’t know how he survived that fall, Doc. Twenty feet is a long way.”

“He was moving everything—his arms and legs,” Carla ventured. “That’s a good sign, don’t you think?” She was one of our third-shift nurses and had been in major trauma with Adler.

“Yeah,” I agreed. “That’s a good sign. And I agree with you, Joel. Falling twenty feet and surviving is—”

“It’s a miracle.” Amy Connors finished my sentence. “Gotta be a miracle.”

Joel shook his head and looked over at me. “Doc, when was the last time you saw a
real
miracle—something you couldn’t explain?”

I was sitting in a chair behind the desk and rolled it back, stretching out my legs. I was tired.

“Joel, I would say what we just saw with Ricky Adler is something that’s hard to explain. I showed you his X-rays, didn’t I? He has two fractures in his neck and the C-3 vertebra is riding
way
over C-4. And yet he doesn’t have any spinal-cord injury. Like Carla said, he’s moving everything.
When they get him to the OR and get that fracture stabilized, he’ll be fine. He might end up having more trouble from his wrist than his neck. Explain that one.” I raised my eyebrows and looked at the paramedic.

“I hear ya, Doc.” Joel was standing on the other side of the counter, his forearms resting on its surface. “But you know what I mean. People talk about miracles and strange things happening—brain tumors disappearing and people regaining their vision after fifty years. When’s the last time you saw anything like that?”

I closed my eyes, folded my hands behind my head, and searched my fatigued memory banks.

And there, filed safely away, was the image of three-year-old Bobby McManus lying unconscious on the stretcher in major trauma.

Gerald McManus was in the backyard, throwing a baseball with his oldest son, Andy. The twelve-year-old had a promising arm and Gerald was giving him pointers on how to throw a slider.

The ball thwacked into Gerald’s webbed glove. “That’s better, Andy.
Now
you’re starting to get some action on it.”

The boy grinned and slapped the leather of his oversized outfielder’s mitt. “Come on, Dad, bring the heat!”

Gerald hesitated and cocked his head. “You sure about that?”

“Bring it, Dad!” Andy taunted.

Gerald went into his pitcher’s windup, checked an invisible first base, glanced over his right shoulder at a nonexistent runner on third, looked up at the cloudless sky, and let fly.

He didn’t see Bobby bolt around the garage and head straight for Andy.

The sound—a loud
thud
—was sickening, and would forever haunt Gerald’s dreams.

The three-year-old crumpled to the ground as if he were a deer shot from a tree stand.

“Bobby!” Gerald screamed. He ripped off his glove and threw it onto the grass. “Bobby!”

He cradled the unconscious child in his arms and looked up at Andy.

“Go get your mother! Tell her to call 9-1-1!”

Andy stood frozen, his eyes wide and mouth open. Every bit of color drained from his face and his legs trembled. He didn’t move.

“Go!”

This time he took a few hesitant steps toward the house, then burst into a sprint. With head back and elbows flying, he yelled, “Momma!” over and over again.

“What do you make of this?” Drew Pritchard asked. The young ER physician was pointing to Bobby McManus’s pupils. They were both larger than normal and deviated to his right side. That’s where the ball had struck his head, just behind the temporal area. His scalp was swollen and bruised, and I thought I could feel a step-off in the bones of his skull.

“He’s bruised his brain,” I answered, once again checking and not finding the boy’s reflexes. “And he probably has a subdural. The eyes are supposed to look toward the side of the injury, so that makes sense.”

“They’re ready in CT.” Amy stood in the doorway and stared at the small, motionless body on the stretcher. She shook her head, turned, and walked slowly back to the nurses’ station. She had a son Bobby’s age.

“Vital signs still stable,” Lori told us. She stood at the head of the bed and was making notes on the clipboard for major trauma.

“Still doesn’t react to pain, or verbal stimulation, or…” She was mumbling to herself, charting his neurologic status.

“Anything.” I finished her sentence. “He doesn’t respond to anything.”

Drew and I talked with Bobby’s parents while he was in CT. Gerald McManus sat on the edge of the small sofa in the family room, rubbing his hands together and staring at the floor.

“Is he better, Dr. Lesslie?” his wife asked.

“He’s the same. Still not moving or responding, but he’s breathing on his own…and that’s good.”

“Is he going to wake up?” she sobbed. “Is he going to be okay?”

Bobby did have a large right-sided subdural hematoma with evidence of significant bruising of the brain on that side of his head. And he didn’t wake up.

We sent him by helicopter to Charlotte, where he would need an emergency operation. The hematoma would need to be drained and
the pressure in his brain closely monitored. After that, it was a matter of time—watching and praying.

The surgery was a success, and the swelling in Bobby’s brain gradually improved. He was moved from the neuro ICU to a less acute unit, where his family and friends could visit him more freely. His neurosurgeon was “cautiously optimistic,” as Bobby’s uncle would tell anyone who asked. But after three and a half weeks, the neurosurgeon was less “optimistic” and more “cautious.” Bobby still did not respond or move—he remained in a coma.

“How long can this go on?” his mother repeatedly asked the surgeon. “When will he wake up?”

She didn’t want the answer—not the
real
one. Bobby might never wake up, and the longer he remained like this—unresponsive, in a coma—the dimmer were his chances of a recovery.

A brain-wave study was inconclusive. “There’s activity there,” the parents were told. “But it’s not normal. We’ll just have to wait and see.”

Wait and see. The three and a half weeks dragged into five, and then six.

But the McManuses were a strong family. Aunts and uncles and cousins visited and prayed and helped keep the vigil, never giving up hope—confident that one day Bobby would again be running through his backyard. And in spite of this unbearable stress, his mother and father hung together, supporting each other. Gerald was overcome—almost destroyed—by guilt, but his wife never wavered in her support of him. There was never a moment of blame or accusation. That was the only thread that kept Gerald from completely unraveling.

Seven weeks passed and Bobby remained the same—still in a coma, still unresponsive. That’s when his great-grandfather, Virgil McManus, came to visit. Virgil was the ninety-seven-year-old patriarch of the family. Though his body had failed him years earlier, his mind was quick and agile. He resided in a retirement center and couldn’t travel. But on this day he demanded that he be taken to the hospital to see his great-grandson.

Virgil’s wheelchair was rolled into the boy’s room and over to Bobby’s bed. For a long, silent moment, he looked down on the motionless body lying under a single thin sheet.

Slowly, Virgil’s weak and trembling hand stretched over the boy and gently came to rest on his forehead. The old man closed his eyes and his head dropped to his chest.

“Lord, if it’s your will that Bobby recover and wake up—let it be.”

Joel’s eyes were locked on mine. I leaned back in my chair, exhausted by the memory and retelling of this story.

“What happened, Doc? Tell me.” The paramedic edged closer.

I took a deep breath and sighed. This part was always difficult for me.

“Two days later, Bobby woke up. It was gradual, but within another day or so he was talking and walking and ready to go home. He didn’t remember anything that had happened—not the baseball or the hospital or his great-grandfather’s visit. Still doesn’t. But he’s completely normal and doing fine.”

Joel nodded slowly and looked down at the floor.

A quiet moment passed. He looked up at me and said, “That’s an amazing story. But Doc, I gotta ask ya. How do you know it’s true? Were you there with his great-grandfather? When Bobby woke up?”

“I
know
it’s true. I’ve seen him, and now he’s a completely normal six-year-old. But no, I wasn’t there.”

I motioned with my head to the cardiac room, where Carla was restocking supplies.

Joel turned and looked at the nurse.

“But
she
was,” I said quietly. “That’s Bobby’s mother.”

Gone

“Now, tell me again how this happened.”

My hand rested on the teenager’s ankle, carefully feeling for a pulse. It was still there, strong and bounding. Reassuring, considering the obvious fracture of his right femur.

EMS had just brought him in from one of the local high schools. He had been running the 440 in a track meet and had suddenly gone down with a little over a hundred yards to go.

One of the paramedics replied. “His coach said he heard a scream and looked just in time to see Ben grab his leg and fall to the ground.” He had gone on to describe the obvious angulation of the boy’s right thigh. He and his partner had immediately placed him in traction, started an IV, and brought him to the ER.

This still didn’t make sense. Ben Stevens was a healthy, muscular fourteen-year-old with a fractured femur. There must have been something more to this injury—maybe a pothole in the track or an awkward plant of his foot with a sudden twisting of his leg. This kind of thing just didn’t happen out of the clear blue.