Courtesy Readers Digest 1981. November.
From the frontiers of science and the far horizons of
personal courage, these stories of medical triumphs and miracles will reaffirm
your faith in the awesome powers of the human spirit. Dramatic victories and human
triumphs
Everett “Eddy” Knowles, Jr., a merry, freckled, red-haired
boy of 123, stood just off the roadbed and watched the Boston & Marine
gravel train grinding slowly past Gilman Square in Somerville, Massachusetts, a
suburb of Boston. It was about 2:20 p.m.
May 23, 1962. Eddy was on his way home
from Northeastern Junior High School, and had decided to have a fling at
forbidden fruit—hooking a ride on freight.
As a gravel-laden gondola car moved slowly past him. Eddy pulled himself to the steel step and
grasped the handrail. He hung there in
triumph, all five feet and 90 pounds of him.
The spring breeze eddied through his jacket and cotton shirt as the
freight groaned eastward.
A few seconds later the world went black for Eddy. His leaning body slammed full force into a
stone abutment supporting the Medford Street overpass. His right arm cracked, and he dropped into
the roadbed, crushing his thumb and the first two fingers of the left
hand. For a minute he laid there, a
small-bewildered heap, until the train passed.
He was sure he had broken his right arm, the arm that had so
far earned him a 3—1 winning record as a Littler League pitcher. A smear of blood spread on his shirt just
below the shoulder where the jacket had been torn. Supporting his right arm with his mangled left
hand, he struggled to his feet, climbed a steep bank and started home.
As Eddy shuffled past the back loading platform of the Handy
Card & Paper Co., Norman Woodside, the foreman saw the bloody, bedraggled
figure and shouted to Richard Williams, a press operator, ‘Grab him!’ Williams
laid Eddy on the wooden platform while Woodside phoned the Somerville
police. Woodside returned with Mrs.
Alice Chmielewski, a clerk, who tried to put a rag tourniquet on Eddy’s arm. Suddenly, she felt faint. At the place she sought to apply the
tourniquet, there was nothing but space.
Eddy Knowles had walked more than 100 yards, mostly uphill, clutching an
arm that had been severed from his body.
Mrs. Chmielewski pushed some rags against the shoulder stump
in an effort to stanch the bleeding. “I
got to get out of here,” moaned Eddy.
She held him gently and wiped the sweat from his forehead. Eddy didn’t cry. Indeed, he was not to shed a tear for the
entire day of his ordeal.
A police squad car arrived in two minutes, and by 2:40p.m
Everett Knowles, Jr.,had the good fortune to be wheeled into Massachusetts
General Hospital, one of the finest in the United States.
As emergency ward administrator Ferdinand Strauss and his
assistant, Michael Hooley, wheeled Eddy toward the emergency operating room,
Hooley, asked Eddy his name, address, phone number, religion. The boy replied clearly. Hooley now put a complex system into
operation. One call went to the Knowles
home; another to the patient-index center in the basement where 1,500,000 names
are filed, luckily, Eddy had been a patient there before. Within five minutes his medical record with
his blood type reached the operating room.
Eddy already was receiving 250 cubic centimeters of plasma through a
‘cut down’ in his leg. Now, the first of
the six pints of whole blood he would receive flowed into him through the
transfusion tube. “My arm hurts.” Eddy
told the doctors. “Is it going to come
off?”
Nurses Mary Brambilla and Francis Brahms lifted Eddy from
his litter to the operating table. Nurse
Brahams cut away Eddy’s clothes with scissors.
Then, they all saw it: Eddy’s right arm lay three or four inches from
the shoulder stump. Not a single thread
of skin bridged the gap. “Will my arm be
all right?” Can you save it?” Asked Eddy.
Dr. S.B.Litwin, a duty surgeon, nodded.
“Yes, son,” he said. But at that
moment nobody knew.
Dr. L.Henry Edmunds, Jr., the duty surgeon in charge now
gave brisk, routine orders: tetanus shot, atropine, injections of penicillin
and streptomycin, a sedative shot, pulse taking, blood pressure. Eddy’s pressure was low, his pulse 120, and
he was cold, sweaty—all indications of shock.
Hank Edmunds noticed on encouraging detail. Eddy’s right-arm artery protruded almost an
inch from his damaged flesh and, with each pulse, it throbbed and dilated—but
no blood emerged. It is one of nature’s
miracles, this self-sealing quality of a severed artery. In a young person especially, the vessel’s
elasticity is so great that it closes within few seconds of rupture.
Dr. John M. Head, staff surgeon, and Dr. John F. Bruke
consulted with Edmonds. They all noticed
that the lone arm, while bruised and damaged, was fairly clean. Edmunds ordered Nurse Brambilla: “Put that
arm on ice.” Mary Brambilla filled two basins
with crushed ice from the ward kitchen’s ice-making machine and placed the arm
on them, then packed ice-filled bags around it.
At Edmond’s side now were a number of doctors, including
30-year-old Dr Ronald A. Malt, the resident in surgery and perhaps the most
important man Eddy Knowles was to see that day.
These physicians conferred in the corridor. Never in medical literature had they read of
a case of a major limb successfully reattached to the body. But Eddy and his severed arm appeared ideal
for am attempt. Each step that would be
necessary—rejoining veins, arteries, bone, muscle, skin—had been performed
routinely for years. Could they all be
done atones?
As the doctors talked, Father L. Chanel Cyr, duty chaplain
at the hospital, administered extreme unction to Eddy. Then Eddy’s father, a meatpacking employee,
who worked nights and had been asleep at home when the phone rang,
arrived. Physicians explained the situation. Would Mr. Knowles send to a reattachment
operation? Knowles signed the release.
Dr. Malt asked Dr. John Herrmann, his assistant in surgery,
to take the arm upstairs to Operating room No 5. There Dr. Herrmann scrubbed, donned a
surgical gown, and wet to work. First he
fished out the arm’s three major nerve trunks and the torn blood vessels. They appeared reasonable intact. Placing a syringe in the artery, he flushed
the blood channels with heparin, and anticoagulant, with antibiotics and with a
solution approximating the body fluids.
The antibiotics severed to kill any grantee of lockjaw bacteria that
might be starting. There were no
lacerations on the arm. The bone was
broken and jagged, one side longer than the other, but it was not crushed. Then Dr>Herrmann injected a radiopaque
solution into the artery. A technician
took X rays to determine whether there were any blood-vessel blocks.
Eddy Knowles, meanwhile, was wheeled into the “White 3”
anesthesia induction room. Here at
3:40p.m. Dr. Joan Flacke injected a muscle relaxant into Eddy’s leg and gave
him an intravenous dose of thiamylal, a sedative. “I just thought of something,” said Eddy to
her. “My family was going on a vacation
in a couple of weeks, and now I guess I’ve spoiled it.”
Malt looked at the X-ray plated of Eddy’s arm. The limb appeared to be fine. No blood clots, no obstructions
appeared. It was 4:05p.m. When Malt
reached his crucial decision: they would try to sew back the severed arm of
Eddy Knowles. Malt ordered Joan Flacke
to begin anesthesia. Then he phoned Dr.
Robert S. Shaw, an expert in vascular surgery who was working in another
hospital building. “Bob,” said Malt,
“there’s a boy here with his arm off, and I think we’ve got a chance to put it
back on.” Shaw came, on the run.
Under great overhead light in OR 5, Dr. Flacke fitted a mask
over Eddy’s face. The boy began to breathe a mixture of halothane, nitrous
oxide and oxygen from three tanks. He
fell quickly into a sound sleep.
Judy Moberly, the scrub nurse, felt queasily for the first
time in months of watching operations.
The sight of an arm on one table and a boy on another had strangely
upset her. “Do I have to watch?” she
asked. But then, as soon as the arm was
brought close to Eddy, she was no longer disturbed.
Around the boy now stood three doctors, two nurses, three
anesthetists and two orderlies. The
glassed balcony above them was crowded with a score of doctors and nurses,
drawn there as word spread through Massachusetts General that a limb was to be
reattached.
Eddy’s right side was propped up, the bloody stump irrigated
with salt water and draped with gray linens.
The Shaw directed the initial step, the sewing of the veins. These had to be connected first, so the blood
would have a way to get back to the heart when the artery was repaired. The arm has two outer veins and one deep
plexus entwined about the artery.
Ignoring the outer veins, Shaw selected two veins from the intern
network. With forceps, he gasped the
minuscule curved needle attached to green but hardly visible Dacron 6-0 thread.
Through a vein he pushed the needle, let loose, picked it up on the other side
and pulled. He did that again and again,
30 stitches to the vein.
It was painstaking work.
Save for the occasional asides of the doctors, muttered though their
gauze masks, the room was hushed. Malt’s
job required excruciating patience. He
had to hold Eddy’s arm so firmly that not the slightest movement would
occur. Occasionally, Herrmann helped
with this. One little tilt, and the
delicately stitched veins would rip.
When the two veins were reunited, the doctors joked a bit, to crack the
tension.
Now Shaw tackled the brachial artery, still self-sealed and
throbbing with each heartbeat. This task
was easier, for Eddy’s artery was large—about two-thirds the size of a lead
pencil. Still, the procedure was
complicated and took 45 minutes.
Anatomists, of the suturing of blood vessels, were completed just three
and a half hours after Eddy fell form the train.
And now came the moment of truth. While Malt still held the arm tightly, Shaw
removed the artery clamp. Blood rushed
down the arm. People in the balcony
stopped talking. Not a word was spoken
around the operating table. Everybody
watched. Slowly, the waxen limb began to
regain its flesh coloring. A glow seemed
to envelop the arm. The doctors wanted
to cheer. In the balcony, there were
exclamations of joy.
“My,” said Malt, “its nice and pink, isn’t it?” Judy
Moberly, the scrub nurse, felt the hand.
It is warm.
In the huddle of surgeons now were Dr. Bradford Cannon, a
plastic-surgery specialist, and Dr. David C. Mitchell, an orthopedist. Now it was time to repair the bone.
Consulting with other bone experts and with Malt, Mitchell
decided the bone would have to be reinforced.
If not held securely in place, it might snap and tear the blood vessels
again. There are many shapes of
stainless-steel rods for intramedullary fixation, as the profession calls
it. Mitchell tried several of these,
forcing them into the marrow of the bone, but wasn’t satisfied. At last, he and Malt settled on the Kuntscher
nail, which in cross section is roughly the shape of a cloverleaf and grumps
firmly. They measured the length
required—six and a quarter inches. Malt
drove the nail part way up the marrow of the stump bone with a stainless-steel
mallet. Then Mitchell held the arm and
forced it onto the rod. It was 8p.m.
Next job: nerve suture.
The doctors struck a snag here.
They couldn’t find all the nerves in the stump, and they couldn’t be
sure how badly damaged the located nerves were.
The smallest scar on a nerve end could thwart full healing, giving Eddy
a lifelike but useless arm. With an eye
on the clock, because Eddy already had been on the operating table four hours,
Malt made another one of the scores of decisions made that day. He decided to postpone nerve rejoining for a
later operation.
Malt now removed dead tissue to block infection. Normally this would have been done first, but
the doctors postponed it because, until circulation was restored, they couldn’t
be sure how much would ultimately be dead.
Next: the muscle. Malt jointed
the muscle with 12 large stitches of catgut.
A skin graft was clearly called for now, since a large, raw
wound showed. But Malt, in still another
decision, ruled against an immediate graft.
A graft would take 45 minutes, and there was little time. It was now past 10p.m., with much work still
to be done. A dry dressing was placed on
the patched arm. Then Eddy was fitted
with a spica cast covering both his shoulders and down to the hip tops and
holding the rejoined arm firmly, crooked at the elbow.
Eddy’s left hand still had to be cared for. Dead tissue was cut away from the smashed
thumb and two fingers, and a skin graft taken from Eddy’s right foot was
applied.
It was almost 1 a.m. when Eddy was wheeled into the recovery
room, eight and a half hours after the operations started. As he emerged from unconsciousness, Eddy
smiled at Joan Flacke. “How’s my broken
arm?” he asked. Then he thought
something. “Next time,” he said, “just
give me the gas. I don’t like those needles.”
Eddy stayed in the recovery room until daylight, and then
was wheeled into a private room on the 12th floor. Although Eddy and his arm were one again, the
doctors’ vigil had just begun. When days
passed with no sign of infection, they breathed more easily. On the fifth day they took a large piece of
skin from Eddy’s right thigh and grafted it onto his arm in two places. On the 12th day they changed the cast, and
again on the 15th day, June 13, Eddy went home to his family’s two-story frame
house on Dell Street in Somerville.
Eddy Knowles, at age 30, is doing well. His recovery has been good, and his hobbies
include weight lifting and tennis. He
has held various jobs, among them, delivering 200-pound slabs of meat and
cross-country truck driving. All in all,
a very remarkable, productive life for Everett Knowles, jr., once a brave
little boy who never cried, and who helped to blaze a new trial in medical
science. Suture of Right upper
Extremity.” Ronald Malt called it in his laconic one-page official report.
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