Dr. Edward Ashley was sewing up the scalp of a soldier who had lost a bar fight. Edward Ashley had been a doctor at Geary Memorial Hospital for thirteen years, and before going into private practice he had been an air force flight surgeon with the rank of captain. Several prestigious hospitals in large cities had tried to lure him away, but he preferred to stay where he was.
He finished with the patient he was working on and looked around. There were at least a dozen soldiers waiting to be patched up. He heard the sound of the approaching ambulance siren. “They’re playing our song.”
Dr. Douglas Schiffer, who was tending a gunshot-wound victim, nodded. “It looks like M*A*S*H in here. You’d think we were in some kind of war.”
Edward Ashley said, “It’s the only war they have, Doug. That’s why they come into town every weekend and go a little nuts. They’re frustrated.” He finished the last stitch. “There you are, soldier. You’re as good as new.” He turned to Douglas Schiffer. “We’d better get down to emergency.”
The patient wore the uniform of a private, and he looked to be no more than eighteen years old. He was in shock. He was sweating profusely and his breathing was labored. Dr. Ashley felt his pulse. It was weak and thready. A splotch of blood stained the front of his uniform jacket. Edward Ashley turned to one of the paramedics who had brought in the patient.
“What do we have here?”
“A knife wound to the chest, Doctor.”
“Let’s see if his lung is collapsed.” He turned to a nurse. “I want a stat chest X ray. You’ve got three minutes.”
Dr. Douglas Schiffer was observing the jugular vein. It was raised. He looked over at Edward. “It’s distended. The pericardium’s probably been penetrated.” Which meant that the sac that protected the heart was filled with blood, pressing against the heart so that it could not beat properly.
The nurse who was taking the patient’s blood pressure said, “Blood pressure’s dropping fast.”
The monitor measuring the patient’s electrocardiogram began to slow. They were losing the patient.
Another nurse hurried in with the chest X ray. Edward scanned it. “Pericardial tamponade.”
The heart had a hole in it. The lung was collapsed.
“Get a tube in him and expand the lung.” His voice was quiet, but there was no mistaking the urgency in it. “Get an anesthesiologist. We’re going to open him up. Intubate him.”
A nurse handed Dr. Schiffer an endotracheal tube. Edward Ashley nodded at him. “Now.”
Douglas Schiffer carefully began to push the tube into the unconscious soldier’s windpipe. There was a bag at the end of the tube, and Schiffer began to squeeze it in a steady rhythm, ventilating the lungs. The monitor began to slow, and the curve on the monitor was completely flat. The smell of death was in the room.
“He’s gone.”
There was no time to wheel the patient up to the operating room. Dr. Ashley had to make an instant decision.
“We’re going to do a thoracotomy. Scalpel.”
The instant the knife was in his hand, Edward reached down and slashed it across the patient’s chest. There was almost no blood, because the heart was trapped in the pericardium.
“Retractor!”
The instrument was put in his hands, and he inserted it into the patient’s chest to spread the ribs apart.
“Scissors. Stand back!”
He moved closer so that he could reach the pericardial sac. He snipped the scissors into it, and the blood released from the imprisonment of the heart sac spurted out, hitting the nurses and Dr. Ashley. Dr. Ashley reached in and began to massage the heart. The monitor began to beep, and the pulse became palpable. There was a small laceration at the apex of the left ventricle.
“Get him up to the operating room.”
Three minutes later the patient was on the operating table.
“Transfusion—a thousand cc’s.”
There was no time to match blood type, so O negative—the universal donor—was used.
As the blood transfusion began, Dr. Ashley said, “A thirty-two chest tube.”
A nurse handed it to him.
Dr. Schiffer said, “I’ll close, Ed. Why don’t you get cleaned up?”