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Running Out of Time
At large hospitals, emergency rooms are open around the clock. Generally, at smaller hospitals, personnel are on an "on-call status" after-hours. It takes time to gather a medical team. Carter didn't have much time.That morning, however, the Sidney Health Center happened to have a fully staffed emergency room. When Aaron rushed through the doors with Carter in his arms, Dr. Edward L. Pierce immediately took the boy into a medical bay. Confirming the uneven pupil dilation, Pierce ordered a CT scan. The CT suite staff -- the very team Aaron worked with -- was on hand at that hour. When they completed the scan, they gave Aaron the images, and with a trembling hand he put them up on the light board.
His legs buckled. The scans showed a large gray shadow -- a massive hemorrhage inside the skull. Aaron had seen patterns like this before -- and the outcome had never been good. With colleagues gathered around him, he wept.
In the emergency room, medical personnel were frantically working to stabilize Carter. There was no brain surgeon in Sidney. The closest Montana hospital able to treat brain trauma was in Billings, 250 miles to the southwest. They called for an air ambulance, but with the plane more than an hour away, Carter might not make it.
Carter's life functions were rapidly deteriorating. Nurses intubated the child, using a hand bag to force air into his lungs to keep him alive until the plane arrived.
Then a return call came from Billings. Doctors there felt that given the severity of Carter's injury, he'd be better off flying to Denver, where there was a neurosurgical center with a pediatric intensivist. Denver was 550 miles distant. Billings would send a medically equipped plane for the trip.
But Carter almost certainly didn't have that much time.
In a room a hundred yards away, Dr. Edward P. Bergin was unaware of the battle to save Carter being fought in the ER. He was preparing for his first scheduled surgery of the morning, a routine gallbladder operation. A scrubbed staff and a fully prepared operating table were waiting for him.
Just then a phone rang. It was Pierce calling from the ER. He had a critically ill patient. He wanted to know if Bergin could drill burr holes in the skull of a three-year-old boy.
Bergin felt himself tighten up. As a general surgeon he was the "turn-to guy," the doctor they called when other doctors needed something done beyond their realm of expertise; but this was a request for brain surgery, an area in which he had limited training -- and no neurosurgical tools on hand. Bergin also knew if Pierce was asking him, he was the only option left.
He hung up the phone and looked at his crew. Brain surgery was novel for them as well. But with no alternatives, you fall back on frontier medicine. You improvise; you do what is needed. Telling the anesthetist to hold the gallbladder patient, Bergin, in his teal-colored scrubs, hurried to the ER.
When he pulled back the curtains to the emergency room bay, Bergin saw a child who had regressed into flexor posturing -- arms bent inward, hands clenched into fists -- a sign of severe brain injury. Nurses were still bagging air into his lungs. The main thing Carter had going was his youth -- and strong little heart.
Bergin looked at the parents. "I'm sorry," he said, "but I have to try and do something or your son's not going to make it."
The Engstroms put themselves and their son in his hands.
Back in the brilliantly lit, tiled operating room, Bergin scrambled his team to gather an array of tools and prepare the boy for emergency surgery. As he rescrubbed, he searched his memory for anything he'd ever read about this operation. Then he made a quick decision. He'd call for help. He asked the staff to find a neurosurgeon somewhere, anywhere, who could walk him through the procedure. He'd use a speakerphone in the operating room.
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