The stainless steel skewer that Xavier Cunningham found in his backyard two Septembers ago was about a foot and a half long and the width of his pinkie. One end had four sharp prongs, and the other had a single point—it was the kind of rod used to cook rotisserie chicken over a grill. It also made the perfect spear, and Xavier and his friends Silas and Gavon, all ten years old, took turns seeing who could chuck it the farthest. When they got bored, they ditched the skewer near a neighbor’s tree house, sticking the four prongs in the ground as an anchor. They then climbed up the tree house’s ten-foot ladder.
Apparently, the boys hadn’t seen the large wasp nest wrapped around the back of the tree, for once they were in the hut they were under attack. The swarm was so aggressive that Silas kneeled in the corner and started praying.
“I’ll get my mom!” Xavier said as he descended the ladder. About halfway down, a wasp stung his left hand. Xavier swatted at it with his right, lost his balance, and fell, facedown. Before breaking his fall with his arms, he felt a sting just under his left eye. Was that a wasp? he wondered.
In fact, it was the skewer. About six inches of it was now buried in his head. Screaming, he got up and ran to his home, some 50 feet away.
Gabrielle Miller, 39, was upstairs folding laundry in the house she shared with her husband, Shannon Miller, and their four children.
Shannon, a teacher, had taken two of their kids to an arcade, while Gabrielle, who manages a title-insurance business, stayed home with Xavier and his 14-year-old sister, Chayah. She heard her son screaming and thought, When will he grow out of this stuff?
Xavier—called Bear by his family, after a story Shannon had told him as a toddler—always made a fuss over the smallest scratch. If one of their two dogs jumped up on him, he’d start screaming; he was too scared to walk Max, the coonhound he’d gotten as a puppy, because the dog pulled on the leash.
Gabrielle was almost down the stairs, Chayah right behind her, when Xavier pushed the front door open, shrieking, “Mom, Mom!”
Chayah took one look and fled back upstairs in horror. Gabrielle was trying to make sense of what she was seeing. “Who shot you?!” she said. It looked like there was an arrow through her son’s face, and a single trickle of blood ran down from it. On the back of his neck was a lump—the tip of the skewer that hadn’t pierced the skin. “Chayah, go find the boys. I’m taking Bear to the hospital!”
As Gabrielle backed the car out into the road, a neighbor watching them thought, That boy’s not coming home.
Emergency room personnel acted quickly when Xavier walked in, giving him painkillers and sending him for X-rays. The skewer didn’t appear to have hit his spine, but an X-ray can’t show tissue damage. They had to send him somewhere with more advanced imaging equipment—Children’s Mercy Hospital in Kansas City, Missouri, about 40 minutes north of the family’s home in Harrisonville. To prevent Xavier from moving his head, hospital staff put a plastic cervical collar on his neck, and they wrapped his entire head in white gauze to help stabilize the skewer. The only thing left exposed besides that mud-caked metal rod was his mouth.
At Children’s Mercy, doctors performed a computed tomography (CT) angiogram to see whether the skewer had pierced one of his major blood vessels. They were amazed to find that it had barely missed every vital artery when it penetrated his head. It was like the proverbial threading of a needle, only with life-and-death consequences.
But there was a wrinkle. Metal shows up on CT scans as vivid white, without defined edges. If the skewer had any kind of bend, a sharp edge, or a gap, then pulling it out now would be rolling the dice, as it could catch on an artery and rip it open.
The only other way to get a clear picture of the skewer was with biplane angiography—a process that gives doctors a crystal clear three-dimensional view inside the vascular system. It is performed using highly specialized equipment that only some hospitals have. One of them, the University of Kansas Hospital, was just five miles away. An ER doctor got on the phone with KU to describe the case they were about to transfer.
It was now around 7:30 p.m. Xavier had been impaled for six hours.
Koji Ebersole, MD, an endovascular neurosurgeon at KU, was playing tennis when his cell phone rang. At the side of the lighted court, he took the call from another KU doctor telling him about a boy who had been impaled by a large metal skewer.
Dr. Ebersole looked at the photograph from the hospital on his phone. Whoa, he thought. He’d never seen anything like it. The poor boy was lying on a gurney with a huge spike sticking about nine inches out of his face. How was this kid even alive?
Dr. Ebersole headed home to make some calls. He knew they’d need to get the boy into the angiography suite quickly to see exactly what the skewer had damaged, or still could damage, and then remove it while carefully monitoring its exit. If it hadn’t yet harmed any key vessels, it could uncork something on its way out and cause a stroke or worse.
Using the angiography suite required a team of 15 to 20 medical staff. It would be tough to get the right people together so late on a Saturday evening. But could the boy wait until morning? For now he was stable physically, but what about mentally? What if he panicked, grabbing at the skewer? Everything depended on his state of mind. Dr. Ebersole asked the doctors in the pediatric ICU, where Xavier and his family waited, to talk to them and gauge whether he was brave enough to hold on. When Dr. Ebersole heard back from the hospital at 11:30, he made his final call of the evening. “We can wait until the morning,” he told a fellow doctor. “The boy is on board.”
It was late now, almost midnight, and Xavier’s ICU room was dim. He’d just told doctors he could stay calm a few more hours. He understood that his life depended on his not trying to pull out the skewer. He remembered a scene from the movie Black Panther. At the end, the hero, T’Challa, impales the villain, Killmonger, with a spear through the chest. Killmonger declares he’s ready to die, pulls the spear out, and collapses, dead.
“Go to sleep, Bear,” Xavier’s mom told him now, holding his hand as she had almost nonstop since the accident. His head was still wrapped in gauze. The four-pronged end of the skewer was still caked in mud; everyone had been afraid to try to clean it, lest it jiggle the skewer and cause injury. They could give him only painkillers, which made him sleepy, but not sedation; that could make the tongue collapse, suffocating him.
“When you wake up in the morning, this thing will be out,” a nurse told him.
Xavier slept fitfully. Each time he woke up, he asked, “Is it out yet?”
“No, not yet sweetie,” Gabrielle would tell him. Xavier cried softly each time he heard this.
Gabrielle, her eyes moist with tears, whispered to her son, “You’re the strongest person I know.”
“The biggest problem is that barbed end,” Dr. Ebersole told the team assembled at 8:30 a.m. in the angiography suite. Xavier had been anesthetized and was sound asleep as the doctors began to plot their next moves. Dr. Ebersole pointed to a computer screen; it revealed the skewer had a notch in the shaft near the point. If they pulled the skewer out the way it went in, the notched tip could rip an artery open.
They discussed pushing the skewer through the back of Xavier’s head to expose the notched end and cut it off before pulling the whole thing out through the front. But the rod was made of thick stainless steel, and it would take a lot of force to break that end off. The movement this would create could tear arteries. They’d have to pull it out the way it went in—if that was even possible to do without killing him.
Xavier was wheeled to the angiography suite about 10 a.m. Meanwhile, his family and many friends were in the waiting room, and every nearby church had dedicated that Sunday to praying for the boy.
In the angiography suite, some 20 surgeons, specialists, and nurses wearing blue radiation-protective gear and lead-lined glasses were waiting.
Two giant “arms,” one attached to the floor and the other hanging from the ceiling, were positioned close to Xavier’s head. Each arm held two X-ray devices that moved in wide arcs around his head to create three-dimensional images. The images were displayed in real time on a large flat-panel screen hanging from the ceiling at eye level for Dr. Ebersole, just above Xavier.
Dr. Ebersole could now see the one-in-a-million trajectory the skewer had taken: It had missed his spine by about half an inch. It had missed the cerebellum, the part of the brain that controls things such as balance and speech, by the same margin.
It had punctured the carotid sheath but didn’t appear to have damaged the hypoglossal nerve or the vagus nerve, which control tongue function, the swallow reflex, and the voice box. Also in the carotid sheath is the jugular vein. The skewer had torn the jugular, but it appeared to have sealed itself. The skewer had missed his facial nerve, which controls facial expression and the sense of taste.
Most important, it had missed both the crucial arteries: the carotid and vertebral. In fact, it appeared to have actually nudged them out of the way without puncturing them. I don’t know how a kid can be so lucky, thought Dr. Ebersole.
“Jeremy,” he said, “put your hands on that thing, get a feel for how easily it’ll move.” He was speaking to chief resident Jeremy Peterson, MD, a burly 32-year-old who stood near the boy’s head. It would be up to him to remove the skewer.
Truth be told, Dr. Peterson was nervous, but he placed a steady left hand at the base of the skewer to anchor it; his right hand grasped just above his left. He nudged it back and forth ever so slightly while Dr. Ebersole watched on the monitor in case the movement harmed a vessel. It barely moved. “It feels pretty solid,” Dr. Peterson said.
“OK, let’s go,” said Dr. Ebersole. He’d be the eyes, watching the monitor constantly, while Dr. Peterson would have the feel of the thing as he worked on getting it out. He’d have to do it slowly, strongly, yet smoothly, mostly from his right arm, while being careful that his left “base” hand didn’t exert too much pressure—because it was literally on Xavier’s eye.
The skewer was surprisingly hard to budge. It took all the strength in Dr. Peterson’s right arm to move it an inch—then it stopped. “It feels stuck on something.”
“OK, hands off,” ordered Dr. Ebersole. Dr. Peterson carefully let go of the skewer and took a half step back, while Dr. Ebersole enhanced the view. The clearer picture showed that it was hung up on a neck ligament, not a danger. But the skewer was now so close to the vertebral artery that it was bending it.
“Jeremy, angle it a little toward you.” This would move it away from that artery. Dr. Peterson did as asked. “OK, go again.” It worked. Dr. Ebersole watched the tip of the skewer safely pass the vertebral artery.
“It’s sliding pretty easy now,” said Dr. Peterson. Yet he continued to pull it very slowly, especially as it passed the jugular—would it pull open the seal that had formed? No; the jugular had healed itself. Then, finally, the last hurdle: the carotid artery. The metal passed it smoothly, too—and suddenly, the skewer was out.
It was 3 p.m. when Dr. Ebersole came into the waiting room and told Xavier’s parents, “It’s out. He’s OK.” There was a cheer from the crowd of family and friends.
“Can I hug you?” asked Gabrielle, and she did.
The only physical evidence of Xavier’s unplanned adventure is a tiny bump beside his nose and some numbness on the left side of his face. And yet, things are different nowadays. Xavier often grabs the leash to take Max for walks—he’s no longer scared to walk the dog alone.
And when he gets a scrape or has a mishap, instead of going straight to ten on the pain scale the way he used to, he’ll look at his mom calmly and say, “This hurts pretty bad.”
“Is it skewer bad?” Gabrielle will ask, and Xavier will laugh.