A Definite Maybe: Chapter 1

1

ST. JUDE TRAUMA CENTER, KANSAS CITY, MISSOURI

“What you see is what you get,” is an old adage that usually proves to be true.

Yeah, well, I gotta tell you that’s not always the case when it comes down to everyday

humanity. Let me explain a little further.

I am a trauma surgeon who puts people back together after a lot of them have done

something stupid without thinking first about what the consequences might be. Especially when

their often spur-of-the-moment plan does not play out in the expected fashion.

The uncertainty of this well-worn adage came into play when I was on trauma call on a

typical Tuesday night where I work at St. Jude Trauma Center in Kansas City. According to the

corresponding police report that came later that evening, there was this one muscular, daredevil

disciple who had built for himself quite a profitable scheme to push himself into the next echelon

of economic security. This budding capitalist had developed an expertise of hot-wiring cars,

particularly of the expensive, highly desired foreign made types. In addition, he seemed to have

cultivated a special knack of evading any pursuing law enforcement efforts through his

adventurous driving skills. He would then deliver the desired autos to one of his cadres of auto

fencing contacts. It seems his talents were in high demand these days.

Well, as this economic upstart found out, just like everything else in life, all good things

must come to an end.

On this particular evening in April of 1997, our industrious hero had just successfully

hot-wired a 1996 Mercedes W140 S-Class luxury sedan complete with a pearl haze sparkle,

Pg. 2

black exterior paint job with a matching black leather interior. The car was fitted with custom

tires and rims. It was obvious to any novice that this vehicle had been customized especially for

its demanding owner. The car had all the bells and whistles on it that would bump the resale

price up to the next level. There was no doubt in his mind that our hero believed that he had just

hit the jackpot with this automobile he had just heisted. Speeding away from the scene of the

crime, he was on his way to deliver this car to his contact, elated by his stroke of luck.

Making his way to a large metal building warehouse on the industrial north side of

Kansas City, he pulled up to the gate where a similar large guy was waiting in a car for him. The

tough looking guy immediately got out and unlocked the lock to the chain-linked gate to let our

hero enter the compound in his shiny new prize. Driving around to the back to the large building,

he pulled the gorgeous luxury sedan up in front of the closed garage door and got out of the

newly acquired prize. He walked over to the locked back door and knocked twice on it waiting

for his fencing contact to let him in.

Instead of having the door opened by his contact, a young, black male, no more than

fifteen years of age, opened the door with his eyes wide open with surprise.

“Who the hell are you?” our hero growled.

“Get out of my way, old man before I fill you full of lead,” the skinny youth bragged

back to him instantly.

Well, while there was no witness at this scene, it must have been quite a sight of

inequality to see. Just outside the door stood our massive hero, a muscular white guy with

bulging arms and a thick beard not backing down an inch. He was probably around six foot six

of total brawn with a barrel shaped chest and matching expansive gut. Inside the doorway was a

Pg. 3

thin teen, all of ninety pounds at best, trying to show his bravado with one of his arms wrapped

tightly around a boom box.

“Where’s Gino? And what the hell are you doing here, anyway?” our hero barked.

“I told you, honky, to get out of my way,” the boy answered in a shaky tone.

“And what do you think you’re gonna do about it if I don’t?” our hero said in a loud

voice to the much smaller boy in the doorway.

It was then that fate then reared its unexpected, ugly head in the middle of our hero’s

previously smooth plan of easy money profit.

You’d think that right about then this thin boy would have already taken off running for

dear life with the boom box he just stolen from this auto chop shop that our hero’s fencing

contact, Gino, ran stolen cars through. But everyday situations like this one show that our

mentioned adage does not always turn out to be true.

Instead of getting an expected frail response from a weakling teen, this young kid had the

audacity to pull a .22 caliber snub nose revolver from his back pocket. Without hesitation, the

teen immediately fired all eight shots at the unexpected mountain of man, striking him seven

times in the chest and abdomen. An almost impossible feat for an inexperienced gunman. The

enormous man slowly fell to the ground in complete surprise as the teen sprinted across the yard

with boom box in hand, making his way through a break in the fence. The kid made his getaway

on his bicycle, of all things, while the professional carjacker sat on the ground stunned in total

amazement.

After yelling multiple times and deciding that Gino was not around in any way, shape, or

form, our hero pulled his cell phone from his back pocket calling 911 for help. After talking to

Pg. 4

the operator about his present situation, he hung up and began cursing the slender teen for not

getting what his frail opponent appeared to be upon initial visual evaluation.

Hence realizing that our everyday adage had its shortcomings.

It was approximately eight p.m. on that routine Tuesday night when the triage nurse had

me paged that there was a multiple gunshot wound victim who had been evaluated at the scene

and was being transported to our facility. She told me in no uncertain terms that my presence was

needed ASAP at St. Jude Trauma Center.

Luckily, as a matter of routine precaution, I had already crammed some form of

worthwhile nutrition into my body knowing that there was a chance that I wouldn’t get to eat

again for a while. I hightailed it to my place of employment embracing my usual outlook of

expecting the unexpected.

About the time I arrived in Trauma Room #1, the EMT’s wheeled in a gigantic specimen

of a man on a gurney who was somewhat agitated, and I would say not at all pleased.

“I know you guys are trying to help, but I’m not really hurt,” the mammoth human

shouted as he entered the trauma room. “So, you guys just get me out of here and we’ll call it

square.”

One of the EMT’s pulled me aside to give me the rundown of their findings and what had

happened at the crime scene as it took eight people to transfer the huge patient from his ER

gurney to the trauma room treatment table.

In my line of work, sometimes you see things that are hard to believe. As I turned to go

speak to the patient, it was very obvious to everyone in the room that the patient was wearing an

unusual piece of jewelry that caught everyone’s eye. Hanging snugly on a thick, gold link chain

around his neck, the patient was wearing what appeared to be a lion’s head about the size of your

Pg. 5

fist made of solid gold. In each of the lion’s eye sockets was a glistening red ruby that made it

like the lion eyes were looking directly at you. In each of the lion’s nostrils there was a round cut

clear diamond. And to top it off, the open lion’s mouth was filled with a large, oval shaped,

green emerald.

Not exactly subtle, everyday jewelry.

“Mr., um… Turner,” I announced as I read the chart thrusted in front of me. “I’m Dr.

Chandler, the trauma surgeon here for the evening. I want to explain that there will be a lot of

people coming at you doing some things that you might not appreciate right now, but they are all

trying to help you here tonight, so don’t be afraid. They’re all part of the team that are trying to

help you, so please cooperate with us. Ladies, and Bill, of course, can we start with the usual

additional large bore IV, foley catheter insertion, EKG monitoring, the usual blood and urine

samples, and have an abdominal peritoneal tap kit ready to open? Now, Mr. Turner, can you,

very slowly and calmly, tell me what happened to you tonight?”

I know it sounds like a lot for someone to absorb when so many people are doing so

many things around them in a time of crisis, but I tend to call it a necessary evil intervention.

“So, you’re the one in charge?” the patient answered while one of the trauma nurses was

taking a very large set of scissors, or ripping shears you could call them, and cutting every bit of

his clothing on either side of him to be removed.

“At least for the time being, yes sir,” I replied.

“Vital signs are all stable at this point Doctor Chandler,” Bill chimed in. He was one of

the veteran trauma nurses I had worked with and trusted on many a trauma case since I arrived in

Kansas City back in 1988.

“Thank you, Bill.”

Pg. 6

“Hey Doc, why are they cutting all my clothes off?” the patient yelled.

“All routine, Mr. Turner,” I calmly replied. “We have to evaluate every square inch of

your body, both front and back, inside and out for any possible trauma. We don’t want to miss a

single possible injury.”

Just about then, one of the nurses put a routine hospital gown over the patient’s exposed

body, attempting to cover his massive girth. It barely covered him. She then reached under the

cervical collar he had around his neck to try to unfasten the gold chain to remove the unusual

jewelry as a routine step in all trauma cases.

“Hey, no one touches my necklace, EVER,” he said loudly as he reached up to grab the

nurse’s wrist with his right hand.

I quickly grabbed his right wrist with both of my hands that allowed the nurse to break

free from his grasp.

“Mr. Turner,” I began in a firm, but calm voice, “We don’t grab the people who are

trying to help you. Do you understand?”

“I got this as a gift from my uncle when I was fifteen. I never take it off. So, no one ever

touches this,” he demanded.

“Well, Mr. Turner,” I said while still having a firm grasp on the patient’s strong right

wrist, “I understand your concern about your jewelry. But according to the EMT’s, the fact is

you have been shot a total of seven times in the chest and abdomen areas. In order to evaluate

you properly, we have to remove all, and I mean all foreign objects touching your body. If we

don’t, those objects could cause a severe burn on your skin or even make your heart stop

pumping by way of an unwanted electrical shock. And we don’t want that, do we?”

Pg. 7

“It will get stolen if you remove it. I know it will,” he pleaded, more concerned about his

jewelry than his status of staying alive.

“It won’t because here’s what we’re going to do. Let this nice nurse carefully undo the

gold chain and then she will immediately go put it in the narcotics cabinet under double lock and

key. And to make you rest easy, you should know that the cabinet has not one, but two cameras,

one from each side, sending video recording to the hospital security center with the date and time

of each person opening that cabinet twenty-four hours a day, seven days a week. Fair enough?”

“Are you sure?” he said as he slowly put his huge right arm back by his side.

“Positive. Now Mr. Turner…” I began.

“Call me Clyde. That’s my first name, Clyde.”

“Okay then, Clyde. We are going to be slowly turning from side to side to check every

square inch of your body. Please be patient and when we tell you to move, then move. If there is

any excessive pain, please tell us exactly where the pain is located and what the pain rates on a

scale of one to ten, ten being the most pain.”

The patient didn’t answer me while his eyes intently followed the nurse who took off his

valuable lion’s head and left the room with his expensive prize in hand.

I began examining the patient just like we always did, starting from the top of his head

and working my way down to the bottom of both his feet. I called out all findings and their

approximate sizes of injury to the recording nurse standing at the lectern who wrote down my

observations in the medical record. When we were finished with the front side of the patient, it

took seven of us to turn the patient on to his stomach in the prone position. I then repeated the

process from head to toe, including a rectal exam. At completion, we turned the massive human

back onto his back.

Pg. 8

At this point, the nurse transcribing the trauma care on the chart standing at the lectern

shouted, “All vital signs continue to be stable. BP 130 over 83, Pulse 98, Respirations 18, O 2 Sat.

98 percent on two liters by nasal canula. Additional IV with 16-gauge needle inserted into left

antecubital fossa, foley catheter in place.”

“The A-Team comes through on its usual proficiency,” Bill added.

“Thank you, team. Now, Mr. Turner, can we get back to what exactly happened to you

tonight?”

The large man looked around at all the people doing their jobs around him and finally

responded.

“I was at work this evening when I pulled up to one of my stops,” our hero began. “I got

out and went to the back door to meet one of my contacts. I knocked on the door and when it

opened, instead of my contact, it’s a scrawny kid with a boom box arm under one arm.”

“Well, remember that I’m not the police, but did you know this person?” I asked.

“Never seen him before in my life.”

“And then, what happened next?” I continued with my questioning.

“The little twerp tells me to get out of his way. Well, I’m not going to take that kind of

crap from anyone, you know what I mean?”

“Okay, and then what happened next?”

“Well, instead of running off scared, the little bastard pulls a revolver out of his back

pocket and unloads every bullet he had on me. The kid didn’t say a thing more. Just shoots all his

ammo at me and ran off. It really knocked the wind out of me,” the stout man confessed, like he

had been beaten with a small stick or something.

Pg. 9

This patient just took seven point-blank slugs in the chest and abdomen and all he can say

is that “it knocked the wind out of me?”

“Well, Clyde, I examined you thoroughly front and back and I found three projectile

entrances wounds in the chest, and four entrance wounds in both lateral abdominal areas. The

entrance holes are small, indicating the use of a smaller caliber pistol, probably a .22 caliber. If

your perpetrator had used something larger, like a .38 caliber, you would probably not made it

alive to this trauma center, bleeding out on the way here.”

“Really?” our hero responded with only a minimal interest.

“Yes, that’s right, Clyde. Now in this situation, if your vital signs were shaky, we would

perform what is called an abdominal peritoneal tap. We would make a small incision in your

lower abdominal wall, insert a small tube and drip in a small amount of IV fluid. We would then

take a sample of the fluid out through the tube and send it to the laboratory to see if there was

any blood in it. If there was, then we would need to go to surgery immediately to assess what

damage there was to internal organs.”

I didn’t happen to mention to him that it would be a big-time additional struggle for me to

fight all the way through the patient’s thick abdominal fat just to place the catheter.

“Sounds complicated,” he responded like he was completely bored.

“And as for your chest, we would need to get a thoracic surgeon here double quick if you

were bleeding from one of the gunshot wounds to your chest.”

Just a look of disinterest on the patient’s face was all I got.

“But Clyde… all of your vital signs are extremely stable, which is good for you. So, we

are going to send you for a CT scan of your chest and abdomen to see how deep each one of

those bullets penetrated into your body. Do you understand?”

Pg. 10

“How am I going to pay for all this?” he asked.

“What kind of work do you do?”

He stammered for a second before answering, “I’m in auto sales. I can fix you up with a

fine ride at a real good price.”

“I’ll bet you can, Clyde,” I answered doubting his part about auto sales. “Let’s not worry

about the costs of what we need to do right now. We need to find out if and when you’ll need

surgery tonight. I’m going to give you a little something in your IV to help you to relax so you

can stay still during the CT scan. Bill, Valium 7.5 milligrams IV please.”

“Right away, Doctor,” Bill replied. “I already called the CT scan department, and they

said they can take him in ten minutes.”

“Good enough. Clyde, I’ll see you when you get back here from CT scan.”

In about forty-five minutes, Clyde returned to Trauma Room #1 with copies of the CT

scans on his gurney. There was an unofficial radiologist report paper clipped to the folder with a

note written in ink at the bottom saying, “You got lucky on this one, KC.”

Th radiologist was right on this case. All seven projectiles did not hit any vital organs.

The three slugs to the chest were all imbedded in muscle next to the ribs. The four abdominal

slugs, three on the right and one on the left, didn’t penetrate inside the intraabdominal cavity.

This was probably the only person on Earth at this moment that had benefited by being

grossly obese. The layers and layers of fat had actually saved his life.

I awoke the snoozing Mr. Turner and explained the situation to him of how lucky he was,

but that we just couldn’t leave the slugs inside him due to the high risk of infection. He agreed

that removing them probably should be done so he could get back to work faster.

Yeah, we don’t want to slow down those auto sales.

Pg. 11

I called to set up everything with the surgery desk and the transport team took him away

up to the surgical floor. On my way out of the trauma room, a group of three policemen came up

to me asking about Clyde Turner’s status and when he would be released. Upon further

discussion, they explained the whole situation about Clyde’s profession and that they would have

an officer in the recovery room and at all times with him after surgery.

Walking to the surgeon’s changing locker room, I smiled that I guessed pretty well on the

patient’s false auto sales profession.

The surgery went pretty routine. All seven slugs were sent to pathology for

documentation to be used as evidence in the police search for the shooter. Wow, seven slugs and

no real damage.

Better to be lucky than good. Now that’s an adage you could count on.

After dictating my operative note and my findings in surgery for the medical record, I

laughed at myself about all the correlations on this case about the old adage of “what you see is

what you get.” That sure did not at all prove this adage to be true.

Clyde said he was in auto sales. Well, car snatching was not exactly auto sales. Next, Mr.

Turner never thought a skinny, fifteen-year-old punk would take him down, but damned if the

kid unloaded his whole revolver on him. What was even more amazing was the kid hitting Clyde

seven times. That was definitely surprising.

And then most of all, when I got a call that 32-year-old white male was coming into the

trauma center with seven gunshot wounds to the chest and abdomen, what you should have seen

was a patient crashing and burning while likely bleeding to death the moment he hit the trauma

room door. Instead, what I got was a stable patient, albeit big as a house, who claimed he only

felt like he “got the wind knocked out of him.”

Pg. 12

Go figure. This was one case to remember for future reference.

Note to self, Chandler, a lot of the time, what you see is definitely not what you get.