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Nestled warmly beneath the covers, Army Lt. Col. (Dr.) Jonathan Sexton heard the low buzz of his cell phone next to the bed.
By rote memory, he picked it up.
“Dr. Sexton here,” he mumbled. Sitting upright, he wiped the sleep from his eyes. On the other end of the line was a trauma surgeon from George Washington University Hospital.
“Got it. I’m on my way.” Sexton jumped out of bed and threw on some clothes.
At GW’s trauma center, the team had already been working tirelessly to save the patient, who was suffering catastrophic bleeding from a gunshot wound to his retrohepatic vena cava—the body’s largest vein, located behind the liver.
As a vascular surgeon at Walter Reed National Military Medical Center, Sexton had known that the partnership with GW would be a win-win-win: They got specialists they otherwise didn’t have on staff, he got valuable trauma experience he could potentially use on a battlefield, and the patient got expert care.
Sexton gowned up and entered the OR. “What do we have here?”
“I think it’s his aorta,” the GW physician said. “But I can’t find where it’s bleeding from.”
Sexton plunged his gloved hands into the patient’s open abdomen and felt around. “It’s not the aorta,” he declared after several seconds. “I think it’s the inferior vena cava. But it’s behind the liver and I can’t see it. Wait -- I can feel the bullet hole. I’ve got my finger on it,” he told his teammates, as the bleeding seemed to temporarily subside.
His own heart was racing now. He knew most people with an injured vena cava will die. Injuries like this carry an overwhelming mortality rate of 85 to 95 percent.
Realizing the complexity of the injury, Sexton called for backup: a transplant surgeon who could maneuver the liver and provide access to the damaged vein. Then he remembered: He’d recently met a colleague at Walter Reed – a transplant doctor -- who was also collaborating with GW Hospital.
“Call Dr. Diaz Robinson and get her here fast!”
Army Lt. Col. (Dr.) Jamie Diaz Robinson, chief of transplant surgery, wasn’t on call that July night and was just dozing off when she got the call.
“We’ve got a gunshot victim,” Sexton told her. “With massive bleeding from the retrohepatic cava, we could use some help here. He’s stable now but I don’t know for how long.“
Diaz Robinson was no stranger to high-pressure cases. As an Army transplant surgeon, she had honed her skills in complex abdominal surgeries, including trauma during her deployment to Afghanistan.
She knew how to bypass the blood from the organs in the abdomen, and that there aren’t a lot of people like her and Sexton who can operate on an inferior vena cava. This would be tricky, but she was confident that she and Sexton were well-suited for the job.
Minutes later, Diaz Robinson entered the OR. Sexton was in exactly the same position as he was during the entire time he waited for her arrival: arms extended over the patient, one hand plugging the hole in the vena cava, stemming the bleeding.
Diaz Robinson looked around the abdomen, expertly moving the liver up and out of the way and providing a view of Sexton’s hand on the punctured vein.
“Look, my hand is numb now. Can we trade places?” he asked.
In the mere second or two that it took to make the trade, blood from the 4.5-centimeter hole flooded the abdomen.
“What’s happening?” she exclaimed.
“Don’t take your hand off!” Sexton warned.
They determined they couldn’t sew the hole shut without creating a “detour” for the blood flow. The team worked in concert, placing the patient on bypass to temporarily reroute blood flow, allowing the surgeons to repair the through-and-through injury using sutures and bovine pericardium patches.
The delicate procedure was a success. Blood flow was restored, and the patient’s vital signs stabilized.
But the patient would need additional surgery. Two large-caliber bullets had ricocheted through his entire torso, ripping through his liver, lungs, stomach, and left and right sides of his chest.
Less than 24 hours later, Diaz Robinson returned to GW to assist in a second surgery to address these injuries.
Against all odds, “He looked great!” Diaz Robinson says now, recalling the patient’s ear-to-ear smile when she entered his room. “I told him he was lucky that the bullet didn’t hit his aorta or spine as well. He most certainly would have been killed or paralyzed. I said it was a miracle he survived. He told me he was very grateful.” The young man is now thriving and back at work.
In recognition of their life-saving efforts, GW recently honored Diaz Robinson and Sexton during its annual Trauma Survivors Day, celebrating the exceptional collaboration between the military and civilian medical communities. She said this case underscores the value of military-civilian partnerships in trauma care, she said.
She sighs deeply and seems far away. “This is why I joined the military,” Diaz Robinson reflects. “We train for the battlefield, but this collaboration with GW saves lives here at home.”
This experience, she says, shows why subspecialties are so important and why Walter Reed will benefit from even more collaborations. It’s a way to serve the community and bring lifesaving skills from the battlefield to the beneficiaries.
| Date Taken: | 12.17.2024 |
| Date Posted: | 12.17.2024 12:29 |
| Story ID: | 487695 |
| Location: | BETHESDA, MARYLAND, US |
| Web Views: | 106 |
| Downloads: | 0 |
This work, Walter Reed Doctors Win Shock and Trauma Recognition from GWU, by Carol Kaplan, identified by DVIDS, must comply with the restrictions shown on https://www.dvidshub.net/about/copyright.
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