Once we started, we moved very quickly, because every movement, especially removing the largest pieces, resulted in blood loss, sometimes fairly significant blood loss. If we hadn’t moved quickly, Ben would surely have died. There were a number of scares, and a number of times when his vitals dropped dramatically, and a number of times when we couldn’t stop the bleeding in what I considered a timely manner. But Ben wouldn’t die, and now, at this point, after everything, I believe that what we did that day probably didn’t matter very much. Ben was not going to die.
Nine hours after we started, we tied the last suture. He had a total of 745 stitches, both internal and external, and an additional 115 external staples. We had used 40 units of blood, which is approximately double the amount any human has in their body at any given time. We also gave him multiple units of platelets and fresh frozen plasma. And for him, the day was far from over. There was a team of cranio-facial surgeons and neurosurgeons standing by to deal with his skull and brain injuries. As I stepped back from the table, I saw one of his hands twitching, which I took to be a good sign, and I stepped over and took hold of it, hoping that somewhere, on some level, he might find it comforting. To my great shock, his grip was very strong, very firm, and I immediately felt something similar, but deeper and more profound, to what I feel in those moments just before surgery, an intense calm and sense of peace and contentment. It was unreal, and obviously unexpected, and it ultimately changed my life in so many ways. I didn’t want to let go. I didn’t want that moment to end and I didn’t want that feeling to ever leave me. But all things leave us, all people, all feelings, no matter how we want them to stay, no matter how tight we hold on to them. We lose everything in life at some point. I lost that moment the instant I let go of his hand.
After he was hemodynamically stable, he needed a CT scan of his head to determine the extent of intracranial injury. Moving a patient as critical as he was can be very difficult, very complicated, and very slow, so I knew I had some time to take a break, and I needed one. I went to our break room and took a shower and tried to take a nap but couldn’t fall asleep. I was extremely awake, felt electric. I imagine I felt the way people feel when they take cocaine or ecstasy, though I have never used either of those or any illegal drugs. I got dressed and found Ben back in the OR, where the surgeons were now working on his brain, and I gowned up so I could watch the procedures. They had basically completed what was already a craniotomy, and evacuated both epidural and subdural hematomas. I watched the surgeons do some skull reconstruction using titanium plating, though they appeared to leave much of his skull as it was in case of cerebral edema, swelling of the brain, which can lead to brain herniation downward and death. Four hours after they started, Ben was taken to the post-anesthesia care unit.
He was later moved to the surgical ICU, and even though he was stable, he remained on life support: supplementary ventilation, intravenous therapy with fluids, drugs, and nutrition, and urinary catheterization. He was kept sedated using propofol so that we could monitor brain swelling and function. The ICU took over his day-to-day care, though I would continue to treat him, as would the cranio-facial surgeons and neurosurgeons. When I left the hospital, I felt very good, given the extreme nature of the situation and the trauma, about the care we had provided and Ben’s prospects for some type of recovery. It was very early in a case like this, and normally it takes quite a while for us to really know how and if a patient is or is not going to recover. I assumed that I would come back the next day and everything would be more or less the same. I should have known better.
When I arrived, there were no urgent cases, so I went to the ICU to check on Ben and see if there were any new developments. I picked up his chart, and I noticed immediately that his name had been changed from Ben Jones to John Doe, and that his date of birth had been changed to unknown. I placed the chart back into the wall file and went towards the ICU offices, where I saw the ICU attending standing with two uniformed police officers and another man who appeared also to be a police officer but was wearing a suit. The attending introduced me to the men and told them that I had treated the John Doe when he had first arrived and had performed the first surgery on him. I asked them why he was being considered a John Doe, and they proceeded to tell me that his name was fake, his driver’s license was fake, his fingerprints did not show up in any city, county, state, or federal databases, and that they could find no records of a man named Ben Jones born on the date listed on his driver’s license in any of the city, state, federal, or law enforcement databases at their disposal. Needless to say, I was surprised. I told the officers that I didn’t know anything beyond what was on his chart and what I’d experienced with him in surgery, and I had no idea who he was or where he was from. I also suggested they speak to the men who had been gathering in the waiting room, who had said that they worked with the patient on a construction site. They said they had spoken to those men, and that all of them knew him as Ben Jones, and they had examined all of the paperwork the site manager had on file, and that all of it contained the same information that appeared on the fabricated driver’s license. Again, I told them I knew nothing. They asked if anybody else had asked about the patient, or if there had been any other inquiries about him. I said not that I knew of, but that I had been either performing or observing surgery with him for almost twenty-four hours and normally didn’t have that type of contact with individuals looking for information on patients. They said thank you, and they left.
I went back to Ben’s room with the ICU attending and we started talking about his case, his prognosis, and started exchanging ideas about treatment. He had ordered an electroencephalogram to test brain function and was hoping to get a quantitative electroencephalogram to fully map Ben’s brain and see what areas had been damaged and how badly. When he left, I had a moment alone with Ben and I reached for his hand, the same hand I had held before, but there was no reaction. It was limp and cold and felt like the hand of a corpse.
I continued to follow the case over the course of the next week. There was a fairly significant amount of press related to the accident-it was a controversial building being put up by a high-profile developer-and it gave the newspapers and blogs a few days of salacious headlines. We had hoped the coverage would help with an identification, but no one came forward. I got harassed by a couple of reporters who waited outside the entrance of my apartment building and stuck tape recorders in my face, hoping to get me to say something they could write about, but I knew to keep quiet, and that despite the tape recorders, the reporters would write whatever they wanted and the newspapers would print whatever they felt like printing. My truth is in the life and death I witness at the hospital every day. Ultimately, life and death are the only form of perfect truth that exists in the world. Everything else is subjective, and subject to an individual’s perspective. I don’t look for truth in the media.
Aside from the mystery of his identity, Ben became a medical mystery. His lacerations healed in a remarkable, unheard-of amount of time; after a week we were able to remove all of the sutures, all of the staples, and his wounds were closed and starting to scar. He was weaned down on the respirator, and we continued to feed him intravenously. The electroencephalogram results were erratic and unexplainable. At times he appeared to have suffered brain death, where there is absolutely no activity of any kind registering on the EEG monitors. At other times he appeared to be in a persistent vegetative state, where cycles of sleep and some base awareness, but not cognition, were recognizable. Once or twice a day he went into a state of extreme brain activity, centered in two regions of his brain, the medial orbitofrontal cortex, which is one of our emotional centers, and the right middle temporal cortex, which is often associated with auditory verbal hallucinations. The activity was extreme to the point that it was almost immeasurable, and the neurologists working on his case had never seen anything like it, especially with someone who had experienced such severe brain trauma. The initial worries related to brain swelling, bleeding, and intracranial pressure disappeared, as his brain seemed to heal itself as quickly, and miraculously, as his body did. He would also, at times, twitch, shake, convulse, and make guttural noises, which should not have been possible with the levels of medication being used to keep him sedated. At the end of his first week with us, he had a second major craniofacial procedure, in which titanium plates were used to seal and close the remaining open areas of his skull. The surgery went well, and he was returned to the ICU. Two weeks later we learned his real name, or rather, we learned the name he was given at birth. He was still in a coma, though no longer medically induced. It was some time after that, probably a year or so, that I learned who he was, and that his name, or any name any person could have given him, was meaningless. He was, and that is what is important. He was and he will always be.
ESTHER
My brother Jacob did not allow the mainstream media to, as he said, infect our home. There were no newspapers, there was no television, unless it was Christian TV. We could only listen to Christian radio stations, and our computers had filters on them that prevented anyone using them from accessing MSM websites. He believed, and still does, that the mainstream media is anti-Christian and anti-family, and promotes a liberal
