Dallas Doctors’ Toughest Cases

Local physicians share their most challenging moments in medicine.

Fixing a Man Cut in Half by a Train

Dr. David C. Smith
Medical Director Of Trauma Service, Texas Health Harris Methodist Hospital

Dr. David C. Smith photography by Adam Fish
It was a sunny morning in June 2006. At close to 9, we got a call that CareFlite was bringing in a patient, a man in his mid-30s. Fortunately it was at the time of day when the trauma surgeons switch shifts, so we had one guy going off and one guy coming on. I was the guy coming on.

When I know that a big trauma is on its way in, I try to get what I like to call the biomechanics of the crash. It lets you rehearse in your mind what you’re going to need to do to get ready. In this case, the patient had been run over by a train. He worked in a rail yard, and while they were switching some cars, he slipped and fell and was not only run over, but pinned down by one of the cars. It took CareFlite, the Cleburne Fire Department, and the paramedics an hour just to get him out from underneath it.

My first thought when they brought him in was that, although this was going to be a lot of work, this was a survivable injury. He had been practically cut in half just below the waist. Excluding facial injuries, this was the most disfiguring trauma that I’ve ever seen, and I’ve been performing surgeries for 33 years—trauma surgeries exclusively for the last 13 and a half.

He was unconscious and in need of a great deal of blood. We used close to 5 liters initially. To stop the bleeding, we began operating on him right there in the emergency room, before they took him up to the OR, where we then spent the next three and a half hours in surgery.

We removed all of the devitalized, or damaged, tissue. Although that sounds simple, it was a tremendous amount of work because there was so much tissue that needed to be removed very carefully so as not to cause additional bleeding. We diverted his colon to prevent any further fecal output onto his liver, and we patched up a place on his abdomen that was literally one cell layer thick and about as big as a silver dollar.

At the end of that operation, he had lost half of his pelvis, all of his left leg, and about three quarters of his right leg. The best part was that he didn’t sustain an injury to his head or vital internal organs. We had him off the ventilator in three to five days, but in the ensuing 41 days, he had 23 different operations by multiple specialists.

For his wounds, we used VAC therapy—short for vacuum-assisted closure—which allows you to put a low degree of suction over a large open wound to remove the fluid that seeps out of it. That helps keep it from becoming contaminated.

Normally most wounds require one large 12-by-6-inch pad for this type of treatment, but for him, we routinely used four to six large pads every time we changed his dressing. It was the biggest VAC dressing I’ve ever seen in my life.

At one point, he developed problems with his ureter, which is the tube that goes from your kidney to your bladder. There was a leak in it. He had been cut in half so deeply that the ureter was on the outside wall of his abdomen. Usually, it’s very deep on the inside, and for people who know anatomy, that will tell them how bad his wound really was. He ended up losing his left kidney.

He had a very prolonged hospitalization—about six weeks. Because of this, along with the devastating, life-changing thing that had happened to him, I thought it was important for his mental health that he get out and see the sunshine. We put him on a special gurney and took him outside on a regular basis.

In the end, he survived, and after going to rehab here, he eventually went back to work for the same company that he worked for when he was injured. Later on, we did some research and found out that there are fewer than 50 cases recorded in the world’s literature in which people have sustained this type of injury and survived.

Needless to say, he had an incredible will to live.

—As told to K.L.