Somewhere between Bodden Town and East End, a driver had the darkest chapter of his life.
Nicholas Connor, 30, had driven off the road shortly after midnight on Jan. 25 and collided with a chain-link fence, and an iron support rod had pierced his windshield and abdomen, pinning him to his car seat. Now, miles away from either of the local hospitals, the clock began to tick on the rest of his life.
Every moment was vital, and the longer he remained untreated, the harder it would be to save him.
The first steps were taken by the first responders, who arrived shortly after the accident after a passerby called 911. But they were limited in what they could do.
Mr. Connor could not be removed from the vehicle, and the Fire Service had to be called by the ambulance to literally cut him and the pipe that impaled him out of the car.
Once that vital work was done, Mr. Connor was freed from his vehicle, but he still had a metal pipe entering his chest and protruding through his back.
The ambulance raced him to Cayman Islands Hospital, where staff went about the work of stabilizing the patient. There was no cardiac or thoracic surgeon immediately available, so the hospital made a call to Dr. Binoy Chattuparambil, the clinical director and chief cardiac surgeon at Health City Cayman Islands.
“At this point, it’s about 3 o’clock or 2:30,” said Dr. Chattuparambil, remembering the incident.
“They described the situation. ‘A pipe is going through the chest. The patient is really scary-looking and something could happen immediately. Can you handle it?’
“I told them, ‘Immediately, send him to us.’”
While the ambulance was racing the 18 miles between hospitals, the Health City trauma team was busy assembling. The hospital’s new intensive care facility had just been opened in December, and many of the staff had worked together in India before relocating across the world to Cayman.
Their familiarity with each other and their roles was one of the factors that makes urgent care work.
It is not enough to have a brand-new facility with the most advanced technology, said Dr. Chattuparambil, especially if you do not have the necessary staff prepared for any potential contingency.
“What makes it different for the public is the availability of all the specialists, not only doctors but the whole team,” he said. “When this kind of trauma happens, it is not only one region like bones or the liver or the abdomen. If an accident happens, it can happen to any part of your body. What makes urgent care centers stand out is not the building, it’s the people that can handle the entire situation.”
Arrival at hospital
When he arrived at Health City, the stricken patient was lying on his side in the ambulance, sedated but awake. The medical professionals brought him into the emergency suite and wanted to do a CT scan so they could ascertain what was wrong with him before they brought him into the operating room.
But here, again, they ran into a problem of simple physics.
Mr. Connor could not fit into the CT scanner because of the way the pipe was situated, so the hospital had to call the fire team back. They wheeled Mr. Connor outside to the driveway for the ambulance, and the fire truck used a cutting tool to sever parts of the pipe both in front of and behind his torso.
Now, Mr. Connor could finally be diagnosed, and the CT scan found that the metal pole was going directly through his lung. Six ribs were broken in the front and shattered in the back.
“Immediately I talked to his brother and his parents,” said Dr. Chattuparambil. “I said, ‘We don’t know how it’s going to come out. The lung is totally shattered. The ribs on both sides. We had to go in and see how it was; we couldn’t make a plan. We took him to the operating room immediately.”
Dr. Dhruva Krishnan, Health City’s medical director and head of anesthesiology, ran into his own problems when prepping Mr. Connor for surgery.
“Normally when we start and do anesthesia, we have the patient sleeping on their back,” he said. “It’s easy for us to control when we put the tube into the throat. Here in this case, he couldn’t lie flat for obvious reasons. The pipe was going through and through, and he also had a significant lung injury. Probably bleeding also. So we had to do everything with him lying on his left side.”
Once the patient was prepped for surgery, the operation could begin. The team had to open Mr. Connor’s chest, and once inside, they could see the full extent of the damage. The pipe had torn the right lung from one side to the other, and the ribs were shattered into multiple pieces.
Dr. Chattuparambil had to remove mud and hair and blood from the wound, and he began repairing the lung bit by bit. After two hours of surgery, the doctors had done enough work to remove the pipe, and Dr. Chattuparambil began repairing the patient’s shattered ribs with a steel wire.
“Usually it would heal by itself,” he said. “But in his case, because it was multiple ribs shattered from the front as well as from the back, if we didn’t repair it, once we were done with the surgery and once we took him off the breathing machine, he’d not be able to breathe well. He’d be on ventilation for weeks. So even though it was taking more time and effort, we repaired all the ribs both front and back.”
The surgery took five or six hours. Mr. Connor was also diagnosed with a shattered elbow. The orthopedic surgeons could not repair it immediately, but they cleaned and stabilized the wound.
Mr. Connor was discharged from the hospital within a week, and Dr. Chattuparambil has recently seen him and marveled at his recovery. The patient has had no deficits, said the doctor, and he can thank the first responders, the staff at Cayman Islands Hospital and the trauma unit at Health City for that.
“There were maybe 20-30 people who helped him go home,” he said. “The nurses were there 24 hours with him, and the physiotherapists to help him do the therapy. Their work usually goes unnoticed, but they’re the people that usually make the big difference. If we’re to send him home on the sixth day, it’s not the doctors alone at all. Whatever success we have to tell today, a big credit goes to the nurses.”
The whole episode – from accident to both hospitals and the operating table – took about four hours.
A decade ago, said Dr. Chattuparambil, there may have been a very different result for Mr. Connor.
“This is the advantage of having a state-of-the-art Level 3 Trauma Care Unit. It saves lives,” he said. “Imagine if the treatment that we gave to him was not available on the island? What is the next thing? Going abroad. Imagine the time delay that’s going to take. At 2 o’clock in the morning, to get an air ambulance would take at least 8 to 10 hours. That’s our experience that we’ve seen.
“With this rod poking through the chest and waiting for an air ambulance, by that time, the air is filling inside. … It may not happen that he would reach another hospital in the United States.”
Road to recovery
A week after the surgery, Mr. Connor began to take stock of his situation.
His lungs were fine, and his chest was healing. He was still waiting for the final orthopedic surgery, but he felt healthy and thankful for all the work that went into keeping him alive.
“They told me I’m a lucky man. I give thanks to God too. It could’ve been worse,” he said in a video provided to the Cayman Compass by Health City. “The part I remember, after being told by the ambulance drivers the next day after the surgery was finished, that I was screaming, ‘I’m going to die.’ I remembered that part after they refreshed my memory, but otherwise I don’t remember anything else.”
Mr. Connor said he was thankful for everyone, from the eyewitness who called 911 to the paramedics and firemen and the staff at both the Cayman Islands Hospital and Health City. He seemed acutely aware of how thin the margin between full recovery and catastrophic injury may have been.
“I feel thankful because if I had to be flown out by air ambulance, maybe it wouldn’t save my lung,” said Mr. Connor after assessing his treatment. “Maybe it might save my life but I’d be in more critical condition. The faster you can be worked on or attended to, you should get a better outcome.”
He had never been in an accident before that necessitated surgery, said Mr. Connor, and he said that he could not imagine better treatment than he had received from Dr. Chattuparambil and the Health City staff. Now, with the rest of his life in front of him, he’s filled with warmth and gratitude.
“I feel good within my body and I’m healing fast,” said Mr. Connor. “I told [Dr. Chattuparambil] that I don’t know how I can thank him or pay him back. “And he said to me this: ‘Just be good. Don’t get yourself in trouble and be careful driving.’ He talked to me and said that was all I had to do to pay him back. Drive safe and keep safe.”