by Per Ola and Emily D’Aulaire
As a youth, he’d performed countless daredevil stunts. Now he needed a miracle to save him.
Sun beat down on a grateful Mike Spaulding. The 32-year-old framing contractor had a house to finish in the hills overlooking the town of Truckee, California, in the Sierra Nevada. He and carpenter Travis McMaster, 27, wanted to take advantage of the good weather before snow blanketed the Donner Pass region.
Using 3¼-inch-long spikes that fed into their powerful nail guns like bullets in a machine gun, the two men pinned rafters into place as easily as stapling sheets of paper together. A slight pull on the trigger drove a nail up to its head in the heavy timbers.
By midmorning that December 5, 1991, the temperature had climbed into the low 40s. The two men were working in their T-shirts. McMaster was holding a rafter in place while Spaulding muscled the lower end into position. Suddenly, a gust of wind caught the board and swung it toward him. The unexpected impact caused Spaulding’s finger—resting on the trigger—to squeeze. The gun fired.
At first, Spaulding thought the nail had missed him—he felt no pain. Then a searing agony welled up from his chest. Glancing down, he saw the nail head buried so deep in his chest that it had pulled part of his T-shirt into his body. His mustachioed, chiseled face became contorted with pain. Feels like someone rammed a railroad tie through my chest, he thought.
Gasping for breath, Spaulding tugged at his shirt, trying to wrench the nail free. The fabric ripped, but the nail wouldn’t budge. Frantically, he reached for his “cat’s paw,” a tool with a curved hook for extracting buried nails.
“Stop!” McMaster yelled, as he raced down the ladder from the ridgepole above. He remembered a cardinal rule of first aid: never pull out an object impaled in the body.
Whatever had been struck in Spaulding’s chest, McMaster knew, the nail now acted like a finger in a dike. To remove it without surgery could cause Spaulding to bleed to death in minutes.
“We’re going to the hospital,” he told his boss, trying to sound calm. He steered Spaulding toward the pickup truck.
Spaulding felt himself fighting the darkness squeezing in on him as he propped his feet on the truck’s dashboard and tucked his head down to minimize shock. A former professional freestyle skier, he grasped the irony of what had happened. After all the risks I’ve taken for fun, he wondered grimly, am I going to die on a simple little job?
At age 15 he was doing two backward somersaults on skis after soaring off a ski jump. For a movie, he’d once raced down a 50-degree slope, sailed off a 30-foot-high cliff, performed a perfect back flip over a moving freight train and landed safely on the other side of the tracks. Three skiers who had tried the stunt before him had been killed.
I got through some crazy things, he thought woozily. But I don’t know if I’m going to dance through this one.
With flashers blinking and his hand on the horn, McMaster raced the truck down the mountain roads. “You’ll be okay,” he kept telling his friend. “Just hang in there.”
Spaulding’s eyes shut, and he started to slip into unconsciousness. “You can’t die on me, Mike,” McMaster bellowed. “Hang on! We’re almost there!”
Struggling to stay conscious, Spaulding thought about his girlfriend, Judi Schorr, 28. He’d met the petite brunette a year earlier on a blind date. Almost immediately, he fell in love with her. After a few months he asked her to marry him. She said no—not because she didn’t love him, but because she’d decided marriage wasn’t for her. She’d seen too many marriages end unhappily.
“After you drop me at the emergency room,” Spaulding gasped, “tell Judi what happened. Ask her to come to the hospital. I may never see her again.”
Shortly after 11 a.m. at Tahoe Forest Hospital, emergency-room nurse Judy Erhardt heard a truck skid to a halt in the bay normally reserved for ambulances. Erhardt hurried outside with other staffers.
“My friend’s dying,” McMaster yelled, waving toward the barely conscious figure slumped in the passenger seat. Sweat poured from Spaulding’s face, drenching his clothing. His lips were blue from lack of oxygen.
Inside, emergency-room physician Edward Heneveld looked at the nail head in Spaulding’s chest and grimaced. Pressing on the neck artery, he could barely feel a pulse. The man’s pale, sweaty appearance and deteriorating vital signs were evidence of severe shock.
The trauma team cut off Mike Spaulding’s clothes, inserted I.V. lines into his arms and placed an oxygen mask over his nose and mouth. X rays and a sonogram confirmed Heneveld’s worst fears: that the nail had driven straight into Spaulding’s heart, allowing blood to leak into the space between the organ and its surrounding membrane, the pericardium. Each time the heart beat, more blood spurted into the space. The growing pressure of blood in the pericardium was literally strangling Spaulding’s heart.
His lips were blue from lack of oxygen.
Tahoe Forest, a 72-bed district hospital, boasted a large emergency room for its size. It was not equipped for heart surgery, however. Normally, a patient with the type of injury that Spaulding had would be moved to a trauma center in Reno, 35 miles away. He’ll never make it, Heneveld realized.
“Get Boone in here quick,” he said. “We’re going to lose this guy unless we open him up fast.”
Across the corridor in the physicians’ lounge, Dr. Howard Boone was unwinding after assisting at a hernia operation. The bearded, six-foot-four-inch surgeon favored blue jeans and cowboy boots and was a popular figure both at the hospital and in town.
Boone’s patients liked him for his gentle and confident manner, as well as his skill and compassion. A colleague tells of the time Boone performed emergency stomach surgery on a 76-year-old cancer patient. “We couldn’t help you,” Boone told her when she came out of anesthesia. “But I promise to make you as comfortable as possible.” He remained at the woman’s bedside all that night and into the next afternoon, personally nursing her until she passed away.
“Dr. Boone, ER stat,” the loudspeaker in the doctors’ lounge crackled—hospitalese for “to the emergency room, immediately.” Boone loped across the corridor and shouldered his way past the nurses and physicians surrounding Spaulding’s gurney.
After a glance at the man’s X rays and heart sonogram, the surgeon knew they were in deep trouble. Spaulding needed open-chest surgery immediately. The last time Boone had performed such an operation was 16 years earlier during his residency in San Francisco. Boone knew Tahoe Forest was not equipped for this type of surgery: the hospital had no heart-lung machine and no chest saw.
Without a sternal saw, he’d have to use an old Lebsche knife. This is a ten-inch-long stainless-steel bar with a handle at one end and a sharpened wedge at the other. On the back side of the wedge is a flat surface that can be banged with a mallet to drive the wedge into the bone. Before orthopedic saws, the Lebsche knife had been the standard tool that thoracic surgeons used to crack breastbones open for access to the heart and lungs.
Boone knew the hospital had one left over from earlier years. “Prepare for an open chest,” Boone directed. “We need all the usual stuff, plus the Lebsche knife, a chest jack and a blood recycler.”
Travis McMaster rushed into the emergency room with Judi Schorr. After pleading to be allowed to see Spaulding, Schorr was shown into the area where he was being examined. Recognizing her, he lifted off his oxygen mask and whispered, “I love you.”
A nurse steered Schorr away. “I’m afraid you have to leave,” she said. Trying to prepare her for the worst, the nurse added quietly, “You might want to say good-bye. He may not make it.”
Boone and Dr. Jacinto “Butch” Orozco, the general surgeon who had performed the hernia operation Boone had assisted with, were already suited up and scrubbed. Nurses rolled Spaulding, still conscious, into the operating room. They moved as rapidly as possible, for they could see the patient was dying before their eyes.
Spaulding looked up at nurse Suzanne Achey and asked weakly, “Am I going to die?”
“Not if we can help it,” she answered with her most reassuring smile. “We’re a very determined bunch.”
Boone wanted to hold off until the last moment before giving anesthesia. He couldn’t risk the patient’s blood pressure plummeting further.
Now, scalpel poised, Boone nodded to the anesthetist. “Aren’t you going to knock me out first?” asked a frightened Spaulding.
“Put him out,” Boone said as he began the chest incision. Spaulding felt a sharp sting down the center of his breastbone. As the anesthesia kicked in, a black curtain descended. Incredibly, only 20 minutes had passed since the spike had been driven into his chest.
“Lebsche knife,” Boone called. The scrub nurse placed the gleaming instrument into his gloved, outstretched hand. Boone put the sharpened wedge of the Lebsche knife against the top of Spaulding’s sternum. “Go ahead,” he said to Orozco. “Slam it.”
Orozco struck the knife’s flat surface forcefully with a small stainless-steel mallet. He had expected a few whacks to drive the wedge into the patient’s sternum and split it cleanly in half. But Spaulding was an athlete with stone-hard bone. Although Orozco pounded again and again, the wedge didn’t move. “This guy’s built like a rock,” he muttered.
Anticipating the next move, the scrub nurse asked for an orthopedic tray, which would have a bigger hammer. When it arrived, she said, “Try this, Butch,” and handed him a three-pound hammer.
This time, after only three blows, Spaulding’s breastbone split open. Boone exhaled with relief. “Rib retractor,” he ordered.
The nurse handed him a steel device like a small tire jack. Slowly, Boone cranked the chest open, careful not to dislodge the nail. He probed inside with a gloved finger. The spike had entered Spaulding’s chest just off center of the breastbone. It had angled to the left before perforating the right lung; then it penetrated the right chamber of the heart. Finally, it had punctured the aorta, the garden-hose-size main artery that leads from the heart to the rest of the body. The pericardial sac around Spaulding’s heart ballooned with dark, oxygen-poor blood. Equally ominous, with each feeble beat of the heart, the nail again poked at the aorta like woodpecker pounding a tree.
Boone was amazed that his patient had survived this long. It’s a one-in-a-million chance to get this kind of injury, he thought, and not have it be fatal.
With surgical scissors, Boone carefully cut open the pericardium to relieve the pressure on the heart, suctioning and sponging out the pooled blood. If they could stop the heart for a few minutes, it would be much easier to work on. But for that they needed a heart-lung bypass machine. The surgeons would have to make their repairs while the heart was still beating. Working on a moving target, they would need every ounce of skill they could bring to the table.
By now Spaulding had lost perhaps a quarter of his body’s blood. They didn’t want to transfuse him because there hadn’t been time to determine his blood type before rushing him to surgery. To compensate, three large-bore I.V.s poured more than a gallon of clear fluids into his veins. An autotransfuser recycled the blood spilling into his chest cavity and returned it to his veins.
While Boone pulled the nail back bit by bit, Orozco put his fingers over the holes it had made. At last, Boone held the nail in the air. Then he handed his trophy to a nurse. “l want to save it,” he explained. “I’ll probably never see a case like this again.”
Over the next two hours, Boone worked to suture each hole that the nail had made. First he repaired Spaulding’s damaged lung. Next, with tiny stitches, he attached a Teflon patch to seal the hole in the upper-right chamber of the heart.
He watched the patch pulsate. “This guy’s strong as an ox,” Boone said as he worked.
Finally he tackled what he knew would be the trickiest part of the surgery—repairing the aorta. The staff fell silent as Boone gingerly peeled back a clot covering the puncture wound. A geyser of blood spurted across the room. My God, we could still lose him, Boone thought. Orozco immediately put a finger over the wound.
Boone was now working blind, the hands of both surgeons deep inside Spaulding’s chest. Then, while Orozco kept his finger firmly in place, Boone prepared needles for suturing. Because the puncture was located deep in a crevice where the heart and aorta meet, each surgeon placed half the suture in the part of the wound he could best reach. “I think I’ve got it,” Boone finally announced.
To help seal the hole, Orozco held a gauze sponge in place for five more minutes. An audible sigh went up in the operating room when he slowly removed it and not a drop of blood appeared.
Between his cap and mask, Boone’s eyes registered relief as they met Orozco’s. “Let’s close him up,” Boone said. “This just wasn’t his day to die.”
Mike Spaulding recovered with surprising speed. Only three days after surgery, he was begging so hard to go home that Boone finally granted permission—with a warning.
“If you try anything strenuous during the next two months,” the surgeon said, “your blood pressure could rise enough to blow a hole in one of our sutures. If that happens, you’ll be dead. It’s that simple.”
Judi Schorr and Travis McMaster got Spaulding home and made sure he was comfortable. After nearly losing her man, Judi found that her thoughts about marriage had changed. Just nine days after the accident, Mike and Judi were married. By mid-March 1992, Spaulding was back at work—careful to keep his finger off the trigger of his nail gun until he was ready to fire it.
Spaulding changed in other ways. Formerly hard-driving, competitive and sometimes argumentative, he became more relaxed. “I’ve found I’m not as invincible as I’d thought,” he says. “And I can’t always do everything by myself.”
Still, some of his renegade spirit remains intact. After receiving a clean bill of health from Boone, he asked if he could jump the freight train again.
Boone smiled. “Sure,” he said. “Just tell me when. It’s an event I wouldn’t want to miss.”
The nail that almost took Spaulding’s life nestles in a box on Boone’s desk at his office. Every once in a while, the surgeon twirls it in his fingers and marvels at the gleaming 3¼-inch-long sliver of galvanized stud. He says, “Mike definitely had an angel on his shoulder that day.”
Originally published in the June 1993 issue of Reader’s Digest magazine.
Mike Spaulding died of cancer on July 10, 2013. Dr. Howard Boone is still practicing at Tahoe Forest Hospital. Dr. Jacinto Orozco is a general surgeon in Goldendale, Washington.