A large and significant portion of the practice life of a general surgeon involves taking emergency room calls and treating patients involved in trauma. I treated injuries such as automobile accidents, gunshot and knife wounds, industrial accidents, domestic and workplace violence and injuries sustained at home such as lacerations and puncture wounds. Over the years I thought I had seen and treated patients with every type of injury  until I received a call from the ER one Saturday in mid-afternoon.

The ER nurse said there was a forty-five year old man who had sustained a large puncture wound to his left thigh while working on a tractor earlier in the day. “How large is the puncture wound?” I asked. She responded, “It is really big!” Not knowing what I might find I didn’t waste any time getting to the ER. I had gotten some other information from her such as his vital signs and whether he was actively bleeding, whether he was conscious and alert and how much pain he was experiencing.

When I entered the ER the excellent staff at the South Arkansas Medical Center had an intravenous line well placed, and Robert was receiving fluids, pain medicines and his lab work was being processed. He was conscious, but groggy from the sedation when I told him I wanted to inspect the wound. As I lifted the sheet to inspect his left groin area, I saw an eight inch limb from an oak tree protruding from a puncture wound to his upper, inner left thigh. The limb was  approximately two inches in diameter, and I could tell by slightly moving the limb it was deeply imbedded. The wound was very close to the femoral artery and vein which are the main blood supply to the leg, and because there was no active bleeding I was fairly certain those essential vessels were not injured. “How in the world did this happen?”  Here’s what he told me:

“I was driving a big tractor this morning clearing land and uprooting very large trees and stumps. There was another man about a quarter of a mile away on a similar tractor clearing this land along with me, but we were not in contact with each other. I saw an oak sapling ahead which I thought I could run over, and it would break to the ground. What I didn’t know was the sapling bent over, and when it did snap the lower end sprang back into the cab of my tractor. It penetrated my leg and lifted me off the seat and pinned me to the top of the cab.”

He continued, “For some reason when I was lifted off the seat the tractor stopped running or the tree in my leg would have torn me in two. Normally a D2 tractor will keep running until it runs out of gas. I was pinned so high in the cab I couldn’t reach anything to help me free myself. I reached in my pocket to got my pocket knife and began cutting the limb. Because of the intense pain I kept passing out but was able to hold onto the knife. I was screaming for my friend to come help me, but he was too far away to hear me. After at least fifteen minutes I was able to cut through the limb, and I dropped to the seat of the cab. At about the same time help arrived because my friend could see the tractor was not moving and he came to check on me. I’m sure glad he did.”

Following the necessary tests and x-rays to determine the extent of internal injury Robert was taken to the OR for the exploratory operation. Before we prepped the operative site. I firmly grasped the protruding tree and pulled it out. The internal portion was another ten inches so the total length was about eighteen inches. With the extent of the injuries it was miraculous he sustained no major blood vessel injury, which he probably would not have survived. We were able to repair the massive internal damage.

During his prolonged recovery I discovered  Robert was a bi-vocational pastor, and we both agreed he would now have many sermon illustrations as a result of his experiences this day. We also agreed in God’s plan for each of us we are indestructible until God’s purposes are completed. Robert returned to his responsibilities as pastor and continued his teaching ministry. I’m not certain of this, but I believe he gave up his tractor driving job.

Dr. John