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cardiac arrest. We defibrillated him, which was difficult because of the glass, and on one occasion I absolutely know the defibrillation worked, but on the other two his heart appeared to start functioning again on its own, which was both surprising and confusing. We kept putting blood into him and he kept bleeding and we kept putting it in. I don’t know the actual amount, but it became something of a game, a game where a man’s life appeared to be at stake, and in which I and the other people in the room were working with incredible urgency and resolve, making sure we were transfusing more blood in than he was losing, a game that we knew would result in death if we did not succeed. What we could see of his skin was white, and I don’t mean the Caucasian white, I mean truly white, alabaster white, like he was carved from marble. And no matter how much blood we put in, his skin didn’t change, and his body showed no indication that it was actually maintaining the blood.
    While we were stabilizing him, I also needed to cover and protect his head. He had sustained a comminuted skull fracture, which means it had broken into a large number of small pieces, through which I could clearly see his brain. I assumed there was intracranial bleeding, most likely subdural, epidural, or intraparenchymal, and even if I could keep him alive, he would suffer from massive brain damage. We applied compression dressings using sterile surgical bandages, gauze, and surgical tape and moved his head as little as possible. We found pieces of his skull that were the size of nickels and bagged them in case we might be able to use them later.
    Two extremely long and stressful hours after he arrived at the hospital, his heart rate and blood pressure were stable, or at least stable enough for us to attempt to start removing the pieces of glass from his body. I took a step back and took a deep breath and looked at what was ahead of me. There were three IV lines transfusing blood into his body. We were applying pressure everywhere we could, but blood was still coming out of him at a rather alarming rate. We had been able to clean him up and cut away his clothing, and his skin was still deathly white. There was glass protruding from his legs, his arms, his abdomen and chest, there were smaller pieces in his face, and there were a number of large pieces that had been deeply imbedded into his back when he hit the ground.
    I tried to identify pieces of glass that had nicked, punctured, cut, or potentially severed major veins and arteries: the jugular veins, carotid arteries, and subclavian arteries and veins in the neck, and the femoral arteries and veins in the legs. I wondered what I couldn’t see, possibly damage to the aorta, the inferior vena cava, or the pulmonary vasculature, which are deeper in the chest and torso and were beneath my field of vision. While the conventional wisdom of a non-medical professional might say it would be best to remove the pieces of glass from those veins and arteries, there was the very real possibility that they were tamponading further bleeding and had sealed areas that had been damaged or destroyed. Getting through this part of Ben’s treatment would be part luck and part strategy and, if successful, part miracle.
    I had a vascular surgeon and his fellow join me and offer their opinions. I felt they might have something to offer that would help me, and help Ben, in some way. None of us had any idea where to start, or what to do, or what path to take, or what we might have in store for us when we started to actually remove the pieces. So I just started. I had three residents with me, and I had two of the residents prepared with suture in case sutures were needed, and I had the other prepared with a bipolar bovie, which is an electro-cauterization instrument. We had two surgical nurses with suction and another with an aspiration wand that delivered an anticoagulant. There were other nurses monitoring his vitals and