TMC PULSE

t m c » p u l s e | f e b r u a r y 2 0 1 9 25 Ashley took deep breaths. She reminded herself that it was just a gunshot wound to the arm, oblivious to the severity of his injury. Moore remained by her side, her uniform splat- tered with blood. When Ashley finally noticed, she knew, without question, that the blood belonged to her husband. Family and friends circled through their small room. Police officers came to pay their respects, even Houston Police Department Chief Art Acevedo. Finally, hours after Ashley had arrived, Mileski appeared. "He is very sick," the surgeon told her. "He is very sick." * * * * * * In the operating room at UTMB that morning, anesthe- sia was started at 9:23 a.m. The surgeons' task: determine exactly what damage had been done to Barnes' body and what needed to be repaired. Everything was recorded in what would ultimately become nearly 900 pages of medical records. A "problem list" outlines the severity of Barnes' condition: Gunshot wound Traumatic hemorrhagic shock AKI (acute kidney injury) ATN (acute tubular necrosis—kidney disorder from damage to the tubule cells) Shock liver Laceration of right brachial artery Olecranon fracture Pellets from the shotgun had shattered Barnes' right elbow, including the tip, known as the olecranon. The blast transected the brachial artery just where it splits into the radial and ulnar arteries and tore a hole along the front of his forearm. It was no wonder he couldn't keep blood inside his body. By 10:20 a.m., the team began to reconstruct the arteries, harvesting fragments of Barnes' saphenous vein (which runs the length of the leg) and right forearm cephalic veins (large veins often used for drawing blood) for the repair. Three-and-a-half hours later, with a strong pulse in place, the team set to work stabilizing Barnes' elbow joint using pins and an external fixator. Finally, they closed the large opening in his forearm with the help of wound-VAC, a vacuum-assisted technique that decreases air pressure in and around the wound to promote healing. Last, they grafted skin from his leg to cover the large, delicate area. The surgeries, finally over just after 4 p.m., required expertise verging on perfection, but Mileski would look back on those first seven and a half hours and say that it was nothing heroic. "We're pretty well conditioned to respond to the needs of patients and prioritize what we have to do to get them well," he said. "You don't really think that much, as silly as that sounds. It's like a football player playing football— you react to the circumstance, you don't sit there and run through a lot of thought, at least not if you've been doing it for 30 or 40 years." Heart Brachial artery Radial artery Ulnar artery SHOTGUN WOUND AREA OF IMPACT Shotgun pellets shattered John Barnes' right elbow, cutting across the brachial artery where it splits into the radial and ulnar arteries of the forearm. Because the brachial artery is a main thorough- fare to the heart, Barnes lost blood rapidly and flatlined on Memorial Hermann Life Flight en route to UTMB. The severe blood loss left him in a state of hemorrhagic shock, indicating a lack of oxygen at the cellular level; his kidneys, lungs and liver were threatened. Surgeons at UTMB reconstructed the arteries in his arm using veins from his leg and forearm. Then, they stabilized his elbow joint and closed the large opening in his forearm, grafting skin from his leg to cover the area. * * * * * * * Dimitrios Pagourtzis is accused of killing 10 people in Santa Fe, Texas, and wounding 13, including Barnes. More than half a century ago, on Aug. 1, 1966, another Texas city ushered in the first mass school shooting in modern America, when a 25-year-old engineering student at The University of Texas at Austin climbed the campus clock tower with an armful of guns and ammunition and shot and killed 15 people. Since then, the names of the schools around the country where students and faculty have been gunned down are forever fixed in public memory. Columbine. Virginia Tech. Sandy Hook. Marjory Stoneman Douglas. Santa Fe. There are many, many others. ➟

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