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Become a member and receive career-enhancing benefits
Our top priority is providing value to members. Your Member Services team is here to ensure you maximize your ACS member benefits, participate in College activities, and engage with your ACS colleagues. It's all here.
When a phone rings in the middle of the night in a surgeon’s home, the adrenal glands do what they do—secrete adrenaline into the bloodstream. Sleep stops. A hand instinctively gropes for the noisy device. As the surgeon lifts the phone to their ear, they wonder whether all the skill and experience of a lifetime will be necessary to answer the call or if it is a false alarm.
This photo of Dr. Jim Conyers was taken around the same time as the decapitation case.
If it is the former, the surgeon will be bounding out of bed and away from the warmth and comfort of home. The surgeon will be dead tired in the morning, and all the work planned for the day will still be there to be addressed at some point. If the call is a false alarm, sleep will still be disrupted as the effects of adrenaline slowly burn off during the next 20–40 minutes: heart pounding, blood pressure elevated, pupils dilated.
At the time of this particular phone call, Jim Conyers, MD, FACS, was a young general surgeon not long out of training. With Robert Redford-chiseled features and blond hair, he looked more the part of a movie star. He sported a drooping western cowboy-style mustache and had a slow Texas drawl.
Calm under fire and studious by nature with just a dash of mischief about him, Dr. Conyers was a steady influence during situations that were inherently chaotic. Under this veneer of perfection, Jim was like any other surgeon—willing to take on challenges, fascinated with the human body and what it can withstand, dedicated to his patients, and always carrying that small doubt as to whether he would be good enough to deserve the trust he needed to do his job.
“Dr. Conyers,” a female voice said about an octave higher than normal. “We need you to come to the hospital right now. We have a man coming in with his head cut off.”
Instantly awake, Dr. Conyers thought, “You don’t hear that every day! This sounds more like a case for a coroner than a general surgeon. I’m going in just to see what is really happening.”
“Is the patient alive?” Dr. Conyers asked.
“We think so.”
“I’m on my way. ‘Time to ride to the sound of the guns,’” he said, quoting his mentor, Ernest Poulos, MD, FACS.
Dr. Conyers slipped out of bed. His wife, Sharon, stirred slightly but she had learned ways of sleeping through most of these late-night calls. She figured out if the call was serious by whether Jim was in bed when she awoke.
By the bed hung a pair of scrubs, which surgeons generally keep at the ready for occasions like this. Excursions to the hospital at night often resulted in stains on street clothes that tended to be permanent. It is cheaper and better to have scrubs on when facing the unknown.
Throughout the years, Dr. Conyers's wife, Sharon, learned to sleep through most of his late-night interruptions.
Trusted Mentor Reappears
Dr. Conyers rounded the corner to the tiny emergency department (ED) of his country hospital. As he did so, the ambulance bay doors flew open. A patient on a gurney came through with three emergency medical services (EMS) clinicians in tow and was rushed into ED #1.
“Well, probably not dead. Probably not decapitated,” Dr. Conyers said to himself.
He took a breath and followed the patient into the room. There, he saw the usual ordered chaos of a major trauma arrival. IV lines were being checked, vital signs were being taken, and nurses were talking to the patient. But the patient wasn’t talking back.
As Dr. Conyers surveyed the situation, his attention gravitated toward the patient’s head and neck, and he noticed that the monitors confirmed the patient was alive, but mostly, dead. The blood pressure was sickeningly low, the pulse rate dizzily high, and the oxygen content of his blood dangerously low. Within moments, the pulse rate would likely nosedive, then stop.
A large, bloody bandage covered the patient’s neck. His face was bluish in color. He was suffocating. Basic first aid is to put pressure on a bleeding wound, but this is hazardous in the neck area. All the tubing that carries blood to the brain is in the neck. All the wires (“nerves”) that control the body go through the neck. All the air going to the lungs goes through the neck.
There was nothing to do but relieve this pressure and deal with whatever was lurking underneath the bloody bandage that had kept the patient alive to this point but if not removed soon, would contribute to his death.
Donning gloves, Dr. Conyers began removing the heavy bandage while simultaneously adjusting his head so that he wouldn’t be blinded by a gush of blood from the wound. A surgeon learns this trick early in their career. It seems like a squirting blood vessel always aims at one’s eyes. Protective goggles might keep things out of the eyes, but you still need to be able to see. So, turning your head slightly can keep the blood out of your line of sight.
Dr. Jim Conyers teaches a local girls group how to tie surgical knots.
An hour previously, while Dr. Conyers was still asleep, the patient had been traveling down a farm-to-market road. For unknown reasons, he had lost control of the vehicle—perhaps he fell asleep. His car exited the road and barreled into a typical Texas field full of cattle and bound by barbed wire fencing. All probably would have been well since barbed wire fences are hardly a barrier to two tons of steel traveling 60 miles per hour.
However, directly in the path of the hurtling car was a classic tin shed in the pasture used to house feed and other assorted tools of the cattle trade. As the car struck the shed, it sheared the tin wall into a horizontal and vertical set of fragments. The horizontal piece took on the appearance of a giant scythe entering the windshield as if it was soft butter and then struck the driver across his neck.
Upon removing the bandage, two things happened. The patient took a breath, but not through his mouth. Furious bleeding started, although it did not squirt as far as it normally would since the blood pressure was fading fast. The patient then exhaled, delivering a mixture of blood and bubbles into the wound.
Dr. Conyers could see the trachea was transected and held together only by the thin membrane of tissue along the back of the windpipe. The patient could breathe but was literally drowning in his own blood. Dr. Conyers asked for a breathing tube and shoved it down the trachea. The patient had a stable airway now—well, stable compared to the drowning proposition before. The trachea could tear completely in two and retract into the chest if they weren’t incredibly careful.
Airway temporarily controlled, Dr. Conyers placed clamps on the large vessels he could see and then applied moderate pressure on the many small areas oozing blood. He still had a living patient.
Now retired, Dr. Jim Conyers is a rancher.
“Is the OR ready?”
“Yes.”
“Do we have anesthesia?”
“Yes.”
“Blood on the way?”
“Yes.”
Dr. Conyers contemplated the situation. He had a barely alive patient with an unstable airway. He was in a small hospital and had no assistant, except perhaps a scrub nurse who would have to do double duty passing instruments and assisting him.
They had blood, but not a lot on hand. Trying to transfer the patient would just deliver a corpse to the receiving hospital. He had to go to the OR. How he wished Dr. Poulos was next to him now.
About that time, he heard in his right ear, “Would you like some help, Jim?”
He recognized that voice. It was William C. Brooks, MD, FACS, one of his teachers from his residency. A genial man of indeterminant age, Dr. Brooks was one of the few surgical oncologists practicing in Dallas, Texas, those days.
Dr. Brooks had completed his fellowship after residency at MD Anderson Cancer Center in Houston Texas. He routinely performed radical neck cancer surgery and was probably one of the most knowledgeable surgeons in neck anatomy in Dallas.
Glancing to his right, Dr. Conyers saw Dr. Brooks with his toupee on his head and a wry smile on his face.
Inwardly, Dr. Conyers exulted in seeing one of his mentors magically by his side, and said, “As a matter of fact, Dr. Brooks, I would like some help.”
And so, the two surgeons walked rapidly together down the hall to the OR suite with Dr. Conyers holding pressure on the patient’s neck while he and Dr. Brooks discussed their approach once they had the patient ready for operation. They were in the never-never land that surgeons experience when they are about to face a lethal challenge.
The surgeons had an idea of what they might do, but they also knew that rapid improvisation could very well be necessary. The patient was in such extremis that they could not assess the neurologic status. Being young was an advantage, as the patient probably had enough blood going through some of the vessels to the brain to keep it alive for a while.
This was the priority—to fix any vessels to the head. The airway would come next. Finally, a look around for injury to the esophagus, nerves, thyroid, and muscles.
Working through the night, the surgeons ultimately found the right carotid artery transected, the right jugular vein transected, and the trachea hanging by a thread. The esophagus was mercifully intact. One by one, the two pieced together what tin had rent asunder.
There were many miracles that night:
The patient had not been decapitated.
He was found quickly.
He happened to be a member of the ambulance team, and word spread via scanner that one of their own was grievously injured.
Dr. Brooks had a relative who worked with EMS in the town, and since the surgeon lived close to that country hospital, he got a call that help might be needed.
Two very competent surgeons were present at just the right time, and one of them was an expert in neck anatomy.
The patient’s brain stayed alive long enough for vessel repairs to save him from stroke.
In the long run, the patient went home and lived a normal life except for the hoarseness of his voice (the nerve to the right side of his vocal cords was destroyed) and a surprisingly faint scar that belied the havoc ravaged upon him that fateful night.
Dr. Conyers went on to have an outstanding career as a general surgeon and eventually retired to a ranch in San Saba, Texas, where his physiognomy finally matched his hobby of being a real-life cowboy.
As for Dr. Brooks, he kept teaching surgeons, including yours truly, the secrets of neck dissection. No one ever figured out how old Bill Brooks really was, but he lived a long time saving lives. Quick with a smile and gentle of voice, he had the knack of magically appearing when he was most needed.
Note from Dr. Hughes:
Talking about the “average” surgeon is like referring to an “average” astronaut. Every story is unique; there is no average. In this article series, I will feature surgeons of different specialties, backgrounds, ages, and practice types. Some of the surgeons you may know well, while others have worked in near obscurity. As surgeons, they serve all with skill and trust. If you are an ACS member and would like to meet with me to share your experiences, contact bulletin@facs.org.
Disclaimer
The thoughts and opinions expressed in this article are solely those of the author and do not necessarily reflect those of the ACS.
Dr. Tyler Hughes is a retired Kansas rural surgeon. Born in Texas, he trained in Dallas but spent most of his career working as a surgeon in McPherson, Kansas—a town of 13,000. In retirement, Dr. Hughes plans to travel the world in search of surgeon stories.
