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COLUMN ONE : Rebuilding Eyes, Limbs--and Lives : New medical techniques and Oklahoma City's sophisticated health care system are helping injured blast survivors recover.

June 25, 1995|THOMAS H. MAUGH II | TIMES MEDICAL WRITER

OKLAHOMA CITY — Susan Walton had stopped by her credit union in the Murrah federal office building on that spring morning to make a quick deposit before going to school. Martin Cash was reading a paper in his office at the VA. Steve Pruitt was filling out a travel voucher on the third floor. And Daina Bradley had stopped by with her family to pick up a Social Security card for her 4-month-old son.

At 9:04 a.m. on April 19, their lives changed forever when a terrorist bomb exploded, destroying nearly half the Alfred P. Murrah Federal Building, killing 167 people and injuring more than 500.

Walton had a badly broken jaw, a ruptured spleen and crushed legs. Cash lost an eye. Pruitt was blinded in one eye. And Bradley lost a leg.

All are recovering surprisingly well, thanks both to this city's sophisticated medical system and to several medical techniques developed in the last decade.

That sophistication is a legacy of the 1970s oil boom, which provided funds not only for new buildings and equipment, but also to attract leading doctors from around the country. As a result of that legacy--and a remarkable degree of good fortune--physicians said, relatively few people suffered permanently disabling injuries in the ferocious blast.

Only four people who were brought out of the building alive died later and a handful suffered serious disfigurement--one had a limb amputated and several lost eyes.

If the bombing had to happen, said Dr. M. Alexander Jacocks, chief of staff at the University of Oklahoma's University Hospital, the timing and location increased the victims chances of survival: it was early in the morning, in the middle of the week, and less than a mile from four major hospitals with excellent facilities.

New medical technologies--several developed locally--also are helping the survivors, including surgical techniques, eye implants and prosthetic limbs. "We're doing things that couldn't be done 10 years ago," said Dr. N. Robert Markowitz, a surgeon at the University of Oklahoma Health Science Center.

The experiences with the survivors show that "you don't have to be in Los Angeles or New York to get high-quality medical care," Jacocks said.

*

Every physician within at least 15 miles of the Murrah building heard and felt the explosion and could see the dense black smoke rising from the site. Emergency plans were quickly activated.

Hospitals everywhere routinely practice for such disasters, often twice a year. "The average physician doesn't pay much attention to those practices," Jacocks said. "But having a plan in mind proved to be extremely helpful."

The bombing set off a medical emergency response that, thanks to those routine practices, was immediate and comprehensive.

All non-emergency surgeries at the four hospitals nearest to the blast--University, Presbyterian, St. Anthony's and Children's--were canceled. Waiting patients were sent home and hospitalized patients who could be discharged were. Physicians of all specialties congregated in the emergency rooms to help--so many, in fact, that most victims were seen by several at once.

It was not uncommon for as many as four surgeons to operate on one patient simultaneously. One surgeon might deal with internal injuries while another repaired facial lacerations and two others handled limb injuries. In this fashion, time under anesthesia was minimized and injuries were treated as quickly as possible.

Although some operations continued into the late evening, the emergency rooms where victims were received were largely empty by 4 p.m. There was "a big emotional letdown" among the ER crews when it became apparent that all the survivors had reached the hospital and that everybody else was dead, said Dr. Thomas Lera, chief of staff at Children's Hospital of Oklahoma. "We were devastated when there was no second wave of survivors," Jacocks added.

Most of the hospitalized victims recovered quickly and were released within 10 days. The last patient was released Wednesday.

Among the most common injuries were lacerations from pieces of large plate-glass windows, which flew through the air like shrapnel. The cuts "were like you see in a severe auto accident or bus wreck," said Dr. Hal D. Balyeat of the Dean A. McGee Eye Institute.

Balyeat and his colleagues at Presbyterian Hospital treated four survivors with severe eye injuries. Three lost an eye and one has limited vision. A similar number were treated at other hospitals, he said.

Rebuilding a Face

One beneficiary of the new surgical technologies was Steve Pruitt, a 32-year-old General Accounting Office employee who had been filing paperwork to be reimbursed for a trip. "I don't remember the explosion," he said. "All I remember is waking up and wondering, 'Why am I sleeping at work?' "

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