Brion Benninger, MD, MSc
Professor & Executive Director of Medical Anatomy Center
WesternU College of Osteopathic Medicine of the Pacific-Northwest
Medical Innovator, Researcher & International Educator
At a recent medical conference hosted by the Mexican Society of Anatomists held in Chihuahua, Mexico, an event occurred that revealed acts of humanism on individual, community and international levels. The event resulted in efforts that triggered an unquestionably remarkable and spontaneously heartfelt behavior from both societal and corporate establishments. As the occurrence weaved a humanistic string through many layers and groups of people, it proved the presence of the common good in all of us.
I was honored to have been invited to present a keynote platform presentation titled “Frank Netter, an Empathetic Medical Illustrator Who Humanized Anatomy, Succeeding Henry Gray, Andreas Vesalius and Leonardo DaVinci,” and subsequent innovative workshops titled “Shift in Medical Anatomy Teaching & Research Illuminating Philosophies and Techniques” and “Integrating Netter’s Anatomy Plates with Handheld Ultrasound to Diagnose Common Wrist Fractures.” I incorporated selective Netter plates, the latest handheld ultrasound devices, and Google Glass to identify common wrist fractures for current experts and future trainees representing medical schools in Mexico. I was also privileged to be invited to attend a special dinner featuring local customs and offering local food on the menu, shortly after my ultrasound workshop concluded. It was held approximately 20 kilometers away from the city at a well-known historical site. While I was tidying up the ultrasound equipment from the workshop, two Elsevier medical publishing representatives based in Mexico City, Alberto and Nestor, offered me a ride to the event. I accepted their kind offer, and we were driving through the countryside, with virtually no traffic just minutes after leaving the bustling city limits.
As life occurs, we were about two minutes behind a car that had unfortunately gone off the side of the road and struck a large power pole, which it severed. Subsequently, the pole and it’s transformer had landed on the car roof, crushing and trapping those within it: a driver and two passengers, one in the front seat and another in the rear.
As we came around a corner, we were met with a local farmer. He was waving his arms back and forth in front of his old pickup truck, which he had turned to face us directly with his lights on. His body language suggested something was awry. The farmer had witnessed the tragedy of the car driving off the road, down an embankment, severing a power pole before stopping by the edge of a farmer’s field. The live power line extended across the road about one foot above the tarmac surface. He ran to the car, and when he saw no one moving within it, he returned to his pickup and turned it around to face on comers so they could avoid the wire. The farmer explained in Spanish that the crashed car was full of deceased people. I asked Alberto to translate and to ask the farmer if he had assessed the deceased. The farmer responded, “No.” Aside from the farmer, we were first on the scene. Nestor and Alberto interpreted the farmer’s account of the story. Nestor remained on the road to encounter any other drivers who might arrive and phoned emergency services as well.
Alberto and I ran across the road and down the embankment to the badly damaged car. Once there, I shouted out that we were there to help them and would get them out and to the hospital; Alberto repeated this in Spanish. I tried in vain to bend metal pieces from the car with my bare hands but was useless. Alberto used the light on his cell phone for us to see better so that I could crawl inside and assess the passengers. Suddenly, out of nowhere, two more people, likely farmers from a nearby field, arrived from the dark with a pick, an old hand hacksaw, and a 6-foot crowbar. I asked Alberto to explain to the two farmers that we should rotate using the tools to bend enough of the roof, so I could crawl inside the car from the rear window once the roof is elevated enough. Alberto kept his light on and was also there to warn us if we swung the crowbar or the pick too high, as the downed power line was only five feet over the car and could be struck if we weren’t careful. From the rear window region, I crawled inside on my stomach and found myself lodged between both collapsed front seats, while lying on the cars console. I was shoulder to shoulder with the driver and front passenger. Both were unconscious, while the rear passenger drifted in and out of consciousness and in a state of confusion. I began assessing and checking their airways and pulses. I was able to confirm a positive pulse from only the driver and the rear passenger. The smell of vomit consumed me while I conducted finger sweeps from the oral cavities of the driver and passenger, removing stomach contents which could potentially occlude their airways. I then assessed bleeding and conducted serial Glasgow coma scale scores; all the while being trapped inside the car with the roof dented down as low as the door locks and in the dark.
Using the light on my phone, I assessed pupils on all three passengers. The front passenger had bilateral fixed mid-dilated pupils; the driver had one pupil which was dilated and moving sluggishly; and the rear passenger had bilateral equal pupils which were briskly reactive. I crawled out, fearing that the front passenger could be deceased; I could not feel a pulse, nor did I receive any response of pain stimuli from their sternum or observe any air movement. The rear passenger was now conscious, disorientated, and in pain. Their legs were trapped under the front seat. For the next 25 minutes, the farmers and I took turns using the pick, crowbar, and hacksaw to cut and manipulate enough metal out of the way so that we could assess the passengers more easily. Alberto continued to translate in Spanish to assure the severely injured passengers that we were here to help until emergency services could arrive and take them to the hospital.
Two other physicians, an internist and an orthopaedic surgeon, arrived. They, too, were attending the special dinner; a non-ambulance rescue individual also came with the Jaws of Life tool. With it, he cut away chunks of the car, and together, we lifted the driver out using a seated C-spine device, bringing the driver up and over the car and up the embankment to the waiting ambulance. The internist rode with the injured driver in the ambulance, while I rode with the rear passenger. The surgeon drove ahead to get prepared for operating. While riding with the rear passenger, I applied traction to his femur and reduced a dislocated or subluxed hip which alleviated much of his acute hip and pelvic pain. I grabbed his hand to reassure him that all was going to be okay.
The last person to have been removed from the car was the front passenger which I had returned and assessed for a pulse several times at multiple intervals; but I never felt a pulse on any attempt, and their eyes remained bilaterally fixed and dilated. At the hospital, I was informed that the front passenger had been pronounced deceased on arrival. The deceased happened to be a medical student. The driver, also a medical student, was diagnosed with a subdural haematoma and was subsequently treated and kept in the hospital for several days; they remained stable and were eventually released. Lastly, the rear passenger was diagnosed with a right acetabular fracture and was treated and eventually released, returning home to the Mexico City area. It was discovered the rear passenger was a professor at a medical school in Mexico who had taught both passengers.
Later in the evening, the President of the Mexican Society of Anatomists’ contacted the deceased’s family, offered condolences, and made plans to fly them to Chihuahua to have them stay at the conference’s hotel as their guests. Every conference attendee grieved for the deceased person and for their family. Elsevier, an International medical publishing company, contacted me the next morning and offered condolences and asked where flowers could be sent, and if appropriate, they would also help with or fund the funeral. The family of the deceased was asked if they wanted an investigation conducted, to which they responded no; as no investigation would bring their child back and it could even ruin the life of another child and family if anything more were to be discovered.
This event was undoubtedly a tragedy. Yet the kind and selfless acts of humanism scattered throughout somehow made the affair at least a bit more tolerable.
At an individual level, total strangers from different backgrounds and from different countries, speaking different languages, worked together immediately in unison with simple but effective tools, in order to help people in a desperate life-threatening situation.
At a community level, farmers who could have been eating dinner and looking after their own families, came across a dark field with tools to help total strangers who were not from their community, despite the danger of live wires sitting over their head.
At a societal level, the Mexican Society of Anatomy not only reached out during the late night to contact and console the family following the tragedy of the evening, but also organized payments for flights and accommodation to the entire family. These acts do not fall within the realm of their responsibilities, yet they did not hesitate to reach out to offer a helping hand to the deceased family. The Mexican Society of Anatomy views all the students attending medical schools in Mexico as part of their family, and in doing so, they continue to demonstrate they are true advocates for medical students. For this, I will always be grateful to have been a part of this amazing society!
At a corporate level, Elsevier had no connections with the driver or passengers, aside from the presence of two of their international employees at the site. Alberto’s and Nestor’s working capacity was to support the conference and associated learning events. For Elsevier to demonstrate remorse for all the victims, especially the deceased, and to send flowers and volunteer to help with any funeral services without the expectation of recognition, demonstrated an amazing act of humanism. It seems that not all corporations care only for the bottom line!
At a family level, the family of the deceased chose not to investigate this accident during their darkest hour, an hour of unimaginable emotional pain from losing a child so suddenly and unexpectedly whose future was one of caring and providing health. Any fault discovered could have ruined the life of the other medical student and their family. I have never witnessed a greater act of humanism than the one of the deceased family towards this situation. The mother being so distraught and noble at the same time. For this I have no words, simply amazement and a heavy heart.
Although I often think of this tragic occasion and struggle with its immediate outcome, I am left grateful and hopeful as the individuals, families, a Chihuahua community, members of the Mexican Society of Anatomy and Elsevier reaffirmed our faith in humanity by their humane acts.