THE VIRGINIAN-PILOT
Copyright (c) 1994, Landmark Communications, Inc.
DATE: Sunday, October 23, 1994 TAG: 9410230048
SECTION: FRONT PAGE: A1 EDITION: FINAL
SOURCE: BY LYNN WALTZ AND TOM HOLDEN, STAFF WRITERS<
DATELINE: VIRGINIA BEACH LENGTH: Long : 456 lines
The bullet exploded from the .22-caliber revolver at twice the speed of sound and plunged into James H. Murray's chest, piercing skin and bone on a path straight to his heart.
In an instant it penetrated his heart, diaphragm and liver - leaving a series of holes about the thickness of a pencil - before coming to rest, sizzling in the dark recesses of his body.
For the shortest possible moment, Murray stood in stunned silence.
It was Oct. 30, 1993. He had driven to 2009 Queen Mary Court in the Emerald Point East apartments to deliver a Chanello's pepperoni pizza but stumbled into a diabolical plan hatched by three teenagers.
Their plan was simple: Order a pizza, wait for the driver, then rob him. But they had called Pizza Hut, not Chanello's. Only a twist of fate brought Murray into their trap first.
Murray had never been the victim of a crime. He had taken the job of pizza deliveryman to support his son, Alex, 3, and his Polish-born wife, Angelika.
That night, when he pulled into the parking lot in his gold 1990 Honda Civic, he had seen the three teens loitering near a breezeway by the building's entrance. He had paused, thinking maybe he should leave for safety's sake. Then he thought they might be his customers.
He was wrong. When Murray got out of the car with the pizza stuffed in a red vinyl bag, the three approached him. The one with the gun squatted on the ground. His accomplices stood nearby.
Put down the pizza, they ordered, and place the money bag on top of it. Murray did so. The bag held less than $20. The robbers demanded his wallet. Murray balked. They insisted.
``Gimme your big, fat f-----g wallet,'' the gunman demanded.
There was nothing in the wallet, he said. They insisted, and then let him go without taking the wallet. He headed toward the apartment building. Then one of the robbers yelled, ``Hey, you!''
Murray turned. From about 30 feet away, the 16-year-old gunman fired one shot.
Murray bent over and felt a burning in his stomach. His thoughts began to race. The robbers fled. They had his money bag. They had his pizza. Panic set in, then pain.
He staggered inside the white hallway of the apartment complex.
``Help me! Help me!'' he cried. ``I've been shot. Someone help me!''
He pounded on doors, but no one answered. His thoughts began to blur. He was on the floor, terrified.
By all odds, Murray was a doomed man. Every time his heart beat and sent blood coursing through his body, it also sent blood spurting from two holes: one where the bullet had entered, the other where it had exited.
Luck was on his side. He was a three-minute ambulance ride from Virginia Beach General Hospital's shock-trauma unit, which provides 24-hour care to critically injured people.
Still, it would take a near miracle for James Murray, shot through the heart on the night before Halloween, to survive. Time was his enemy now. PARAMEDICS GET A ``SCOOP-AND-RUN'' ON A MAN WITH A BULLET IN HIS CHEST
There is no record of the time that Murray was shot. But many apartment residents heard the gun go off, heard Murray hollering. Calls poured into the police department's 911 line, the first at 10:09 p.m. One call came from the woman who had ordered the pizza Murray was delivering.
The first of six police cars arrived in less than three minutes.
Police, following procedures to ensure the safety of rescue volunteers, searched the area first before allowing medics to enter the crime scene. The search was quick: The first paramedics, driving a sedan, arrived at 10:14 p.m. - five minutes after the first call for help. They were followed by an ambulance, a fire truck and a second ambulance.
Murray was sitting in the hallway, pawing the air, gasping for breath, a dark red stain spreading across his T-shirt.
``It was a very fast call, what we call a `scoop and run,' '' recalled David C. Baust, the Virginia Beach paramedic who with his wife, Sally, an emergency medical technician, were the first medical personnel on the scene.
``We recognized right away it was a gunshot wound to the chest,'' Baust said. ``I remember Mr. Murray was alert and he was talking, but he was pale and beginning to turn gray. He was going into shock.''
Recalling those anxious moments, Murray remembered additional details: ``I was crawling all over that guy, like a cat. I was pawing the air, clawing. Then I remember the oxygen mask . . .''
Time was crucial and Baust knew it. He immediately put an oxygen mask on Murray and began pumping oxygen at 80 percent concentration.
Blood was oozing from Murray's wound. Baust reached for an occlusive bandage, which comes pre-soaked in petroleum jelly. It would seal off his chest from the outside and slow the collapsing of Murray's lungs, caused by the bullet puncture and the growing pool of blood inside his chest.
Meanwhile, the robbers had escaped. While police scouted the scene looking for witnesses, the robbers, high school-age kids, had taken the pizza and money to a friend's apartment at St. Matthews Square. While the drama they had created unfolded outside, they ate the pizza, taking a moment now and then to look out the window at the flashing lights of police cars and ambulances. HIS WOUNDED HEART WAS IN DANGER OF SUFFOCATING IN ITS OWN BLOOD
In the hallway of building 2009, Baust picked up the pace. With a chest wound near the heart, Murray was at risk for a cardiac tamponade. It's a condition where fluid - in this case, blood - collects in the pericardial sac, the tough membrane that surrounds the heart.
With each beat of Murray's heart, blood spurted into the sac. The more it pumped, the more blood flowed into the sac. If it was not fixed, the sac would fill up, leaving the heart no room to beat. Murray would die, his heart suffocated in blood.
The paramedics elevated Murray's feet to keep as much blood as possible moving into his organs and stave off the effects of shock. Seven minutes had passed. They had done all they could.
They loaded him onto a stretcher and put him in the back of an ambulance. While en route, another paramedic pulled up Murray's sleeve, swabbed his arm with disinfectant, and inserted needles for two IVs of Ringer's lactate solution, a clear fluid that medics use to help wounded people maintain a proper volume of bodily fluids.
They drove down Regency Drive, turning east onto Wolfsnare Drive and north on First Colonial Road for the three-minute ride to Virginia Beach General. As they drove, they radioed ahead to the hospital that they were on their way. EMERGENCY ROOM TEAM SCURRIES TO GET OUT THE ``OH MY GOD TRAY''
In the emergency room, trauma nurses Leslie Keck and Patti Montes had heard the drama unfold over the hospital's trauma bay radio. The key phrase was burned in their minds: gunshot wound to the chest.
Their adrenalin jumped a notch. The ambulance was en route. They had little time. The overhead paging system announced, ``Trauma team alert. Stat.'' An operator set off trauma-team members' beepers. Keck and Montes ordered up the chest tray, which they called the ``Oh My God Tray.'' It contained instruments for on-the-spot chest surgery - clamps, scalpels, forceps, retractors - the items needed when the first reaction is: Oh my God! We gotta move fast!
They slipped on blue cloth gowns, rubber gloves and caps. They prepared the face masks and plastic face shields that would protect them from blood-borne diseases.
Dr. Gregory Schroder, the on-call trauma surgeon, checked his beeper. It was the emergency room number, followed by 911. He called the emergency room, learned of the chest wound, and headed for the trauma center.
Rescuers radioed that the patient had no radial pulse, or pulse at the wrist. They had found a brachial pulse higher on the arm.
Dr. Charles J. Devine III, on duty in the emergency room, knew that implied shock. It could be worse, he thought. There could be no pulse at all. The victim was a 36-year-old male who had been delivering pizza. The patient was confused, another sign of shock.
``Put in the intravenous line. Expedite transport,'' Devine told rescuers by radio.
Trauma team members knew the apartment complex was less than three minutes away by ambulance.
At 10:24 p.m. they heard the siren.
Moments later, the gurney burst through the double sliding doors.
Murray was leaning partly off the stretcher, disoriented. Rescuers on the run were trying to hold him down and give him oxygen.
They wheeled him across the white tile floor onto the gray floor of the bay that said ``Trauma'' in small blue letters over the door.
The fight to save James Murray had begun.
They quickly cut off his pizza-delivery uniform.
Murray was talking, and that was a good sign. He was complaining about everything: He didn't like the backboard. The chest X-ray plate was cold. He didn't like the rectal exam.
But other signs were bad. Murray was having trouble breathing. His face was turning blue. His neck veins bulged.
The team examined the wound where the bullet had entered his chest just to the left of the breastbone at about nipple-level.
The bullet had deflated the right lung, causing tension pneumothorax, or pressure building in the chest.
Still, his heart rate was good: 120.
Schroder used a scalpel to make an incision between Murray's fourth and fifth rib. Then, using a Kelly clamp, he opened a channel through the muscle that allowed him to insert a tube into Murray's chest cavity. A rush of blood filled the tube, telling surgeons the bleeding in Murray's chest was extensive. Devine inserted catheters and drew blood from large blood vessels in the groin to determine Murray's blood type for transfusion.
The anesthesiologist prepared a tube to provide oxygen. X-ray technicians took pictures to find the bullet. Lab workers took blood for analysis. Technicians secured intravenous lines.
Schroder pushed a needle into Murray's abdomen, sending a liter of IV fluid to rinse the cavity - a diagnostic procedure called a peritoneal lavage. The fluid that was siphoned out was bloody. That was not good: It meant Murray had major injuries in the abdomen.
Chest X-rays, back within minutes, showed a bullet lodged in the lower back behind the liver. The entrance wound was in the chest. Schroder could now make an educated guess at the path of the bullet. He was almost positive it had gone through the heart on its way to the liver.
He decided to open the abdomen first. It was the quickest way, without opening the chest, to determine if the heart was injured. The team would go up through the diaphragm into the pericardium, the sac that surrounds the heart.
He gave the order. The team prepared to do an exploratory laparotomy: open the abdomen.
At about 10:55 p.m., as they left the emergency room on the way to surgery, Murray's pulse suddenly speeded up.
Time was running out - 34 minutes had elapsed since Murray had been placed in the ambulance. DESPITE THE EXPERT WORK OF DOCTORS, THE PATIENT'S HEART HAD STOPPED
Murray asked for his wife until he lost consciousness as the team ran the gurney down the hall toward the operating room. They smacked their hands on the square metal buttons on the walls, opening three series of automatic wooden doors.
A right turn, then another, wheeling the corners. The noise level rose as voices conveyed information in the rush. Trained ears listened only for voices that would carry the specific information they needed. It was a cacophony of commands, information and questions.
``Get the chest tray.''
``Make sure we have the sternal saw in the room.''
``Get the aortic cross clamp.''
``Tell the blood bank we need blood as soon as they can get it to us.''
The surgery team swept Murray off the gurney and onto the operating table.
Surgeons skipped the usual washups. Technicians skipped the normal careful sterile prep of the patient. Those luxuries are forgotten when death is imminent.
Instead, the surgeons put towels around Murray's chest to create a sterile field.
As in the emergency room, the team was well-rehearsed. Operating room nurse Michele Hughes sponged Murray's chest and abdomen with Betadine, a red-brown sterilizing solution. There was no time to shave the hair off his chest.
Nurse anesthetist Rosalind Hensor added drugs to the IV: Versed, a tranquilizer; Fentanyl, a narcotic; and sodium pentothal, an induction agent to put the patient to sleep.
Hensor inserted the endotracheal tube down Murray's throat to supply 100 percent oxygen. Dr. William Stickley started bags of blood pumping through two IV lines.
Murray's blood pressure when he came into the operating room was 120 over 82 with a pulse of 108. His heart rate was climbing. That alarmed Hensor.
``He's a little tachy,'' Hensor told the surgeons. His heart was beating too fast. ``His heart rate's 124. His blood pressure's down a bit.''
Within minutes, his pressure fell to 94 over 52. They had to go in.
``Give me the knife,'' Schroder said. ``Let's get in there.''
At 11 p.m., Schroder sliced through the skin six inches down from the breastbone and opened the abdomen. Inside were massive amounts of blood. They had to get control.
The procedure was silent, practiced, choreographed. As one hand moved, another was set in motion, and a third. As one nodded, another caught the signal. They didn't have to say, ``Are you ready?'' They knew. There was no time, or need, for small talk.
Schroder packed the liver wounds, applying pressure to slow the bleeding.
At about 11:10, 15 minutes into surgery, Hensor suddenly called out: ``His heart rate's starting to drop.''
Murray's heart rate, which had raced to a peak of 126, suddenly plummeted. His pulse fell to 106, his blood pressure to 86 over 44.
It was a bad sign.
Another trauma surgeon, Dr. Thomas Clifford Jr., joined Schroder at the table. By about 11:15 p.m., Murray's blood pressure had fallen to 60 over 22, with a heart rate of 76.
They were losing him.
The two surgeons could see the bottom of the pericardial sac which surrounds the heart, bulging. That meant the organ was at risk of drowning in its own blood.
Schroder asked for scissors, quickly cutting a hole in the sac to create a ``window.'' Normally, clear fluid would pour out. Instead, blood and clots slid out.
``He's getting bradycardic,'' Hensor urgently told the surgeons. His heart rate was dropping fast.
``50! 40! 30!,'' Hensor yelled out the slipping heart rate. Then: ``We've got asystole.''
James Murray's heart had stopped. THE DOCTOR HELD THE QUIVERING HEART IN HIS HAND, SEARCHING FOR A WOUND
Schroder poked his fingers through the pericardial window, pulling out more clots, trying to stimulate the heart with his fingers, but the space was too small. The heart would not restart.
It was time to open the chest.
``Get the sternal saw ready,'' Schroder said. ``Give me a knife to open up the chest.''
Murray was dying. Within minutes, there would be no saving him.
Schroder took the scalpel and sliced open Murray's chest, starting below the neck and ending at the incision already in the abdomen. He pulled back the skin, exposing the breastbone.
``Stop bagging his lungs,'' he told Hensor. The heart is directly under the sternum. Any movement as he sawed through the sternum could be catastrophic.
An operating room technician handed him the sternal saw.
``Saw on,'' Schroder said, lowering the small whirring electric saw to the breast bone. He held the cylindrical saw in one hand, using it to cut through the center of the sternum and expose the heart.
He inserted the sternal spreader, cranking it open. With the ribs spread open, the heart lay quivering before him.
Using a scalpel, Schroder opened the rest of the pericardial sac and pulled away remaining clots. The heart was not beating, and blood was leaking from the pencil-sized hole in the right atrium. That's where the bullet had entered.
Schroder used the quickest, most effective remedy he knew. He plugged the hole with his finger.
The surgeons conferred. They knew there had to be another hole in the heart where the bullet had come out. They quickly put four staples in the first hole as a temporary measure, then began looking for the other hole.
The anesthesiologist pumped more blood into the IVs, trying to keep the heart full of fluid. As pressure slowly built, the surgeons saw blood seeping from behind the heart.
Schroder carefully held the heart in his hand, lifting it slightly to look behind it.
Clifford spotted a small hole in inferior vena cava, a large vein that brings blood to the heart from the legs and abdomen. Clifford applied pressure to the hole with his hand to stop the leak.
Schroder held the heart out of the way with one hand, using a sucker tube with the other to vacuum blood from the area so Dr. Clifford could see.
It was an awkward maneuver. Clifford used a needle driver to hold the suture and reached around behind the heart to make two quick stitches. Then he quickly came back to the front, stitching over the temporary staples.
Nearly two minutes had gone by. They had to start the heart. The surgeons inserted a needle with a syringeful of stimulant into the heart to prime it for the shock.
Quickly, they put two internal defibrillator paddles - small, rounded flat lollipop-shaped devices - on either side of the heart.
They administered a shock to the heart. It jumped slightly, then lay still. They tripled the voltage and shocked it again. This time the heart lurched to a start, beating quickly, if a bit irregularly. Then it began to take on a regular rhythm.
Hensor charted Murray's progress.
Pulse, 32, up to 40, then 60. The heart rate climbed slowly.
As more blood - 13 units by the time they finished, roughly 13 cups - was pumped into the heart, it beat more and more efficiently.
By 11:30, the immediate crisis was over.
For the next 15 minutes, Murray's pressure and rate slowly increased and stabilized. His heart rate would vary from 120 to 130 for the next hour and a half of surgery. His blood pressure stayed between 80 over 30 and 100 over 60.
For the next hour, surgeons finished their work on the heart, closing ``bleeders'' - areas that continued to leak blood - inserting drainage tubes around the heart, and reconnecting the sternum with metal wires.
Then, a new and equally critical problem arose. Murray's chest and abdomen had been open, his major organs exposed for nearly two hours. He had lost substantial body heat. Hypothermia was setting in and his blood wouldn't clot.
Surgeons knew if they didn't warm him up and get the blood to clot, Murray would die.
They were out of time. And they hadn't even gotten to the liver wound yet. They had gotten control of the cardiac problems, but repairing the liver would jeopardize his life.
The surgeons decided to fight that battle another day.
Schroder packed nearly a dozen absorbent pads around the liver and closed Murray up with clips and bandages, not taking time to suture.
At 1:05, they wheeled Murray into the intensive care unit. Clotting materials were added to his IVs. He was given morphine for pain, and another drug, Norcuron, to keep him from moving and damaging himself.
He was lifted onto a warming bed under heat lamps called ``French Fry Lights.''
Within 15 minutes, he opened his eyes and looked up at ICU nurse Melissa Burdette. In another hour, he was alert enough to answer questions.
Murray had no idea where he was or how he had gotten there. Burdette told him he had been in surgery and was doing fine. She told him his wife was there and they'd let her in as soon as they could.
Schroder pulled up a chair and sat beside Murray's bed. The physician's mind was still racing, but he was beginning to slow down for the first time in hours.
``It was 2 in the morning. The adrenalin is starting to wear off and you're getting tired,'' Schroder remembered. ``You're trying to think of everything you need. I wasn't going to go home. If something happened, I wanted to be there in case we had to go back into surgery.
``At that point I was tired and thankful, thankful for a lot of things. One, that I'd had the experiences during my training. I'd seen patients shot in the chest and lost some.
``I felt good, but you think about the ones you've lost. You're thinking about a million different things. `Boy, I'm glad he was only a couple blocks away. I'm glad Dr. Clifford got there to help me.' And you're proud of everybody, 'cause everybody did a hell of a job.'' ``I DIDN'T EXPECT TO PUT MY LIFE ON THE LINE IN THE UNITED STATES''
Twenty-four hours later, Schroder and Clifford removed the bloody packs and stitched up the wounds to Murray's liver. They decided to leave the bullet in the back muscles rather than risk further surgery.
For two weeks, Murray lay in intensive care, struggling to make sense of the crime that had shattered his life. To help him cope with the psychological scars, the hospital brought in Scott W. Sautter, a clinical neuropsychologist.
``His eyes were wide open,'' Sautter said. ``He was pale. He spoke slowly. He struck me as someone who was still stunned, psychologically, in shock. He said, `I'm at a loss of what to do, or how to feel.' ''
On Nov. 14, Murray checked out of Virginia Beach General Hospital. A ribbon of purple scar tissue ran from belly button to the base of his neck. He faced an uncertain future.
He developed anxieties about open spaces, about being outside at night, about people moving in his peripheral vision, about young black men. His three attackers were black.
The race question was perhaps the most troubling. Murray had had few opportunities to interact in a positive way with young black men until about a month ago.
``He recently found out that his neighbors are two young black men who are cameramen for two separate TV stations,'' Sautter said. ``He had a positive interaction with them, so he used that as a theme to balance his feelings about young black men afterward.''
Murray is again working for Chanello's, but in a desk job. His rehabilitation continues today. He still has a burning sensation near the entrance wound and pain under his chest if he works too many hours.
Murray has returned to court numerous times to testify against the three teenagers accused of robbing him. All were certified as adults in a juvenile hearing. Two have been convicted in Circuit Court.
Curtis Brandon, the triggerman, was sentenced to 53 years. Brandon had turned 16 less than two weeks before the robbery. Jose Blake, 17 at the time of the robbery, was sentenced to 55 years for Murray's robbery, with 30 years suspended. The third suspect, Terrance Paige, 18 when the crime occurred, fled the state last week.
Murray dreams of being a computer electronics technician. His job as a deliveryman had paid the school bills.
``The scars are always a reminder, but at least I'm alive,'' said Murray, an Army veteran of Operation Desert Storm. ``I can endure. I put my life on the line in Saudi, but I didn't expect to put my life on the line in the United States. I guess we're in some kind of war here, too.'' ILLUSTRATION: Staff graphic by JOHN EARLE/Staff color photo by CHRIS REDDICK\
James H. Murray sometimes feels a burning sensation and pain in his
chest from being shot in the heart while delivering a pizza. And he
has a long scar. But he's still alive for his wife and 3-year-old
son.
SOURCE: Virginia Beach General Hospital, World Book Encyclopedia
[For complete graphic, please see microfilm]
Photos
CHRISTOPHER REDDICK/
Staff
Dr. Thomas Clifford Jr., trauma surgeon: Joining the surgery after
it had begun, he plugged a hole in Murray's inferior vena cava with
his hand before sewing it up with two quick sutures.
Michele Hughes, operating room nurse: As James H. Murray's life
slipped away, the surgical team performed a silent, choreographed
dance with death.
Rosalind Hensor, nurse anesthetist: ``50! 40! 30!'' she said, giving
surgeons the countdown as their patients' heart weakened and then
stopped beating.
On the night that he was shot in the chest, James H. Murray was
lucky to have these people from Virginia Beach General Hospital
behind him: from left, Michele Hughes, operating room nurse; Melissa
Burdette, intensive care unit nurse, Rosalind Hensor, anesthetist;
Leslie Keck, trauma nurse, Dr. Thomas Clifford Jr., surgeon; and
Patti Montes, trauma nurse. They helped save his life.
Photos
Jose Blake, who was 17 at the time of the robbery, was sentenced to
55 years, with 30 years suspended. There was less than $20 in the
money bag taken from James H. Murray.
Curtis Brandon, the triggerman, was sentenced to 53 years for
robbing and shooting James H. Murray. Brandon had turned 16 less
than two weeks before the crime.
Terrance Paige was 18 when the robbery and shooting occurred in
Virginia Beach on Oct. 30, 1993. The third suspect in the case,
Paige fled the state last week.
Photo
D. KEVIN ELLIOTT/Staff
Dr. Gregory Schroder, trauma surgeon: At one point during the
surgery, the doctor had to use his finger to plug a hole in James H.
Murray's heart. This chest retractor, at left, is a tool used in
open-heart surgery to spread the rib cage apart and allow access to
the heart.
KEYWORDS: SHOOTING INJURIES ROBBERIES ARREST
TRIAL SENTENCING RESCUE SURGERY by CNB