Patients At Parkland
From State Journal of Medicine, dated January,
1964. It was written in late
November/early December, 1963 before the 'OFFICIAL'
story was set in stone.
THREE PATIENTS at PARKLAND
Memorial Hospital, Dallas, treats an average of
272 emergency cases a day. It is adjacent to and
is the major teaching hospital for the University
of Texas Southwestern Medical School. It is staffed
by the faculty of the medical school and has 150
interns and residents in all medical specialties.
It is a modern hospital, well equipped, one of
which any community might be proud. Today and for
none of these reasons-Parkland has a new reputation
all over the world, and historians are typing its
name into manuscripts that will be textbooks for
generations to come. This has happened because
three particular gunshot victims were carried there
out of the bright November sunlight, two to die
and the third to leave by wheelchair almost two
weeks later, his arm in a sling.
physicians have visited
Parkland hospital; many
have worked or trained
there. Members of the Parkland
staff are their acquaintances
and friends. Many Texas
physicians know personally
the surviving gunshot victim,
Gov. John Connally; some
personally knew President
John F. Kennedy, who died
in Trauma Room 1; perhaps
a few even knew Lee Harvey
Oswald, the man charged
by Dallas authorities with
the assassination of the
President and who was himself
shot two days later.
The assassination of President
Kennedy, the wounding of Governor Connally, and the
fatal shooting of Oswald are events of profound import
to people everywhere, but they have special, personal
meaning for Texans. So because a Texas hospital and
Texas physicians figured prominently in this tragedy,
the Texas State Journal of Medicine records for its
readers of the medical profession a full account
of treatment given a never-to-be-forgotten trio.
When President John F. Kennedy in a moribund condition
entered Parkland on Nov. 22, there was never opportunity
for medical history taking. Such a history, had it
been taken, would have shown that the patient "had
survived several illnesses, the danger of war, the
rigor of exposure in icy water, and . . . had waged
grueling electoral campaigns in spite of a serious
and painful back injury."
Parkland records show that the President arrived at the
emergency room sometime after 12:30 p.m. (There is
conflict as to the exact moment.) At 1 p.m. Dr. William
Kemp Clark, associate professor and chairman of the
Division of Neurosurgery of the University of Texas
Southwestern Medical School, declared him dead. During
the interim of less than 30 minutes, continuous resuscitative
efforts were made.
Later that day, several attending
physicians filed reports. The following identifies
these physicians and gives the gist of their reports:
Charles J Carrico - Dr. Carrico
was the first physician to see the President. A 1961
graduate of Southwestern Medical School, he is 28
and a resident in surgery at Parkland.
He reported that when the patient entered the emergency
room on an ambulance carriage he had slow agonal
respiratory efforts and occasional cardiac beats
detectable by auscultation. Two external wounds were
noted; one a small wound of the anterior neck in
the lower one third. The other wound had caused avulsion
of the occipitoparietal calvarium and shredded brain
tissue was present with profuse oozing. No pulse
or blood pressure were present. Pupils were bilaterally
dilated and fixed. A cuffed endotracheal tube was
inserted through the laryngoscope. A ragged wound
of the trachea was seen immediately below the larynx.
The tube was advanced past the laceration and the
cuff inflated. Respiration was instituted using a
respirator assistor on automatic cycling. Concurrently,
an intravenous infusion of lactated Ringer's solution
was begun via catheter placed in the right leg. Blood
was drawn for typing and crossmatching. Type 0 Rh
negative blood was obtained immediately.
In view of the tracheal injury and diminished breath
sounds in the right chest, tracheostomy was performed
by Dr. Malcolm 0. Perry and bilateral chest tubes
inserted. A second intravenous infusion was begun
in the left arm. In addition, Dr. M. T. Jenkins began
respiration with the anesthesia machine, cardiac
monitor and stimulator attached. Solu-Cortef (300
mg.) was given intravenously. Despite those measures,
blood pressure never returned. Only brief electrocardiographic
evidence of cardiac activity was obtained.Malcolm 0. Perry - Dr. Perry is
an assistant professor of surgery at Southwestern Medical
School from which he received his degree in 1955. He
was 34 years old and was certified by the American
Board of Surgery in 1963.
At the time of initial examination of the President,
Dr. Perry has stated, the patient was noted to be nonresponsive
. His eyes were deviated and the pupils dilated. A
considerable quantity of blood was noted on the patient,
the carriage, and the floor. A small wound was noted
in the midline of the neck in the lower third anteriorly.
It was exuding blood slowly. A large wound of the right
posterior cranium was noted, exposing severely lacerated
brain. Brain tissue was noted in the blood at the head
of the carriage.
Pulse or heart beat were not detectable but slow spasmodic
respiration was noted. An endotracheal tube was in
place and respiration was being controlled. An intravenous
infusion was being placed in the leg. While additional
venesections were done to administer fluids and blood,
a tracheostomy was effected. A right lateral injury
to the trachea was noted. The cuffed tracheostomy tube
was put in place as the endotracheal tube was withdrawn
and respirations continued. Closed chest cardiac massage
was instituted after placement of sealed-drainage chest
tubes, but without benefit. When electrocardiogram
evaluation revealed that no detectable electrical activity
existed in the heart, resuscitative attempts were abandoned.
The team of physicians determined that the patient
had expired.Charles R. Baxter - Dr. Baxter
is an assistant professor of surgery at Southwestern
Medical School where he first arrived as a medical
student in 1950. Except for two years away in the Army
he has been at Southwestern and Parkland ever since,
moving up from student to intern to resident to faculty
member. He is 34 and was certified by the American
Board of Surgery in 1963.
Recalling his attendance to President Kennedy, he says
he learned at approximately 12 :35 that the President
was on the way to the emergency room and that he had
been shot. When Dr. Baxter arrived in the emergency
room, he found an endotracheal tube in place and respirations
being assisted. A left chest tube was being inserted
and cut-downs were functioning in one leg and in the
left arm. The President had a wound in the midline
of the neck. On first observation of the other wounds,
portions of the right temporal and occipital bones
were missing and some of the brain was lying on the
table. The rest of the brain was extensively macerated
and contused. The pupils were fixed and deviated laterally
and were dilated. No pulse was detectable and ineffectual
respirations were being assisted. A tracheostomy was
performed by Dr. Perry and Dr. Baxter and a chest tube
was inserted into the right chest (second interspace
anteriorly). Meanwhile one pint of O negative blood
was administered without response. When all of these
measures were complete, no heart beat could be detected.
Closed chest massage was performed until a cardioscope
could be attached.
Brief cardiac activity was obtained followed by no
activity. Due to the extensive and irreparable brain
damage which existed and since there were no signs
of life, no further attempts were made at resuscitation.
Robert N. McClelland - Dr. McClelland,
34, assistant professor of surgery at Southwestern
Medical School, is a graduate of the University
of Texas Medical Branch in Galveston. He has
served with the Air Force in Germany and was
certified by the American Board of Surgery in
Regarding the assassination of President Kennedy,
Dr. McClelland says that at approximately 12:35
p.m. he was called from the second floor of the
hospital to the emergency room. When he arrived,
President Kennedy was being attended by Drs.
Perry, Baxter, Carrico, and Ronald Jones, chief
resident in surgery. The President was at that
time comatose from a massive gunshot wound of
the head with a fragment wound of the trachea.
An endotracheal tube had been placed and assisted
respiration started by Dr. Carrico who was on
duty in the emergency room when the President
arrived. Drs. Perry, Baxter, and McClelland performed
a tracheostomy for respiratory distress and tracheal
injury. Dr. Jones and Dr. Paul Peters, assistant
professor of surgery, ; inserted bilateral anterior
chest tubes for pneumothoraces secondary to the
tracheo-mediastinal injury. Dr. Jones and assistants
had started three cutdowns, giving blood and
In spite of this, the President was pronounced
dead at 1:00 p.m. by Dr. Clark, the neurosurgeon,
who arrived immediately after Dr. McClelland.
The cause of death, according to Dr. McClelland
was the massive head and brain injury from a
gunshot wound of the right side of the head.
The President was pronounced dead after external
cardiac massage failed and electrocardiographic
activity was gone.Fouad A, Bashour - Dr.
Bashour received his medical education at the
University of Beirut School of Medicine in Lebanon.
He is 39 and an associate professor of medicine
in cardiology at Southwestern Medical School.
At 12 :50 p.m. Dr. Bashour was called from the
first floor of the hospital and told that President
Kennedy had been shot. He and Dr. Donald Seldin,
professor and chairman of the Department of Internal
Medicine, went to the emergency room. Upon examination,
they found that the President had no pulsations,
no heart beats, no blood pressure. The oscilloscope
showed a complete standstill. The President was
declared dead at 1:00 p.m.
William Kemp Clark -
Dr. Clark is associate professor and chairman
of the Division of Neurosurgery at Southwestern
Medical School. The 38-year-old physician has
done research on head injuries and has been at
Southwestern since 1956.
He reports this account of the President's treatment:
The President arrived at the emergency room entrance
in the back seat of his limousine. Governor Connally
of Texas was also in this car. The first physician
to see the President was Dr. Carrico.
Dr. Carrico noted the President to have slow,
agonal respiratory efforts. He could hear a heart
beat but found no pulse or blood pressure. Two
external wounds, one in the lower third of the
anterior neck, the other in the occipital region
of the skull, were noted. Through the head wound,
blood and brain were extruding. Dr. Carrico inserted
a cuffed endotracheal tube and while doing so,
he noted a ragged wound of the trachea immediately
below the larynx.
At this time, Drs. Perry, Baxter, and Jones arrived.
Immediately thereafter, Dr. Jenkins and Drs.
A. H. Giesecke, Jr., and Jackie H. Hunt, two
other staff anesthesiologists, arrived. The endotracheal
tube had been connected to a respirator to assist
the President's breathing. An anesthesia machine
was substituted for this by Dr. Jenkins. Only
100 per cent oxygen was administered.
A cutdown was performed in the right ankle, and
a polyethylene catheter inserted in the vein.
An infusion of lactated Ringer's solution was
begun. Blood was drawn for typing and crossmatching,
but unmatched type O Rh negative blood was immediately
obtained and begun. Hydrocortisone (300 mg.)
was added to the intravenous fluids.
Dr. McClelland arrived to help in the President's
care. Drs. Perry, Baxter, and McClelland did
a tracheostomy. Considerable quantities of blood
were present in the President's oral pharynx.
At this time, Dr. Peters and Dr. Clark arrived.
Dr. Clark noted that the President had bled profusely
from the back of the head. There was a large
(3 by 3 cm.) amount of cerebral tissue present
on the cart. There was a smaller amount of cerebellar
tissue present also.
The tracheostomy was completed and the endotracheal
tube was withdrawn. Suction was used to remove
blood in the oral pharynx. A nasogastric tube
was passed into the stomach. Because of the likelihood
of mediastinal injury, anterior chest tubes were
placed in both pleural spaces. These were connected
to sealed underwater drainage.
Neurological examination revealed the President's
pupils to be widely dilated and fixed to light.
His eyes were divergent, being deviated outward;
a skew deviation from the horizontal was present.
No deep tendon reflexes or spontaneous movements
When Dr. Clark noted that there was no carotid
pulse, he began closed chest massage. A pulse
was obtained at the carotid and femoral levels.
Dr. Perry then took over the cardiac massage
so that Dr. Clark could evaluate the head wound.
There was a large wound beginning in the right
occiput extending into the parietal region. Much
of the right posterior skull, at brief examination,
appeared gone. The previously described extruding
brain was present. Profuse bleeding had occurred
and 1500 cc. of blood was estimated to be on
the drapes and floor of the emergency operating
room. Both cerebral and cerebellar tissue were
extruding from the wound.
By this time an electrocardiograph was hooked
up. There was brief electrical activity of the
heart which soon stopped.
The President was pronounced dead at 1:00 p.m.
by Dr. Clark.
M. T. Jenkins - Dr. Jenkins
is professor and chairman of the Department of
Anesthesiology at Southwestern Medical School.
He is 46, a graduate of the University of Texas
Medical Branch in Galveston, and was certified
by the American Board of Anesthesiology in 1952.
During World War II he served in the Navy as
a lieutenant commander.
When Dr. Jenkins was notified that the President
was being brought to the emergency room at Parkland,
he dispatched Drs. Giesecke and Hunt with an
anesthesia machine and resuscitative equipment
to the major surgical emergency room area. He
ran downstairs to find upon his arrival in the
emergency operating room that Dr. Carrico had
begun resuscitative efforts by introducing an
orotracheal tube, connecting it for controlled
ventilation to a Bennett intermittent positive
pressure breathing apparatus. Drs. Baxter, Perry,
and McClelland arrived at the same time and began
a tracheostomy and started the insertion of a
right chest tube, since there was also obvious
tracheal and chest damage. Drs. Peters and Clark
arrived simultaneously and immediately thereafter
assisted respectively with the insertion of the
right chest tube and with manual closed chest
cardiac compression to assure circulation. Dr.
Jenkins believes it evidence of the clear thinking
of the resuscitative team that the patient received
300 mg. hydrocortisone intravenously in the first
For better control of artificial ventilation,
Dr. Jenkins exchanged the intermittent positive
pressure breathing apparatus for an anesthesia
machine and continued artificial ventilation.
Dr. Gene Akin, a resident in anesthesiology,
and Dr. Giesecke connected a cardioscope to determine
During the progress of these activities, the
emergency room cart was elevated at the feet
in order to provide a Trendelenburg position,
a venous cutdown was performed on the right saphenous
vein and additional fluids were begun in a vein
in the left forearm while blood was ordered from
the blood bank. All of these activities were
completed by approximately 12:50 at which time
external cardiac massage was still being carried
out effectively by Dr. Clark as judged by a palpable
peripheral pulse. Despite these measures there
was only brief electrocardiographic evidence
of cardiac activity.
These described resuscitative activities were
indicated as of first importance, and after they
were carried out, attention was turned to other
evidences of injury. There was a great laceration
on the right side of the head (temporal and occipital),
causing a great defect in the skull plate so
that there was herniation and laceration of great
areas of the brain, even to the extent that part
of the right cerebellum had protruded from the
wound. There were also fragmented sections of
brain on the drapes of the emergency room cart.
With the institution of adequate cardiac compression,
there was a great flow of blood from the cranial
cavity, indicating that there was much vascular
damage as well as brain tissue damage. President
Kennedy was pronounced dead at 1 p.m.
It is Dr. Jenkins' personal feeling that all
methods of resuscitation were instituted expeditiously
and efficiently. However, he says, the cranial
and intracranial damage was of such magnitude
as to cause irreversible damage.