Mr. Specter.

area sufficient to allow us to gain control of the aorta, superior artery and the vena cava and the placement of vascular clamps across these vessels in order to stop the hemorrhage.
At this point, he was being given blood and of course, the suitable anesthesia measures which were oxygen under pressure. He did not require an anesthetic agent, I am told.

Mr. Specter.

Who told you that, Dr. Perry?
Dr. PERRY. I think one of the residents did, one of the anesthesia residents.

We at that point had restored his blood pressure. I don't know the exact recordings, but I was told subsequently it had returned to near normal levels since we had the bleeding controlled.

Mr. Specter.

What was the situation with respect to his respiration at that time?
Dr. PERRY. It was being assisted and controlled, of course, by anesthesiology. This was no problem. We had a tube in place and was breathing for him so he had no problem with respiration. This was completely under control of anesthesia. The blood pressure was controlled and we stopped for a moment to determine how we would best go about repairing the structures and which would have priority, all the bleeding had stopped but, as I recall, the clamping of the aorta at the level of the superior mesenteric artery means, of course, that you must prevent blood from entering the kidneys, and this in itself can be hazardous if extended, and therefore we decided this must be repaired immediately in order to restore blood into the kidneys and the lower portion of the body.
Then Dr. Jenkins informed me and Dr. Shires that his cardiac action was becoming weak, and I don't remember all the details surrounding the medications and the things ,that were done at this particular time, but he developed a backward cardiac failure, his heart slowed abruptly and the blood pressure fell again and it was apparent the tremendous blood loss he had had set the stage for irreversible shock and lack of pumping action from the heart although he was being given massive transfusions, I don't know the exact number, probably he had 10 or 12 units. I believe it is in the record.
At this point when they told me a cardiac arrest had occurred as a result of the hemorrhage and blood loss I took a knife and opened the left chest in the fourth interspace and reached in to massage his heart, and the heart was flabby, and dilated, and apparently contained very little blood.
I began to massage the heart, to maintain it as we infused the blood and was able to obtain a palpable pulse in the carotid vessels going to the. neck and into the head. We were unable to get the heart to go, and it began to fibrillate which is an uncoordinated motion of the muscles of the heart itself and the successive electrical shocks were applied with the defibrillator and to stimulate heart action, and we failed in this and the cardiac pacemaker was sewn in place, and it was handed to me by the thoracic surgery resident, and I sewed it into the heart to artificially induce heart action, this also was without benefit.
We were never able to restore effective heart action and then Dr. Jenkins informed us neurologically he was not responding, that his reflexes were gone, and he felt that he had expired.

Mr. Specter.

At approximately what time did that occur?
Dr. PERRY. I don't know, Mr. Specter, I would have to look at the record.

Mr. Specter.

At approximately how long after he arrived at the hospital did that occur?
Dr. PERRY. I don't know that either.

Mr. Specter.

Can you approximate the length of time of the operation itself?
Dr. PERRY. 45 minutes or so, I would say.

Mr. Specter.

Is there any question but that he was alive during the course of your operative procedures?
Dr. PERRY. Oh, no, no question. The fact is we were very close, I think, to winning the battle. We have seen injuries of this magnitude, they rarely survive, this is a very serious injury and to the best of my knowledge I have not seen anyone with this particular set of injuries survive. But at one point once we controlled the hemorrhage and once I had control of the aorta and was