Remembering the surgery inside the freeway collapse

Here he was, twenty years later, in surgical scrubs and a white physician’s lab coat with his name embroidered on the pocket: James Betts, M.D.  He has gray in his hair now, but not much. He said hello, sat down at a Children’s Hospital conference room table, waited for the three reporters’ video cameras to get him in focus, and then started talking, just like that.  He described the swaying hospital building, the urgent drive down to the smashed freeway overpass in a station wagon loaded with medical people and pediatric emergency equipment, the sixty-foot climb up a firefighters’ ladder to a car that was crushed under five hundred tons of broken freeway.  A six-year-old boy was inside.  Both his legs were pinned, one under a seat containing an adult’s dead body. But the boy was alive.

“The whole space we were working in was about four and a half feet, at most, and there were a number of individuals there,” Betts said.

His voice was even. No one interrupted to ask a question. He was telling the whole story in one enormous paragraph, including the part where the emergency workers had to request a chain saw to clear away room for him to perform an amputation while lying on his stomach inside the freeway smashings with the police down below yelling up at them that they needed to get out of there because aftershocks could bring the rest of the freeway down with all of them trapped inside it. “We were committed to staying there until either this boy had died, had no life, or we were going to free him,” Betts said. “We were not going to come down.”

Dr. James Betts of Children’s Hospital speaks to reporters about the 1989 Loma Prieta earthquake on Wednesday, Oct. 14, 2009

I seem to remember this about him from twenty years ago, also, the simplicity with which he explained what had occurred.  We were all altered that night by shock and astonishment, though, and I assumed then that he was, too; the Loma Prieta earthquake had struck at 5:04 p.m., and many of us, emergency workers and reporters alike, had converged in West Oakland, where we were told a two-decker length of Interstate 880 had pancaked.  That Cypress Freeway, as that overpass was called, was a monumental structure in the most literal sense, a gray mass of concrete as high as an office building, and when I first got there in the early evening I remember also that I looked up and felt dizzy and sick, as though I were staring at a body that had been disemboweled.  The ripped freeway had opened a great cross-section of gigantic construction innards that sprawled and jutted and smoked and hissed.  Parts of cars were visible inside the striations of concrete and metal, but the whole arrangement made no sense; you couldn’t understand what was roadway and what was broken piling, and on the ground were cars upside down and jerked over at weird angles between the fire trucks and improvised emergency equipment, and at one spot below the overpass a crowd of medical workers had gathered at the base of a long ladder that stretched right up into the mess overhead.

That–two stories above us, that is, inside the mess–was where James Betts, stretched out belly-down on a backboard to help keep his own weight from crushing his patient, was preparing to operate on the boy.

No one knew the boy’s name.  Now we do: It was Julio Berumen, and the two dead adults in the car with him were not both his parents, as Betts feared when he was in there, but rather his mother and an adult friend.  (The friend was female. Much later, it occurred to me to wonder:  Why would he think that was the boy’s father? Then I imagined what Betts might have seen, what would have been visible inside the flattened front part of the car caught directly under plummeting concrete, and I was glad I had not asked.)

“One little whimper,” a man from the West Oakland neighborhood told us, down on the street in the darkness, as we watched to see what would happen up at the top of the ladder.  The man had been the first person to reach the car after the earthquake, and that’s what he said he heard from the boy, Julio. “Just the one little whimper,” the man said. “The boy couldn’t talk.”  There was an older sister in the back seat with the boy, the man told us; she had survived the impact too, and had already been taken away by ambulance. But the boy was too wedged in to extract.

James Betts, three days ago, now continuing his story:  “It was obvious when I looked at this child that his right leg would need to be amputated at the knee. There was no way to remove the 500 tons, or whatever the upper deck weighed, from the weight that was resting on his leg.  We started some intravenous lines…He was breathing on his own, but was comatose, was not communicating… I felt we needed somehow to remove a portion of the body that was sitting in the passenger seat, in order to somehow be able to facilitate my lying down reaching on stomach.  I remember clearly noticing that this person had a wedding ring on. I thought it was his mother.”  It was not, it turns out; his mother was the person in the other seat.  But Betts didn’t know that then.  “And I thought there was should be some way to be able to retrieve the ring on the finger, in order to be able to salvage something for this child.”

So.  Get the ring.  But also, they decided, the body had to be cleared out of the way, so they could reach the boy’s leg.  There was only one way they could think to do it.  “We made a decision to use one of the First Company’s chain saws,” Betts said. First Company were firefighters.  “It was a clinical decision we made quickly, very professionally, in full discussion with the medical team,” Betts said.  “The medical team went ahead and divided the body.  I put a tourniquet on the leg.”

If there was a single worst moment, Betts said, this was it.  He had a procedure to complete. He had lost count of exactly how many people were hunched with him into the broken concrete and squashed metal, with the intense halogen work lights pushing the temperature up to ninety until someone would turn a fan on and the dust would blow out and it would suddenly drop thirty degrees.  They had been there for hours.  Every shuddering aftershock appeared to increase the possibility that what was left of the structure would collapse.  He was afraid, Betts said–not of that, not of the collapse, but that he would fail.  He wanted so badly not to fail.

“I wasn’t certain we’d be able to do it successfully,” he said. “I was very afraid that doing that–” the operation, he meant–“was going to be a fatal event for this child.  That was something I just could not accept. I was lying on my stomach, the lights were right behind my stomach, it was burning my ears…and I literally was holding the artery that supplies the blood to lower portion of the leg between my fingers, because I couldn’t get anything down to this small area.”

He finished the amputation. Together they were able, finally, to bandage what remained of the boy’s leg. They took him to Children’s.  That was where I remember Betts emerging from the operating room twenty years ago to talk to us; it was 4:30 in the morning by that time, and he was in his scrubs, unshaven, gray around the eyes, and worried about shock and toxins that might be released into the boy’s lungs or kidneys.  But Julio had survived. They had saved his left leg.  And sometime after we left at dawn that morning, while Julio was in the intensive care unit, a man whose two children were missing came to Children’s to see whether they were there.

“As soon as his father came into the intensive care unit, he immediately recognized him, and said his name,” Betts said now, proceeding with his story. “I remember the shiver I got up and down my spine, when I realized there was a family member alive, and that all of the family was not lost in this event.  It gave me a lot of comfort.”

A few days later, Betts said, he finally went home.  He slept, but a nightmare pulled him awake. “A panic,” he said. “The horror of a dream that at the time we were trying to  extricate him, I just couldn’t free his leg, and he didn’t survive.”

Finally Betts finished, took a breath, was quiet for a moment, and gazed at the rest of us in the conference room. “There,” he said.  “I thought I had better just tell it.”

Somebody asked whether he’d been in touch with Julio Berumen recently, and he said no, the last time was about ten years ago, that the boy and his sister seemed to be doing all right then, but that Betts believes they have wanted to retain their privacy about what happened to them at the Cypress.

Somebody else asked: Did he feel like a hero?  Betts smiled; there was a twenty-year old People magazine on the conference table, with a big color photo of him in scrubs, and the word “hero” somewhere in its text.  “That term is not something I think is applicable,” he said. “All of us who were there, and there were thousands of people, people who didn’t have medical training, people who had law enforcement training. … My story is no different than any of their stories. It just so happens I’m a  physician.  Perhaps they were steelworkers, people walking down the street, firefighters, police officers.  People rose to what they had to do.”

Betts grew up in Vermont. He’s lived in California most of his life now–his house is in Alameda, on Harbor Bay Island–and he said he intends to stay.  There are fault lines in Vermont, too, Betts said, and hurricanes in Louisiana, and so on.  But he does not drive on congested freeway overpasses, he said, without looking for an escape route.  He’s been known to irritate other drivers, when elevated freeway traffic slows to a halt, by pulling into the emergency side lane and just waiting there in his car, nearer the edge, until the flow  of traffic picks up.  “It’s something I think about quite frequently,” Betts said. “As recently as last night, there was a 3.8 shaker in the East Bay. And I’m very concerned.  Because  I wonder how many of  us, how many of you, are prepared.”

Image: A portion of the Cypress Freeway after the 1989 Loma Prieta earthquake (Photo courtesy of the United States Geological Survey)