Boy Survives After Being Spiked Through Heart : Medicine: Surgeon calls his survival 'one in a billion.' The child asked to play Nintendo after awakening from surgery.

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Justin Stiner, who used to have the ascending inclinations of Spiderman, doesn't climb anything nowadays.

No trees. No walls. And especially no rooftops. It's terra firma for this 9-year-old.

That's understandable for someone who has fallen off a roof and spiked himself through the heart and jugular vein on a 4-foot steel rod, millimeters away from sudden death. Survival was amazing. His story:

- Strapped to a board with the threaded rod inside him, he was flown by helicopter 75 miles from one hospital to another, not bleeding a drop during the 3 1/2 hours he was impaled.

- On awakening from open-heart surgery in which the pole was unscrewed from his heart, he asked to play Nintendo.

- He went home only four days later.

"One in a billion," one of his surgeons, Dr. Phillip Richemont, said after the operation on Nov. 12.

The third-grader took no pain medication after his third day in post-surgery. He missed only seven days of school.

"They kept telling me, 'It doesn't work like this usually,' " said his mother, Amanda Stiner. "The doctor told me, 'You can take him home. There's nothing we can do for him here that you can't do for him at home.' "

But Justin's brush with death has changed him, she said.

From the blissful anonymity of a normal, active, adventuresome kid, he has been cast in the unaccustomed, often-uncomfortable glare of national attention. People around the world have written him, sent him everything from teddy bears to a fire chief's cap to good wishes.

Justin's story has been grist for the tabloids.

He has been flown to the world Nintendo championships, appeared on a syndicated television show and on a talk show in Seattle, and will be riding in a wagon train through New England this summer, courtesy of a pro football player's largess.

There was a scare or two. Richemont recalls talking with Amanda Stiner a week after Justin's release and learning that he was "back to Evel Knievel"--sliding down the stair rail.

That activity was quickly stopped, and Justin faced restrictions at school until January. Books and Game Boy action substituted for outdoor recesses. There was no physical education.

The experience, and the scarring on his chest and neck, have made Justin self-conscious and, his mom said, "a little cocky too, like, 'I can go through anything now.' "

The ordeal certainly put his family on what she calls "a roller coaster of emotions." They were already trying to deal with his single mother's joblessness, his grandfather's serious illness and his aunt's and uncle's military duty in Saudi Arabia.

"He's real sensitive now," his mother said. "Before, he was real quiet. He was really rambunctious, but he was pretty quiet. Now, you can't shut him up anymore. He talks all the time."

Well, not around reporters. Or doctors.

"It's always like pulling teeth to get him to talk," said Richemont, who is completing a residency in trauma surgery at the University of Arizona.

Justin has his favorites, including the Los Angeles Raiders, M. C. Hammer, a teddy bear that sings Christmas songs, lunch as the best part of school. And not liking liver.

Ask the 4-foot-10, 86-pound youngster if he's tired of being grilled by reporters and you get a grunt in the affirmative.

Ask him if he thinks a lot about his accident and he half-shrugs, half-mutters, "Yes." Ask him if it bothers him, and you get no reply.

"He won't talk about it to anybody," said his mother. "He just says, 'I fell.'

"I don't think he realizes what really happened. And I've tried to explain it to him." She said she thinks he views it as "OK, I fell, it's over with."

Amanda Stiner said Justin was, and wasn't, a daredevil before his accident.

"Whatever he wanted to do he pretty much did it. He loved to climb. He was always climbing. Ever since he's been a baby, learning to walk, he's climbed. And now you can't even joke with him about climbing."

But back on Veterans' Day, it was different.

Justin, then 8, was playing at the home of George and Gertrude Howard, grandparents of a friend. He decided to climb onto the roof.

In the yard, threaded steel poles stuck out of the ground, staking the Howards' gardenias.

Justin slipped, later telling doctors that "it was like falling in slow motion." One of the half-inch-thick rods broke his fall, but pierced his body.

With his feet pointed toward the ground, the rod plunged into his abdomen above his navel and below his breastbone. The rod tore its way through the bottom of his heart's right ventricle, exiting through the top of that chamber, skimming within millimeters over the aorta and pulmonary arteries.

Had it pierced either, he would have bled to death in minutes.

It slammed through the thymus gland and ripped the right interior jugular vein diagonally, severing it. It skimmed off the carotid artery but did not leave his neck.

Justin dangled on the pole, about 2 feet off the ground, for about 20 minutes before Sierra Vista paramedics snipped off a portion of the rod without disturbing the 18-inch section inside his body. The boy was awake and alert the whole time. He did not cry.

"He was kind of shook up, but we were able to calm him down and he was just fabulous all the rest of the way," said Sierra Vista-Fry Fire Department paramedic Larry Townsend. "He was scared and it hurt, there was no doubt about it. But there he was talking to us, asking us to please pull it out. He never went into shock."

Richemont remembers Justin being "calmer than I was . . . like, 'Oh, hi, there's a rod in my chest and surely you're gonna take it out, right?' He was very matter-of-fact, truly."

He said he had the feeling that the boy "wasn't thinking, 'I'm gonna die.' He's thinking, 'Man, Mom's gonna really get mad at me for this one.' "

Richemont said Justin was a polite, quiet, "stoic kid."

But older sister Nicole, 12, who was inside the house when he fell, was nearly a basket case. So was their mother, who had been in Tucson at the time and arrived at the Howards' house to pick up her children, only to learn that Justin had fallen on a rod and had been taken to a Sierra Vista hospital. There, she learned he had been flown to Tucson.

As friends drove her back to Tucson, to University Medical Center, they kept talking, trying to calm her. Justin's surgery began 10 minutes before she got there. In the chapel, she "kept asking God to let him live and let him grow old."

Justin's mother said in retrospect that she wouldn't have been able to handle seeing her son lying there with a rod protruding from his body.

Weeks later, the Sierra Vista City Council honored firefighters, paramedics, technicians and policemen for helping save Justin. She recalls that while they were going to the ceremony, her son said: "If I'd realized where that rod was, I would have really cried."

Richemont said the paramedics' care in the early going helped assure Justin's success, along with "conservative management" in the operating room.

He, heart surgeon Dr. Luis Rosado-Lopez and Dr. Michael Esser, another trauma surgeon, evaluated the injuries. They first clamped and tied off the destroyed jugular vein. Next came the thymus, then the heart.

Richemont and Esser said the significantly lower blood pressure on the right, venous side of the heart accounted largely for the lack of bleeding. "But inside, we're all going, 'C'mon, man, nothing? No blood?' It's pretty lucky," Richemont said.

Another factor was that the rod was threaded. "The holes that it made were so clean and the heart actually was sealed around this thing," he added. "It had contracted down around the thread."

Justin was placed on a heart-bypass machine for about 11 minutes while the surgeons unscrewed the rod through the heart, with sutures like fishing-wire in place ready to tighten and seal each hole as it was vacated. The procedure also minimized the bleeding that finally occurred. They flushed and irrigated the wounds with antibiotics, administered immunoglobulin to prevent tetanus and wired his chest together again. The operation took 2 hours, 20 minutes.

Then they began worrying, because "things were going almost too well," Richemont said. Concerned about damage to the child's belly, they ran tests and aggressively looked for some sort of blunt injury.

Then they waited. And marveled.

Richemont said Justin is alive because he did not go into shock, which in his condition would have been life-threatening.

He also said it's possible that the rod's serendipitous path through Justin's body will have a significant positive impact on the child, where "he's more introspective, values his life, starts thinking about what he's doing and the consequences of it."

But he questions whether Justin truly comprehends the seriousness of his injury. "I think if you really comprehend it, you wouldn't be going home and going sliding down the stair rail," he said.

Amanda Stiner agrees that maybe the incident "has made him a little wiser. He thinks about doing things now before he does them."

She said that he was spontaneous before. "See a tree, climb it. Now, he'll be playing outside, and he'll stop and maybe think about what he's supposed to be doing, and he'll walk away. I think common sense comes in and takes over now."

She also said, though, that as Justin's chest pain has subsided, he has become more physical in play and resumed some sports activity.

Justin's accident stirred many sympathies. Letters poured in from Buffalo, N.Y., to Tacoma, Wash. Amanda Stiner has newspaper clippings from across much of the globe, including Germany and Canada.

New England Patriots' tight end Zeke Mowatt sent Justin and Nicole Christmas presents, including a Patriots' sweat suit that Justin wears "all the time," his mother said. He also arranged for Justin to go on a horse-drawn wagon train this summer.

The weeklong trip is provided through the Great American Wagon Train Foundation, of which Mowatt is honorary chairman. It provides the trips for children who have sustained hardships.

Amanda Stiner is still adjusting to the harrowing experience. "I don't want him out of my sight."

She said she'll never be able to say enough about the paramedics. "How can you ever thank somebody enough for giving you back your son's life?"

She said she agrees with Gertrude Howard, the woman whose roof Justin tumbled from, who told her: "God has great things in mind for Justin, because what happened had to have been a miracle."

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