Beyond Trauma

Beyond Trauma

By Adam Klinker

The horrors of violence and war lay bare — raw and deeply personal — before Juan Asensio, MD. The renowned Creighton trauma surgeon, who, in his youth, fled Cuba with his family, has made it his mission to save lives, bring about physical healing, and passionately crusade for something even more enduring: peace.

 

In the 12th century, the Sovereign Military Hospitaller Order of Saint John of Jerusalem, already tasked with defending the Christian faith, was given another sacred charge — the protection of the poor and infirm.

In the intervening 900 years, the Hospitallers, now known as the Order of Malta, continue to regard their position as one aimed at any number of social ills, including war and poverty. It’s a mission a 21st century Knight of Malta, Juan Asensio, MD, has taken to heart in his role as the CHI Health Creighton University Medical Center’s chief of the Division of Trauma Surgery and Surgical Critical Care and a professor in the School of Medicine’s Department of Surgery.

Asensio has dedicated his life and a career spanning nearly four decades to the most complex issues in surgery under some of the most harrowing circumstances. As his forebears in the Order of Malta, he has ministered to the grievously wounded in battle. He has worked trauma centers in hospitals where the bloody tableau of gun violence plays out hourly. He has been up to his elbows in a patient’s chest with no cause for hope and yet he has hoped, all the same.

“My job has been to address the most difficult problems known in life, the impossible challenges in surgery,” says Asensio, who arrived at Creighton in 2014 after stints in Philadelphia, Los Angeles, Miami and Chicago, and as a senior distinguished professor of surgery and surgeon with the armed forces at Landstuhl Regional Medical Center in Germany, the closest hospital for treating casualties of the American conflicts in Iraq and Afghanistan. “I have been blessed by God with a set of talents, and I am using those talents. This is what we do. These are the blessings of God. Our profession is the natural guardian of human rights.”

From an early age, Asensio became adept at dealing with life’s traumas. Born poor in Havana amid the Cuban revolution, Asensio showed promise as a student and was taken from his parents and put into a military academy the Cuban government was using to build a new class of intellectuals. But as a 13-year-old, Asensio balked at what he saw happening under the regime of Fidel Castro and was thrown into prison. The intervention of an uncle with a high military rank and connections in the Communist Party of Cuba helped spring Asensio from prison. His family departed Cuba shortly thereafter.

“This was not a juvenile hall,” he recalls. “It was real prison in a communist totalitarian system. But we got out, and I have never been back. It’s a matter of principle. That the country of my birth could imprison me for independently thinking?”

The family landed in Chicago where they found refuge in residences operated under the auspices of the Jane Addams Hull House Association. Asensio attended the venerable Lake View High School and got good grades while working assorted jobs hauling trash, cleaning toilets, selling produce, driving cabs and even laying down rails for the Chicago Transit Authority’s trains.

“I’m American, man,” he says of his early introduction to his adopted country. “I came from nothing and went somewhere with the help of God.”

After earning his undergraduate degree at the University of Illinois, Asensio completed a medical degree at Rush Medical College in Chicago.

Then, during his surgical residency at Northwestern University, something upended Asensio’s world. The blood and the pain and the anguish with which he dealt nightly struck close to home as his younger brother, Alfredo, an Army veteran helping build gears for NASA’s space shuttle program, was killed during a carjacking.

“I was devastated,” Asensio says. “All of a sudden, the very disease I was fighting takes away my brother. It became sort of a calling card for me. From that moment, I decided I was going to do something about this violence. I was going to reach out to kids and show them what really happens in the aftermath of all the guns and drugs glamorized on TV. I wanted to show them what happens afterward, after you pull the trigger.”

From then on, and at each of his stops as a professor and trauma surgeon, Asensio has partnered with law enforcement, courts, jails and boards of education to meet with at-risk youth and talk about the wages of street violence and humanity’s sometimes basic inhumanity.

He presents to kids using a set of slides that includes vivid imagery of surgeries he’s performed on victims of such violence and on bodies that have suffered the insults of what Asensio calls humankind’s greatest ugliness: war. The pictures show legs mangled by mines, abdomens punctured by bullets and shrapnel, spilling their contents in great rubbery gouts of intestine and fascia. There are missing feet, hands, genitals. One photograph is taken from the shoulders up of a soldier. The head is missing.

Asensio estimates his outreach program has been heard by nearly 20,000 at-risk youth, police officers and medical personnel.

“As trauma surgeons, we’d like to put ourselves out of business,” he says. “Unfortunately, these are things that still happen. Through the portals of a trauma center come all of society’s problems: violence, drug and alcohol abuse, motor vehicle accidents, burns. People who show up here have experienced the very worst, the nightmare scenarios. And as trauma surgeons, as physicians, we have to ask ourselves what we can do to bring an end to the nightmare.”

For Maria Reyes, the nightmare was almost ever-present for her first 17 years, until her life intersected with Asensio’s in cataclysmic fashion.

Born in Honduras in the late 1970s, her father was murdered by political rivals when she was 6 and, with her mother and sisters, she fled to the U.S.

The family settled in the Pico-Union neighborhood of Los Angeles where, Reyes recalls, she and her siblings were often jolted from bed by the sounds of gunfire.

“When we first heard it, it was something new to us,” she says. “We would huddle together and pray and wait for the morning. But after you hear that for a while, you get used to it. And we did get used to it. It became normal and we lived it. Lived it every day.”

She recollects people shot in front of her, of watching people she knew bleed out and die in the streets.

In the early hours of Sept. 11, 1994, a 17-year-old Reyes was sitting in the passenger seat of a pickup truck that belonged to her boyfriend, at the time an active gang member, who was attempting to buy drugs at what he thought was a neutral site.

But as he approached the building, three members of a rival gang emerged. Words were exchanged, but it appeared the three men were going to let Reyes’ boyfriend leave without incident.

“We were just going to leave when I looked back, and there was a 14-year-old boy pointing a gun at me,” she remembers. “And all I heard were shots. Just shots. I could tell I was hit, but all I heard were just hollow sounds and I didn’t see any blood. But I knew I was hit, and I said, ‘Oh my God. This is where I die.’”

Reyes was struck multiple times in the arms, legs and torso. Her boyfriend was also hit but managed to drive the truck until the couple were stopped by police, who immediately called an ambulance.

“I could barely speak but I remember asking the paramedic in the ambulance: ‘Am I going to die?’” Reyes says. “He said he didn’t know but I was going to go right into surgery at USC General Hospital. I went into surgery. And I woke up 38 days later.”

At Los Angeles County/University of Southern California Medical Center’s Level I trauma unit, Asensio was waiting.

“She came in and right away, we could see it looked bad,” he remembers. “Here is this beautiful girl, 17, and her life is just hanging on. We started surgery and we thought we were going to lose her, and I said, ‘That’s not going to happen.’ And we thought we were going to have to amputate the arm, and I said, ‘Not on my watch.’ And little by little, we were able to save the girl and save her arm.”

A few days after Reyes awoke from a coma, she met Asensio.

“And he’s talking about the surgery he performed on me and about a skin graft that will help heal up the wound on my tummy, and it’s all this medical terminology I don’t understand,” she says. “And I have a tube in my throat, so I can’t speak. But I’m looking at this man and he’s saved my life. I can’t really explain what that feeling was like.”

After making a full recovery, both Reyes and her boyfriend joined Asensio in his crusade against gun violence. Reyes said she saw in Asensio a familiar accretion of stories in her own life. Asensio had lost a family member violently. He had also borne witness to the ferocity of political unrest that drove his family from his native land to the streets of an American inner city. And while different from her own Central American accent, his Cuban-inflected speech had a happy poetry that made her smile.

“He is such a great speaker and a great leader,” Reyes says. “His story resonates with kids. He understands the culture because he came from the streets, too. The kids listen to him. I know I listened to him.”

After her near-death encounter, Reyes returned to her education with a renewed purpose. She earned a college degree and has spent her career working in the nonprofit sector. She is presently the director of development at the Salvation Army’s Cascade Division in Portland, Oregon.

Twenty-three years later, she’s still in contact with the man who saved her life. On a recent Monday, she sent him a short video of how her arm — the one he saved through the minute patchings of vascular surgery — works just like it should. Asensio has countless other stories like Reyes’, stories from which he continues to draw important and bracing lessons from the often weary work of trauma surgery.

“Beautiful,” he says, taking in the video scene as Reyes showed the full range of motion of the arm. Watching, he breathes something between a sigh and a stifled sob. “We have gotten pretty good at this, having, unfortunately, done so much of it. But we operate on God’s creatures. We are artists. We sculpt living tissue and muscle. Just look at this. It’s a moment like this that makes you realize what any one person can do to help a person. You find your God-given talents, and you use them to try to help another person.”

Asensio has been the subject of more than 80 documentaries and television news segments detailing his surgical craft. The most prominent are a two-hour Discovery Channel film aired in 2006 when Asensio was serving a sabbatical at the University of Medicine and Dentistry of New Jersey in Newark that referred to Asensio as a “Medical Maverick,” and a 60 Minutes piece with Dan Rather from 2002 that styled him — in a nod to his actual knighthood — “The Crusader.”

In the swirling crush of blood and noise, pain and time, trauma surgery seems an unlikely place to find academic theory at work, but Asensio has earned the tag of nonconformist and innovator through careful study in the discipline.

Since arriving at Creighton, Asensio has found a new platform from which to operate and a new ally in Devendra Agrawal, PhD, MBA’04, MS’05, professor and chair of the Department of Clinical and Translational Science, where cutting-edge procedures in vascular surgery have been ongoing since the department’s formation a few years ago.

“Dr. Asensio has a great practicality about him,” says Agrawal, himself no stranger to pioneering medical technologies and procedures and who, with Asensio, has been pushing the boundaries of shock cardiac, thoracic and vascular surgeries and treatments in his lab. “He has a progressive philosophy to advance the science and the practice of trauma surgery in a way that is accessible to students and faculty. We are very lucky to have him at Creighton. The work in vascular surgery he’s doing, developing new techniques in repair and remodeling, these are crucial components of the curriculum in clinical and translational science.”

Complications in trauma surgery are legion and Asensio has seen them all, in cases from the seemingly casual violence of the streets to the exquisite cruelty of battlefield wounds. As part of the Senior Distinguished Visiting Surgeons Program sponsored by the United States armed forces, Asensio spent parts of a decade during the nation’s wars in Iraq and Afghanistan at Landstuhl in Germany, treating combat casualties.

In his role as a senior surgeon, Asensio was unsettled by the increasing brutality of each new case — the IED packed with nails, the daisy-chain explosives designed to go off to inflict death with the maximum of suffering, the land mines, the rocket-propelled grenades. Even so, Asensio was learning and relearning the tools necessary for his profession and more lessons to take home.

“We can’t cure the common cold, but we have phosphorous and fragment grenades,” he says. “Land mines are cheap. Nothing has changed except maybe the firepower. Somehow, we still think of war as the easier path. We think of prison as the easier part of treating the real diseases of poverty and ignorance. Yes, we treat the most difficult injuries in a trauma center. But tell me that war, poverty and lack of education are not the greatest diseases and injuries our society faces. I was born in poverty. I grew up in inner-city Chicago; I was a first-generation American kid who might have been lost on the streets. It’s time to invest and to evolve so more people, more Americans, can have the kind of lives where they are not living in a battleground.”

And in this, Asensio has also proved himself a maverick not only in his practice but in his ultimate responsibility as a surgeon and a humanitarian — and in the old undertaking of the Hospitallers.

“People might say that it’s not my area of expertise, to go into the roots of the problem,” Asensio says. “People might say that it’s just my job to perform the surgery. I work on the heart, the lungs, the internal organs, the vascular injuries. But science is not mutually exclusive of having a strong social conscience. 

“It says something to me that the Hospitallers are the only remaining order from the Crusades. These were men who saw battle and, having seen it, like I have, chose to seek the peace. In the midst of all that hell, they sought something higher — how to make it stop. Today’s Hospitallers are the inheritors. We seek the peace. As a trauma surgeon, engaged in the work of God Almighty, I seek that peace.”