How a rare Evansville murder almost took - then saved - the chief's life

By Kristy Bleizeffer Nov 22, 2013

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Evansville Police Chief Zachary Gentile poses at his desk recently. While investigating a rare Evansville homicide in July, he suffered a ruptured abdominal aortic aneurysm. He credits staff at Wyoming Medical Center for saving his life -- and for catching the cancer he didn't know he had. 

It’d been a long night and Zachary Gentile lay down almost as soon as he hit his front door.

A rare homicide had pulled Gentile and his Evansville officers out of bed just after midnight on July 25. A 21-year-old man allegedly shot another man in the parking lot of Taylor’s Sports Bar, and the officers worked the case for 12 straight hours. At noon, Gentile decided they needed a break, and he took his folks to lunch. His stomach started to hurt soon after arriving home.

“The pain was just astronomical. So, I went into the bathroom and I am sitting down and the pain got to the point where I could not breath, OK?” said Gentile, Evansville police chief. “I fell down, hit my head and cut my eye. My wife called the EMTs.”

Sometimes, Gentile jokes that he must have landed in the witness protection program to find himself in Evansville. He grew up in New York City, retired from Miami’s Metro Dade Police Department after 24 years, and came to Wyoming 15 years ago to take the chief job.

But he will tell anyone that asks that his care at Wyoming Medical Center rivals the care he would have gotten in cities 10 times the size of Casper.  The medical team here saved his life, he says, no two ways about it.

“I have run into a couple of nurses that were there. They are just amazed that I am actually back to work. They told me my condition is mostly discovered in an autopsy,” he said.

“So, yeah. I do feel thankful. It obviously was not my turn to go yet. I don’t know why I did not chip in, but here I am. And I am glad.”

***

Gentile bypassed the WMC emergency room for an immediate CT scan. His doctor and nurse noticed an 6-centimeter rupture in his aorta. Gentile didn’t have time to report back to the Emergency Room and wouldn’t survive an emergency flight.  Emergency staff called Dr. James Anderson who responded within five minutes to meet Gentile in surgery. Gentile’s aortic artery had ruptured, and he was bleeding into his abdomen.

A healthy aorta branches into smaller arteries, carrying blood to the kidneys, abdomen and legs.

A healthy aorta branches into smaller arteries, carrying blood to the kidneys, abdomen and legs.

An aneurysm forms when part of the aortic wall weakens and bulges out like a balloon. When an aneurysm ruptures, as in Zachary Gentile's case, it bleeds into the abdomen.

An aneurysm forms when part of the aortic wall weakens and bulges out like a balloon. When an aneurysm ruptures, as in Zachary Gentile's case, it bleeds into the abdomen.

An arteriogram of a healthy aorta (left) compared to an aortic aneurysm.

An arteriogram of a healthy aorta (left) compared to an aortic aneurysm.

“ER staff caught it and recognized that it was life threatening. If they did not catch it, who knows what would have happened,” Gentile said.

The aorta is the body’s largest artery, about the circumference of a garden hose. It carries oxygenated blood directly from the heart to the kidneys, abdomen and the lower body. A healthy artery is smooth inside allowing easy flow of the blood.

For years and without him knowing it, the lining of Gentile’s aorta had been growing weaker – a condition that likely ran in his family. His aorta bulged outwards like a balloon, stretching the walls and weakening them further. His blood pressure dropped, but he displayed no outward symptoms. At 170 pounds, he could have stood to lose a few pounds, but which of us couldn’t?

Then his phone rang shortly after midnight on July 25. His blood pressure almost certainly rose as he and his officers investigated the shooting at Taylor’s Bar, putting more pressure on his weak aortal walls. By the time he lay down for his nap, the walls could no longer withstand the pressure. His aorta ruptured.

“Murder is not something that happens in Evansville very often. Chief does a good job and he takes his job very seriously. I’m sure his blood pressure was elevated,” Anderson said.

Within about 20 minutes of Gentile's arrival at WMC, Anderson was in the operating room with his patient. Gentile had suffered a ruptured abdominal aortic aneurysm – a condition that is fatal if not immediately treated.

There are two ways to fix an aortic aneurysm, Anderson said. One is with a catheter inserted into two small incisions in the groin and threaded through the artery. Doctors place the graft inside the aneurysm using X-ray guidance. That wasn’t an option for Gentile.

“When the aneurysm is ruptured and the patient is bleeding to death, you don’t have time to get there with a catheter. You just open them up and put a clamp on the artery and sew the graft inside,” Anderson said.

The national survival rate for ruptured aortic aneurysms is about 50 percent, said Anderson who sees 8 to 10 such cases a year. When the patients get to the emergency room with a blood pressure, Wyoming Medical Center surgeons save about 95 percent of them.

That’s an advantage of having a community hospital with expertly trained specialists and subspecialists so close to where we live, Anderson said. In emergencies, patients recover more often when they are treated within a few minutes to a few hours following trauma. If patients must be transported to another hospital – especially in Wyoming where the next trauma center might be hours away and out of state – the delay in care increases the chances of death or a longer, more difficult recovery.

“There’s not many things we can’t take care of right here. Basically, we are so far from anywhere else that if we don’t take care of it here, they don’t do well,” Anderson said. “The hospital recognizes that if we make sure we provide the highest quality care that is available, people will come to see us. We as surgeons have committed to that.”

***

Gentile woke up the next day in the Intensive Care Unit. He considers himself lucky to be back at work, and knows how close he came to being Evansville’s second fatality that day.

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Zachary Gentile poses under the insignia of the Evansville Police Department. He is now back to work after doctors removed his kidney. 

He likes to tell people about the care he got at Wyoming Medical Center because he thinks it’s an asset the community is fortunate to have.

“I tell you what, those people in the Intensive Care Unit never left my side. I had one nurse assigned to me, and if I wanted something, they were there. I never had to use my call button because they were always there asking me if I was okay, checking on me, making sure I had my medications on time,” he said.

“I had to walk three to four times a day before they would let me go home. They were not pushy, but they let you know that, ‘Hey. You got to get your dead butt out of that bed and start walking, Jack, or you’re not going home.’ They treated me with respect and I appreciate that.

“As far as your cleaning folks, three to four times a day they were in there. The food was actually good. It really was. When you ordered it, it was up there and still hot.”

Gentile has since lost 35 pounds and makes sure he keeps his weight under 145. Because he’s had one aneurysm, he has a 10 to 15 percent chance of developing another. Doctors will monitor him at least annually for the rest of his life.

Getting to the hospital in time obviously saved Gentile’s life. It also probably caught his cancer and gave him more time with his three grandchildren.  In the process of all the tests, doctors spotted a mark on his left kidney. His doctor told him it was probably cancerous and the kidney should come out.  He recently underwent that procedure at Wyoming Medical Center.

“Well, you know, it is like the bad thing that happened to me was the ruptured aorta. But if I did not get it, I would have never known about this; so eventually, I would have died from it. One way or the other, bad things happened for good reasons.”

So what about that rare Evansville homicide, the stress of which likely started this medical odyssey? Did Gentile get his man?

“Of course we did,” Gentile said. “He goes to trial in December.”

Know your risk

Abdominal Aortic Aneurysm is often called a “silent” problem because it rarely causes symptoms. It’s often found by healthcare providers conducting other tests. The aneurysm could create a pulsatile abdominal mass – a pulsating in your stomach that you can feel, usually in people who are not overweight. Your doctor should be able to feel this and can easily diagnose the aneurysm with an ultrasound.

Anyone can develop this type of aneurysm, but certain factors increase the risk:

  • Having a family history
  • Smoking
  • Having high blood pressure
  • Having a blood vessel disease in another part of the body
  • Being over age 55 for men and 65 for women

Symptoms of a ruptured aneurysm

A ruptured Abdominal Aortic Aneurysm is a medical emergency that requires immediate treatment. Call 911 if you:

  • Have severe abdominal or back pain
  • Your blood pressure drops noticeably

James Anderson M.D.

Dr. Anderson is a general and vascular surgeon at Wyoming Surgical Associations. He grew up in Casper and graduated from Natrona County High School. After his residency, he returned to Casper with his wife and three sons. For 25 years, he was the only board-certified vascular surgeon in Wyoming. In fact, he was one of several highly trained specialists and subspecialists who came to Casper to build a full-fledged medical center in the middle of a rural state. He is board certified in general and vascular surgery.

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