Trauma in the ER
It was 5 pm on a cold November day. I was a third-year medical student heading into my first night on surgery call.
Changing into my scrubs, I wondered what it would be like. I knew that we had to carry a "trauma pager" and, when paged, get to the ER as fast as possible. There my job would be to listen as the ER physician called out his exam findings and enter them on a history-and-physical form.
I felt a mix of things. I was excited about the learning possibilities, but I also knew that whoever gets wheeled through the ER doors is someone's daughter, son, mother or father. I decided not to think too hard--I'd just take what came my way and organize my thoughts later.
The night started off slowly. I checked on a patient our team had operated on earlier and added a couple of people to the next day's surgery list. If the evening stayed this mellow, I might have time to study in the call room and get some sleep before rounds the next morning.
Around midnight, my pager went off: "29 y/o female; head on motor vehicle collision; laceration of head; compound fracture of right tibia."
The ER was hushed as the surgery, emergency, orthopedics and nursing teams waited for the patient, some chatting quietly about what the paramedics had told them over the phone. It was like sitting in the eye of a hurricane, knowing that chaos is poised to break through from outside.
Then the patient arrived. She didn't look good: she had an ugly head laceration to go with the fractured tibia, and her systolic blood pressure was in the 40s--too low to sustain life. After minutes that felt like hours, my surgery team took off with her toward the OR for exploratory surgery.
Wheeling her down the hall, I couldn't help remembering that this young woman--a newlywed, I'd just learned--was about my age. We passed her husband and several family members, their eyes filled with heartbreaking fear and sadness.
When we reached the OR, the chief resident called out, "Mike, scrub in, we need you!"
My answering burst of adrenaline reminded me of how I'd felt jumping out of an airplane at 15,000 feet during my first skydive. I was going to learn a lot! But my excitement faded as the enormity of the young woman's situation began to sink in.
Only moments after the first incision, we saw blood spilling out of her liver--so badly ruptured that it was unrecognizable. As the trauma surgeon did his best to stop the hemorrhage, the resident and I pressed our hands to other sites of bleeding. It was difficult to believe that a bit more than an hour ago the purplish clumps running through my fingers had been part of a fully functioning organ.
After an hour of trying, we knew that the woman's injuries were inoperable.
"This isn't working--the bleeding will never stop," my attending told us. "Let's pack in some sponges to slow the bleeding, close her back up and take her to the ICU. I don't want her to die here. I want her to be with her family."
Just ninety minutes ago, I reflected, this woman had been a healthy young newlywed who'd just gotten off the phone with her mother. Then, in one tragic second, her life was over.
Shortly afterwards, I went with my team members to the ICU, where the family members now encircled the patient's bed, looking at her and waiting.
The silence was eerie, broken only by scattered whispers. For me, the loudest noises were my own thoughts as I tried to make sense of what had just happened.
My focus shifted once the attending walked in. It was only a matter of time now before he broke the bad news; then the silence would be pierced by shrieks and sobs.
I found myself wondering how I should act once he'd told the family. Was I supposed to keep my distance and give them space? Or would that seem like indifference? Should I talk to them, express my condolences, even though they looked like they didn't want to be approached? It was confusing.
I decided that, at this stage of my medical career, I should watch my attending to see how he interacted with the family. Witnessing and learning seemed the best I could do.
So, as he spoke quietly with the woman's family, I paid attention from a respectful distance.
"I'm so sorry, we did everything we could," he said gently. "I'm so sorry for your loss."
Tears began to flow, but the family members also seemed appreciative. They gave their permission to take the patient off of life support.
My attending moved to the bedside. Silently, he sat down in a chair, reached over and took the dying young woman's hand. It's an image that will be etched in my mind for the rest of my life.
Sometimes you learn more than you bargained for.
All too often, I realized, we take for granted that we and our loved ones are living, breathing and healthy. All it takes is one instant's misfortune for that to be taken away.
I thought about how I'd sometimes gone weeks on end without communicating with my parents, brother and sister because I had "too much studying to do." I thought about how sad and empty I would feel if a loved one of mine were lying there dying in the ICU, especially if I'd been keeping a distance.
I changed out of my scrubs and headed to my car. Looking back on my weeks of absence as a son, brother and uncle, I asked myself, "Have I become one of those people who's placed his career ahead of his family and loved ones without even realizing it?" The thought was too much to bear.
Pulling up at my apartment complex, I turned off the car engine and reflected.
In that moment, I decided that I was no longer going to make excuses for not being present in the lives of the people closest to me. I realized that my accomplishments mean nothing unless I can share them with those I love.
And I knew that, of the many things I'd learned in my first night of surgery call, this was the biggest lesson of all.
About the author:
Michael Gutierrez, originally from Texas, is now in his final year of medical school at the University of Missouri-Kansas City School of Medicine. He plans on pursuing a career in internal medicine while continuing to write about his experiences as a medical student and, beginning in 2011, as a resident. Michael first became interested in writing as an undergraduate at Pepperdine University. He is an avid reader of historical nonfiction and a dedicated practitioner of Brazilian Jiu-Jitsu.