Summer: Trauma

So, here’s to reviving the blog! I’ve thought about writing an entry about every day this week…but I’ve been too lazy! So, if you’ve been feeling the same way—get off your bum and write something! I know that I would love to hear something from everyone, especially since we don’t get to talk all the time. I have special requests for recipes, anecdotes, new music, and book recommendations. And just as a warning…this is a long one! And might be a little gross.

Last weekend, I had the awesome privilege of “shadowing” a 2nd year resident on a trauma rotation. Excuse my use of words like “awesome” and “exciting” when writing about some of these events.

Saturday 7 January 2012 was not a good day for motorcyclists. You wouldn’t have guessed because it was a beautiful, clear day—blue skies and dry roads. One minute they’re cruising down smooth Texas highways, and the next they’re being flown in by AirLife.

It’s an odd feeling to be in a room with 2 coding people. Coding for these folks on this day meant their blood pressure was in the toilet. The room gets packed with residents, techs, nurses, police officers, the paramedics that delivered the patients. Everyone’s breathing the same air—stealing each other’s air, because it’s cramped in there. It’s like this team of people trying to save a life are all tangled up in each other, and yet they still operate like a well-oiled machine—at least to the eyes of an outsider, an observer, the one at the bottom of the totem pole. Hell, not even on the totem pole.

There’s the person taking notes in the corner while others yell out “Abrasion to left shoulder; deformed right shoulder; fractures to left arm, left thigh, and right arm; pupils non-reactive to light.” Pinching and poking, hoping to elicit a primitive pain reaction. The attending trauma surgeon calling for the blood bank, “8 units blood, 8 FFP, 7 units platelets.” The techs that are changing out suction tubing. The radiologists pushing films under the patient’s back to get preliminary x-rays. Nurses trying to find lines. Residents determining oxygen saturation by taking a small amount of blood.

And then. Then, things get a little crazier. Monitors beep. And it’s not even in an alarming way—it’s more like a chime. But the blood pressure is dropping. Time for chest tubes—to potentially decompress the lungs. To make sure that there isn’t blood in the thoracic cavity. A bottle of betadine gets squirted on the patients chest; residents dawn sterile gloves over the gowns they’ve already thrown on. If they had more time, this procedure would be done with more care. But there is not time. A blade is taken to a space between the ribs. Cut through the skin, fascia, fat, and intercostal muscles. The resident places his finger into the hole, wiggles, and then inserts a tube. Luckily, no blood comes gushing out. The patient is not bleeding from the chest.

But now they need to make sure there is no abdominal bleeding. They must do a FAST—Focused Assessment with Sonography in Trauma. A bedside evaluation with ultrasound. That all sounds much nicer then, “cutting open the belly to check for bleeding.” After finding nothing, they staple his skin closed. And move on. It’s fix one thing and move on, fix and move on, until the patient is stable enough to get a CT scan—to get a better look and determine if there is bleeding they missed. Eventually things slow down when the patient is stable and everyone takes a deep breath…until the next call comes in. And there’s a rush to mop blood from the floor, get rid of all the trash from equipment used. Wash hands, and get the next bed ready. Like I said—they are a freakin’ machine.

And then, there are the patients. Real people. Ones that can’t breath for themselves. Completely exposed for all the world to see. The most physically vulnerable they will ever be. And they’re not even awake for it. Thank God. It’s weird to watch them (and others) fight for their lives. It’s surreal. So. Yeah. It’s an odd feeling when you realize that you don’t have much of a feeling at all. Really—I just feel…aware. I am an extra set of hands holding sutures, holding fat back, breathing for a man—and that pleases me. I am a little scared that I don’t seem to have more compassion. I would look at this man, his face bloodied and swollen, tubes down his throat. Tubes in both sides of his chest. Lines in his groin, in his wrists, in his forearms. Staples on his abdomen. Restrained so that an unconscious reflex doesn’t “contaminate” the sterile field. I look at him and try to see him as a person. A man with a family—wife, kids, parents. A home, a job, friends. But the only reality I seem to find is the one where the blood is on the floor, where I am excited to pump the bag that blows airs into his lungs. Watching and waiting, I feel like a child—horrified at what is going on, but fascinated too. Whole-heartedly believing that every patient is going to be alright, because I could not fathom a reality in which one of them is not. Even the woman who has shot herself in the head. It will be awful for her when she wakes up—because she took herself out believing that she would never wake again. Somehow, she was okay leaving behind her two young daughters and her husband. But I feel that she will wake up. That there is no way that she won’t make it. She’s made it this far, to the hospital, to this bed, to these people sweating and cursing, re-wrapping her head in gauze so that she doesn’t bleed out.

Trauma is a rush. I do not feel panic. I do not feel emotional. I only feel charged, hyper-aware. Granted, I can’t really do anything. I just stand around and hold things, stay out of the way and retrieve tools if I can. But I love it. I stayed 2 extra hours because it was so busy. I never found out what happened to any of those 4 patients that day. I still believe they made it.