In an Emergency Dept., Trauma Bay 1 is where the medics drop off the most critical patients, usually hovering close to death. They're swarmed by a seasoned trauma team, experts at pulling patients back from the brink; these stories are a few I remember vividly from my time there.
The Boy She's Crushing On.
Two patients were brought in together, a boy and a girl, both 18 y/o. The girl had minor injuries, cuts and bruises mostly, but the boy was a mangled mess - comatose, with compound fractures in nearly every bone on his right side and an open skull; he looked like he'd been run over by a truck. The girl was hysterical, but eventually we got the story: she'd been driving along the interstate with her boyfriend; they were coming into town to see a concert. Traffic was fast and heavy and he'd criticized her driving. Tempers flared, the quarrel got heated,and in a fit of high drama she'd slammed on the brakes while doing 70 mph. Her light import stopped short, unlike the loaded semi-truck directly behind, which smashed into them at highway speed then tore up and over the passenger side, crushing her boyfriend but leaving her relatively unharmed. After hearing the story, his parents refused to even look at her. We were able to stabilize him, but he died a few hours later. She will carry the crushing burden of her momentary temper tantrum for the rest of her life.
Those Who Live In Glass Houses....
A man and his wife got into a fight in their living room, which escalated into a shoving match. He pushed her, she punched him, he stumbled back, the glass coffee table caught him behind the knees, he fell backwards.... Medics brought him in strapped to a backboard in the fetal position, sloshing in a pool of blood, a two-foot shard of glass protruding from his left kidney. It took multiple units of blood, long runs of I.V. antibiotics and a month's stay in the ICU to save him. Of course, he lost the kidney, but he survived to fight another day.
Great Taste! Less Filling!
The flight team choppered in a man who'd been shot in the head. He was, of course, unconscious, intubated and mechanically ventilated, with the classic swollen, purple eyelids of head trauma patients. He reeked of beer. The medics said he and his son-in-law had been drinking all day outside their trailer. As their intoxication levels rose, so did their passions regarding the proper dog food required to produce the best performance from their hunting dogs. Exasperated, the man grabbed the rifle leaning against his lawn chair and shot his son-in-law's big toe off. This got the son-in-law's dander up, so he limped into the trailer, grabbed a pistol, hobbled right back out and, as Southern men with wounded pride must do, shot his father-in-law in the face. The bullet entered just under his left cheekbone, tumbled along the inside curve of the cranial vault, coming to rest at the back of his brain, a brilliant white mushroom on the CT scan. Discharged after two months in the ICU, he was back to his old self - using volume and violence to defend the bruised honor of his ignorance. I expect it wasn't long before his son-in-law paid a visit to Trauma Bay 1, too.
The Heart Has Reasons, Which Reason Knows Not Of.
He was a big guy and he was swinging mad, so the medics had strapped him to the backboard - tight. Aside from a small bloodstain on his t-shirt nothing looked seriously wrong with him except his evil temper and foul mouth. Dodging his fists and feet, it took forty-five seconds to cut his clothes off, which is how we found the slim 1-inch gash just to the left of his sternum. He cursed and howled and lashed at us while the x-ray tech swung her overhead gantry into place for the chest picture, by which time ninety seconds had passed. Medics stood in the background explaining that he'd been savagely beating his girlfriend in front of her mother, who'd defended her daughter by stabbing him in the chest with a paring knife. The lack of external blood was troubling - it meant the bleeding near his heart was internal and unchecked. Sure enough, within two minutes of arriving, his violent agitations abruptly stopped, he fell unconscious, and immediately turned blue.
Trauma bay 1 is purposely chosen for its proximity to the surgical suite reserved for emergencies; we didn't even bother with chest compressions, just dropped what we were doing, grabbed his stretcher and ran him to the operating room, trailing IV tubing and EKG cables behind us. Locking the stretcher under the lights, we scrambled out of the surgery team's way while they dumped a gallon of iodine over his chest, dispensed with the scrubbing, and slashed an opening between ribs four and five under his left armpit. Four minutes from rolling into the ED a surgeon was attaching a rib-spreader, whirling the crank like he was starting an old tractor, the ribs parting wide with a dull crunch. A second surgeon slit the faschia containing the thoracic cavity, then plunged his gloved hands under the lung and grasped the man's still heart, pulling it halfway out. It looked like an enormous, wet, wine-grape, the sac surrounding it stretched to bursting with blood. A third surgeon used a scalpel to open the sac causing two double-handfuls of clotted blood to tumble out; the heart lay naked and gray in his hands. Freed from its suffocating constriction, it slowly stirred to life - twitching irregularly for a second, then gathering momentum and resuming the life-giving lub-dub that had faithfully borne the man right up his moment frenzied rage. We walked out of the OR with mixed feelings; we were elated at seeing the heartbeat return, but troubled by the violent abuser it was returning to. If he survived, would the experience change him for the better, or would the lives of those two women be in danger; if he died, would the woman who stabbed him go to jail for murder?
He died, three weeks later. I never discovered what ripples his death made in the lives of his girlfriend and her mother - by then I'd had a hundred more stories like theirs roll through my hands. That's just how it goes, in Trauma Bay 1.
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