Saturday, 25 August 2012

NEVER give up

What's the first thing that comes to mind when you think about a trauma surgeon?  Patience?  Good hands?  The ability to stay calm under pressure?  Perhaps.  Persistence may not seem like an obvious attribute of a good trauma surgeon, but it should.  Just when all seems lost, the willingness to keep going under the direst of circumstances despite overwhelming odds against you may mean the difference between life and death.

There's a certain "look of death" that some patients have - they just look like they are about to die.  It's impossible to describe, but trust me when I say that it scares the shit out of me.  I had such a patient roll through the doors a while back.  He was a 16 year old kid who was stabbed once in the upper right portion of his abdomen.  The medics called in and said he was stable, but as they rolled through the door, the boy looked at me, his eyes rolled back, he went pale as a ghost, and he slumped back against the bed.  He had that look.

Uh oh.

We quickly transfered him to our gurney and looked over him quickly - all he had was a tiny 1cm stab wound just below his right ribs.  But he had no pulse - he was dead.  I assumed he had bled to death in his abdomen, so I quickly made the decision to perform a resuscitative thoracotomy - so-called "cracking the chest".

"But Doc, why open the chest when he was stabbed in the abdomen?"

An excellent question!  The idea in this situation is to preserve blood flow to the brain, and the best way to do that is to clamp off the aorta to shunt blood upwards.  The quickest and easiest way to do that is through the left chest.

When we opened his chest, his heart was empty and still.  He had bled to death internally.  We had started pumping blood into him, and I started internal cardiac massage - basically CPR directly on the heart.  After a few minutes, my assistant looked at me, frowned, and motioned for me to stop.

No.  NO.  This kid had just died a minute ago, and I was NOT about to give up yet.

About a minute later his heart started beating...weakly.  But that was enough for me.  As we continued transfusing him with as much blood as we could get our hands on, we wheeled him quickly down to the operating room.  When we opened his abdomen, his entire blood volume was in there.  As I suspected, there was a 1cm laceration to the liver, but no other injuries.  I quickly sutured his liver laceration, but his heart stopped beating again.

GODDAMMIT!

I did internal cardiac massage again and shocked him, but during all this my assistant again tried to convince me that it was a lost cause.  I realised at this point that this boy's chance of survival was around 1%.  That's it.  But my stubbornness had the best of me, and I kept massaging his heart and transfusing him as fast as possible.  A minute later his heart restarted again.  This time, it started for good.

A week later the boy walked out of the hospital.  A week after that he walked into my office.

"Thanks for saving my life," he said with a shy smile.

My wife likes to call me stubborn sometimes.  She's right...and I think it's one of my best traits.

13 comments:

  1. And that, DocBastard, is why you're the Trauma Surgeon. And if you want to, you can see this situation as a metaphor on how you should never give up in life, either.

    ReplyDelete
  2. It's stories like this that so contradict your handle doc... :)

    ReplyDelete
  3. Wow this story gave me goose bumps and bought tears to my eyes! U r utterly amazing, stubbornness is a good trait to have when your a dr don't ever loose that! Being a nurse I see far to many drs give up on patients...... If only they could take a page from your book! Keep up the fantastic work doc!:)

    ReplyDelete
  4. Always have the utmost respect for all staff in the ER and hospital I. General, and Doc, even though your patient said it, thank you from a stranger. I would place my life in your hands anytime!

    ReplyDelete
  5. I have read your blog after finding you on FML and I love the way you view the world. Thank you for sharing so much in your unique way. My mom is a RN and she has worked in geriatrics most of my life but recently began to work in her local ER. I am amazed by her determination and the staff at her tiny hospital. I can't handle blood and crazy people and I don't know how anyone who works in the ER handles the daily insanity. Thank you for sharing bits of your life online. You're excellent at giving your readers common sense lessons. This story warmed my heart and the others have touched me in their own ways. Thank you and keep sharing. :)

    ReplyDelete
  6. Thank you for doing all that you do, and of course for sharing it with all of us.

    ReplyDelete
  7. Stubbornness is a good thing Doc - nothing was ever achieved by giving up at the first setback.

    That's a kid with another 60, 70, maybe 80 years. Thanks to your stubbornness. Who can say that's a bad thing?

    Well done! And never give up the great work Doc. Never give up.

    ReplyDelete
  8. Definitely one of my favorite posts.

    ReplyDelete
  9. Congratulations Doc!!! Stubbornness is a wonderful quality to have in the ER. Don't ever lose it! :) if anything horrible ever happens to me I sincerely hope I have a ER doctor half as determined and as wonderful as you are. Thanks for sharing with us!!

    ReplyDelete
  10. Wow. I wonder what the kid would say to the assistant. And also, did you mention that he actually died twice?

    ReplyDelete
  11. Damn. You just made me cry.
    (Yes, I just found your blog last night and I've been reading ever since. With brief breaks to work and take care of my kids.)

    ReplyDelete

If you post spam or advertisements, I will hunt you down and eliminate you.

Comments may be moderated. Trolls will be deleted, and off-topic comments will not be approved.

Web-hosted images may be included thusly: [im]image url here[/im]. Maybe. I'm testing it.

COVID-19 Mythbusting (clean)

Due to popular demand (well, two polite requests, actually), I have decided to create a clean version of my post about COVID-19 myths . If...