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.
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.
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.