Monday 13 October 2014


  • Sadness
  • Frustration
  • Grief
  • Relief
  • Bewilderment
  • Happiness
  • Amusement
  • Fear
  • Curiosity
  • Anger
These are a few of the emotions that try to run through my mind as I evaluate every new trauma patient, especially the tough ones.  Not every emotion rears its ugly head for every patient, but there is usually some combination of several of them.  I say they "try" to get through, because in order to get through my day, I am forced to suppress every one of them and yield only to "Rational Thought".  It's the only thing that allows me to do my job thoughtfully, professionally, thoroughly, and without yelling at people and going completely bonkers.  I've been asked innumerable times how I'm able to separate my emotions from my actions and stay calm in the midst of turmoil and chaos, and there's one very simple answer:

I have no goddamned clue.

No really, I haven't the slightest idea.  I don't meditate, I don't say any calming words to myself, I don't try to align my qi, and I don't use any other techniques (that I know of) to remain unflustered.  But however I do it, you'd better be damned happy that I can, because as a trauma patient lying on a gurney and staring up at the ceiling with your intestines hanging out, the last thing you want is your trauma surgeon freaking out and losing his mind.

Several months ago, however, I experienced a case that threw my entire system into sheer turmoil and threw my qi right out of alignment.  Or something.

There are three B's in the trauma arena that I just don't do: bones, burns, and babies.  I let the orthopaedic surgeons do bones, I transfer any burn victims to the local burn centre, and any injured children are supposed to be taken to the local children's trauma centre.  Yes, I said "supposed to", so if you're reading between the lines, you can probably see where this is going.

After a full day of mostly uninteresting patients, I was just sitting down to eat a sandwich (meatball, of course) when my pager went off.  Meh, probably another elderly person who fell and bonked her head, I thought.

"HAHA not even close, jackass!" the Call Gods laughed.  "Try a gunshot wound!  Level 1!  In the trauma bay now!  Put the sandwich down."

Damn you, Call Gods.  Damn every one of you.

A "trauma in the trauma bay NOW" call usually means a family member or friend (or occasionally an ambulance) drove the patient in, and the triage nurse upgraded the patient to a trauma on arrival.  When it's a "gunshot wound in the trauma bay NOW", it usually means a car drove up to the emergency entrance, pushed a gang member with several new holes in him out the car door, and sped away.

If only it were something that mundane.

I ran down to the trauma bay, and what greeted me was a crowd of approximately 195 people milling about.  I pushed my way through the throng and what I saw made my mouth go dry and my heart sink: a little boy about my daughter's age with a bullet hole in his forehead.

WHAT. THE. HELL. IS. THIS, I thought to myself as I tried to force out of my head the image of one of my children lying on a gurney like this.

Despite the chaos I managed to compose myself and get the story from one of the police officers in the room.  He had found the child on the ground at a local park, and instead of waiting for an ambulance, he picked the boy up, put him in his car, and drove him directly to the hospital.

I couldn't get the picture of my children out of my mind.

The little boy was still breathing and his heart was beating, but he was obviously in very bad shape.  We inserted a breathing tube and took him straight to the CT scanner, where I saw exactly what I was hoping not to see: the bullet entered his forehead and went through most of the right side of his brain before stopping in his occipital lobe.  His brain was already swelling dramatically, and there was almost no space left for it to go.

My son . . . my daughter . . . lying on the ground . . . 

My hands were shaking.

I got on the phone immediately with the local children's trauma centre and told them the story, and they said they would send a team immediately to pick him up.  As I hung up the phone and sat down, the raw emotions flooded over me like a tidal wave washing over a defenseless beach.  I looked at one of my assistants who looked like she was about to cry too.  Fortunately for the sake of the boy's mother (whom I had just brought into the trauma bay), both of us were able to keep our composure.

If anyone has ever wondered why I only treat adults, now you know.

The minute I got home the next morning I grabbed both of my children, hugged them, kissed them, and told them over and over again how much I love them.  They both seemed very confused why Daddy wouldn't let them go, but I finally let them wriggle free after I was sure they knew.  Even Mrs. Bastard started crying when I told her about it.

It takes a lot to get me riled up, but cases like these shake me to my very core and make me appreciate what (and who) I have that much more.


  1. Pick him up before surgery? Or do they have to transfer him at the children hospital in order to do that? Nevertheless, I don't even want to know how a child received a bullet wound to the forehead, but this is truly heartbreaking.
    Do we know if he made it?

    1. Sorry to be the pessimist, but "I saw exactly what I was hoping not to see" makes me very doubtful that he did. Maybe he's alive, but my uneducated guess is he's gonna be in a coma for a pretty long time.

      Any doctors or other knowledgeable people, feel free to tell me I'm a moron...

  2. That is heartbreaking. Do you know what happened to the boy after he was transferred to the local children's trauma centre?

  3. my very worst call was also for a child. in this case, a child with a disorder causing a very high risk of unintentional injury. very bright, very brave, and unimaginably tough - taken in comparison to some of the adults I have seen with a similar injury.
    in fact, this is why I have no plans to take advanced medical training.

    my biggest critique of the incident: the officer presumably had a radio in his car. did he not call dispatch and tell them what he was doing, so they could warn the hospital? there is a good chance that his decision to transport the child, himself, saved some time - but having then just appear in the ER surely slowed treatment.

  4. addendum: "this" meaning the fact that I have a strong reaction to such injuries, not the particular incident.

  5. All the respect in the world, to medical professionals, for all you have to deal with!!!

  6. My brother can no longer do children's autopsies since having his daughter. The younger officers, whom don't have children yet, take those awful calls.

    I don't think I could work at a Children's Hospital but support them as best possible.

  7. Oh my god!
    That is horrible. Sorry you had to go through it.
    I once had to excuse myself because one of our terminal care pediatric patient-not really as I'm still a student- who insisted on calling me auntie cried because I didn't come say bye before I left. She hugged me and wouldn't let me go. I found that hard to deal with. I felt guilty, because the first time I saw her she was crying and begging to go home. Her mother told me that she refused to eat that day and she cried herself till she fall asleep. I didn't know how I convinced the child that a hospital is a good place to be in and that we are all a big family. Her mother was thankful to say the least. But I felt guilty lying to a little child and to let her down.
    God forbid I be in your shoes Dr B. I loved my ped rotation but it was full of tears.

    1. sometimes a lie is not a lie - if she was terminal and the hospital could serve her needs it WAS a good place for her to be in.

  8. Pretty much anything involving kids is the worst. My personal worst: a pair of grandparents carrying in their 8-year old grandson, who did not wake up after a nap. I happened to be walking by (I was working ER) when the family was at the front desk, registering the boy. The grandparents were calm. The child was already in a coma.

    As calmly as I could, I told grandpa to just come on back and the admissions clerk could finish her work later. Stuck an IV in him with no reaction whatsoever; doctor did a spinal tap and the boy didn't move or make a sound. Meningitis was the diagnosis, the boy was transferred to Stanford Children's Hospital via helicopter, where he died within 8 hours. (I ended up on a course of rifampin).

    This horrific story trumps mine. I would have been a quivering ball of goo the instant that kid left my ER.

  9. This really was not a funny story.

    1. too bad. emergency services is often not funny, and DocB is in the business of cheating death, not comedy.


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