Monday, 12 January 2015

Just Some Guy

Unlike most surgeons, trauma surgeons don't usually have the luxury of getting to know their patients before they operate on them.  Most surgeons see patients in their office and have the opportunity to ask and answer questions prior to scheduling surgery.  On the other hand, my typical preoperative introduction goes something like this:

Me: Hi, I'm DocBastard (not my real name).  You're dying.  I'm going to try to prevent that from happening.  Now.

That's only a slight exaggeration.  Seriously.  Even in a typical "normal" emergency situation (ruptured appendicitis or perforated gastric ulcer, for example), I have the opportunity to ask my patients various questions about themselves.  However, when you have a hole in your abdomen and are actively bleeding to death or leaking stool into your peritoneal cavity, I barely have time to ask your name before I need to start doing terrible things to you, like cutting you open, removing things, repairing things, stopping exsanguinating haemorrhaging. . . you know, a typical Saturday night.

Despite this sense of overwhelming urgency, I try my damnedest to avoid dehumanising my patients by referring to them as "The guy in trauma one."  Unfortunately in my position it can be next to impossible to think of everyone as an individual person rather than Gunshot Wound Victim, Car Accident, Run-Over-By-Lawnmower Guy, or Old Lady Who Fell.

I got an excellent lesson on why this is so important early in my training while in the ICU.

The guy in bed 4 (not his real name) was not just some guy.  Apparently he was a member of the Board of Trustees of the hospital, and everyone was doing everything possible to make his hospital stay as comfortable and uneventful (read: complication-free) as possible.  But he wasn't the one who was actively dying that night.  No, that would be his neighbour, the guy in bed 3 (also not his real name).  He had undergone a heart transplant earlier that day, and things had not gone exactly as planned.  After his surgery, he started bleeding profusely.  He had been brought back to the operating theatre, but the transplant surgeon had not found any specific bleeding site.  Rather, he was bleeding from every raw surface in his chest due to DIC (disseminated intravascular coagulation), because his body was rejecting his new heart (we found this out later).  Unfortunately that is medical bleeding, not surgical bleeding.  All we could do when he got back from surgery was continue transfusing him with blood products, replacing what he was losing faster than he was losing it, and hope he started clotting.

But every unit of red blood cells we gave him, every pack of platelets, every unit of plasma, he bled right out again.  We had IVs everywhere we could think of, but still we were having trouble keeping up.

He was still dying, and we couldn't stop it.

People were running around, shouting, getting equipment and supplies, trying to do everything they could.  I could have stood there watching, but instead of simply letting the blood drip in or putting it on a pressure bag, I decided that the best thing I could do was to squeeze the blood products into him.  So that's what I did, one bag after another, waiting until one bag was empty, then spiking a new one.  One bag of blood after the next.  For 6 hours.

And in the midst of this chaos, I overheard a conversation between two nurses just outside the room that would change my bedside behaviour forever:

Nurse 1: Oh, that doesn't look good.  Is that the VIP?
Nurse 2: No, that's just some guy. The VIP is next door in four.

Just some guy?  Really?  His name was David (also not his real name) and he had just gotten a brand new heart less than 24 hours ago.  Was his life really any less valuable than the VIP next door, just because his bank account was smaller?  Were we supposed to give less or care less or do less, just because he didn't have a famous name?  After gaping at them for a few seconds, I turned away and squeezed in bag #89.

Over the course of the night, I squeezed in 134 bags of blood products (the human body only holds about 8 liters of blood, and each bag contained between 250 and 500ml.  Do the math.)  David survived the night, but I found out the next day that, despite everything, he had succumbed later that afternoon a few hours after I went home.  His body had rejected the heart much like I had rejected those nurses' lousy attitude.

Ever since that day I have made it a point to learn my patients' names, even if there really isn't time for it.  To me, my patient isn't The Guy Waiting To Have His Appendix Out.  He isn't The Splenic Rupture In Trauma 2 or the Drunk Idiot In 6.  No one deserves to be Just Some Guy.

Everyone is Someone.

20 comments:

  1. And here was me thinking that NHRN (TM) was just because you never knew!

    Only kidding Doc' - it makes much more difference than most doctors realise that their patients feel they are being treated as living, breathing, and more than anything thinking people. It must be very easy to see us all as just pieces of meat when it's your job to butcher is as if we were.

    Keep it up Doc' - otherwise, you never know, one day it really will be their real name, and you won't know it!

    Ugi

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  2. I try to make a habit, when I'm first on scene, to get the patient's name, and introduce them to the paramedics by name. (I.E. "this is Guy (not his real name) and his chest hurts when he inhales (a symptom I was called on sometime in my career)") but really, if I'm in your operating theatre, if you only have time to find out one, knowing my name is less likely to save my life than knowing what is going wrong. If there is a chance to learn my name later, I will be fine with that, and if not, I'm sure I won't hold a grudge.

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  3. This story is exactly why I keep reading this blog. Great work, Doc.

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  4. I like you, Doc. Your pretty cool.

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  5. "Exsanguinating Haemorrhaging" <--- That would be an awesome name for a Heavy Metal band ... Just sayin'. ;)

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    Replies
    1. I make a point of using the term "exsanguinatrix" for a female lab tech doing a blood draw whenever I can. for some reason "exsanguinator" isn't as fun.

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    2. It'd be even more metal if the band members could actually spell it. :P

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  6. I KNOW THAT YOU LIVE IN SOUTH AFRICA AND YOUR NAME IS DEREK... Homoeopathy users from all over the world will find you and eliminate you...

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    Replies
    1. with what. a 1000 times diluted drop of water that was dripped on a bullet?

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    2. Uhh, how did you come to that conclusion?

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    3. Watch out guys, we got a badass over here.

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    4. @Ken Brown: probably, but only after they beat the container with a horsehair whip, to brainwash the water molecules into believing they are all part of a bullet. It would be a shame if they arranged for the transport of said water only for it to forget about it's purpose and just go for some splashing around instead.

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    5. right, I completely forgot about that.

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  7. Hey Doc, in you blog posts I have noticed that some people who come into your trauma bay use drugs. Theoretically, If a person came and used an illegal drug such cocaine or heroin, and did some stupid trauma to himself and did not hurt others and was not escorted by the police, would you be obligated to tell the police of his drug use?

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    Replies
    1. No. But if the police are there, I happily inform them. Sadly, they seldom care.

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    2. As a small cog in the great prison industrial complex, I would say that it isn't that they don't care, it's that...well, ok. They pretty much don't care. We need the resources for the ones who commit crimes against persons or crimes against property. Prisons are already overcrowded. We don't have room for everyone who commits a crime of stupidity.

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  8. This comment has been removed by a blog administrator.

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  9. I like this. I can totally understand the anonymity of patients - especially the unconscious ones. I am sorry the fight was lost in this case.

    The gastroenterologist who does breath testing (the hydrogen/methane type, not the DUI type) is a (self?) published author, so keep looking for that publisher!

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  10. I am an ICU nurse in the U.S. I wish our doctors were more hands on like you. In my unit, the nurses would be squeezing the blood and would only see the doctors if the patient coded.

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