Timing

Probably the most difficult aspect of being a trauma surgeon is not being able to control my schedule.  I don't necessarily mean my call schedule itself, though that is often outside my control as well.  What I mean is that other specialties have the ability to see patients on the days that they choose and at the hours that they choose.  I, on the other hand, get whatever patients I get whenever they decide to come in.  I can't choose to get a guy who falls off his bar stool and bonks his head at 1 PM, because those idiots don't fall off their bar stools at 1 PM, they do it at 2 AM.  What I've discovered over the course of my career is that surgery and trauma patients usually have terrible timing.  No one seems interested in letting me sleep, so instead they get appendicitis at 11 PM or stabbed at 3 AM.

Such was the case with Michael (not his real name©) and his series of friends.

My pager woke me from a dream about Scarlett Johansson (at least I wish it had been about Scarlett Johansson.  Seriously Scarlett, call me) to tell me that I would be getting a high-level stabbing victim in five minutes.  I looked at the clock and was completely unsurprised by what I saw.  

Of course.

As I was walking briskly downstairs, my pager went off again, telling me I would be getting another high-level stabbing victim in four minutes. 

My walking pace quickened.

Over the next few minutes my pager would go off three more times, all stabbing victims who, I learned later, had all been at a house party when two cars full of lunatics arrived with various sharp stabby things and a thirst for random violence.  

At least that's what Michael, who turned out to be victim number four out of five, asked me to believe.

I ran from room to room to room trying to determine who was the worst injured.  Two of them appeared to be completely fine, and two looked to be slightly less fine though still seriously injured.  And there was one whose wound looked like it should have been actively killing him, though in reality he looked as though he could have walked home. 

That, of course, was Michael.

His rather scary-looking injury was a single stab wound just to the left of his sternum.  Though it was a potentially dangerous (ie lethal) area, his heart rate was 70, his blood pressure was 120/65, and he looked calmer than I (though the fact that I kept running back and forth among four other victims may have riled me slightly).  He kept asking when I was going to patch him up and send him home.  I did a quick ultrasound which showed a bit of fluid around his heart, and a CT scan done a few minutes later (as I was putting a chest tube into Victim #3) confirmed a hemopericardium (blood around his heart).

Uh oh. 

There's only one place that blood could be coming from, so he went straight to the operating theatre where we found a small injury to his heart muscle, but no active bleeding.  His myocardium was repaired, and he was closed up.  Success!

Except that I still had 4 other victims to tend to.  Fortunately #1 and #2 just needed a few stitches and #3 and #4 both needed only chest tubes.  Nothing else life threatening.

When I went to see Michael the following morning in the intensive care unit, his very pregnant wife was sitting next to him.  When I say "very pregnant", I mean she looked like she could have popped at any second.  They asked all the usual question, including how long I expected Michael to be in hospital.  I told them probably three or four days, and his shoulders slumped.

Michael started to speak, but his wife finished the sentence for him:

"But I'm having the baby in three days!"

I asked if it was their first child, and of course it was.  I told them that I would do the best I could to get Michael to see his first child's birth, but I also told them I would make no guarantees.  I promised I would send Michael home as soon as he was ready, but not a minute before.  They were both visibly disappointed, but they also understood.

Fortunately Michael's hospital course was completely uneventful.  Over the next two days he recovered rapidly and smoothly.   By day three his chest tube was out, and he was ready to go home. I thought I would have to physically restrain him from running out the door.

I found out sometime later that I had discharged him just in time for him to make it to the other hospital to see his son being born.

Well, at least one of us has good timing.