On the other hand, there are some who come in dead and stay dead. Despite my best efforts and plenty of practice, my resurrection skills remain poor.
And THEN there are the ones at death's door. These are the ones we feel really good about, the ones we talk about over coffee the next morning, the ones I write about. They are the patients that give me pause, that make me stop and think, "NOW THIS is why I went into trauma." They are the ones who make the commitment, the loss of time with my family, and the sleep deprivation totally worth it. These are the "Great Saves".
Bosley (not his real name™) was a Great Save. Except that I didn't save him.
"Hey Doc, if you didn't save him, why are you writing someone else's story? Isn't that even more arrogant than usual for you?"
Didn't your mother ever tell you what happens when you make assumptions? Something about U and umptions. I don't remember.
Anyway, the story we got from the ambulance crew as Bosley was en route was strange enough, but it only got stranger after he hit the door. We were told that Bosley was the driver of a car that ran into a building, which happened to be a chemist/apothecary/pharmacy/drug store. Coincidence? Perhaps, but perhaps not.
Hm. Strange things are afoot.
By the time the ambulance got to us about 10 minutes later (just before midnight), Bosley was awake and talking, though something was definitely off. I couldn't tell exactly what it was, but he just Didn't Look Right. The medics were acting rather cavalier, however, clearly playing off the whole "trauma" thing as nonsense.
"Hey there everyone, this is Bosley. He's 72, healthy, never sees a doctor. He was on his way to the drug store tonight to pick up some medicine for a stomach ache when he hit the wall of the building, low speed, basically no damage. But he lost consciousness, so with that and his age, we made him a trauma. No sign of trauma on him, though. Probably just fell asleep at the wheel, right Doc?" he concluded with a grin.
No. A quick glance at Bosley told me that was not right. Though he was awake he looked awfully pale, and he was a bit sweaty despite it not being very warm. When he was hooked up to the monitor, however, his vitals were all completely fine - heart rate of 71, blood pressure 121/70, oxygen saturation 98% on room air.
The nurses started disrobing him and asking his medical history. He had no medical problems, no prior surgeries, took no medicines on a daily basis, no allergies, doesn't drink, smokes 1-2 packs of cigarettes a day since he was 17. Hasn't seen a doctor in 45 or 50 years. I started my cursory secondary survey, trying to find any body part that hurt. His head was fine, neck was fine, chest was fine, arms and legs were fine. But when I pushed on his abdomen, I got a bit of a grunt in return.
I asked him how much it hurt when I pushed, and he replied, "Not that much, Doc. But it's been hurting me all day. That's why I was going to get some medicine, to try to settle my stomach. It hurts in my back, too."
"And I passed out in the parking lot. That's why I crashed."
Unfortunately it was right about this time when we got two walk-in stabbing victims. Well, that's not exactly true. Only one of them walked in, while the other had CPR in progress. I didn't get a chance to examine Bosley more carefully like I usually do, but I glanced at his monitor as I rushed out to try to save the dead patient and saw that his blood pressure was steady at 120/75 and his heart rate was 68.
Good, I thought. He's stable. His CT scans should be done by the time the dead guy finishes dying.
It took me about 20 minutes to discover that the dead guy was dead because the knife had created a big hole in his left pulmonary artery (which is generally regarded as a Very Bad Thing), and as soon as I pronounced him dead I ambled over to the CT scanner to look at Bosley's scan. The tech flashed through the pictures quickly, and something caught my eye.
WHAT THE FUCK IS THAT IN THE MIDDLE OF HIS ABDOMEN??
I took control of the computer's mouse and scrolled through at a more human pace, and what greeted me was a huge (and I mean FUCKING HUGE) abdominal aortic aneurysm.
|Not actually Bosley's huge fucking AAA|
Let me repeat that in case the gravity hadn't set in: the aorta had a big fucking hole in it and was leaking.
Bosley didn't know it, but he was actually in danger of dying at any second. He was literally a figurative time bomb that could literally explode at any moment. Literally.
And just in case you think I'm being hyperbolous (why the hell isn't "hyperbolous" a word?), I grabbed the radiologist and dragged him over to the screen. This was his exact reaction:
Oh. OH! Oh, oh wow. Oh, uh that's bad. That's really bad. That's a ruptured AAA with a huge retroperitoneal haematoma. He needs to be in theatre. Wow. Just make sure you MOVE HIM REALLY CAREFULLY.The aneurysm had nothing whatsoever to do with the car accident but rather had been slowly growing over several decades and was related to his smoking and untreated high blood pressure and general lack of medical care over 70+ years.
Eighty two seconds later (I counted) I was on the phone with the cardiovascular surgeon on call, and 29 minutes after that (you're damned right I counted), he was standing next to me looking at the scan, and Bosley was waiting for him in front of the operating theatre.
His aortic aneurysm repair was completed about 4 hours later just as I was finishing an exploratory laparotomy and right colon repair for yet another stabbing victim that came in about two hours after Bosley did (of course). He stayed in hospital for about 2 weeks before going home with several new prescriptions for high blood pressure and diabetes, none of which I suspect he will take.
It was a great save, it just wasn't mine. Actually now that I think about it, Bosley's car accident saved his life. If he hadn't crashed and had simply passed out at home, his neighbours would have probably found him dead on his floor several days later.
Well, I must be off as it's time for my resurrection practice. Now was that wave the left hand twice and then pronate the right while incanting, or . . .