Success Being RelativeAugust 8, 2012
We trouped in from the parking garage through the fading starlight of early dawn to find most of night shift gathered in one room. Portable surgical lights added to the overhead fluorescence, casting a striking glare on the scene. The patient was ominously flat: his positioning and pallor an instant indicator of his perfusion status, which was confirmed by a quick glance at the monitor. His blood pressure, we said among ourselves, was “in the toilet.”
He’d been in a motor vehicle accident and had suffered a prolonged extrication. There’d been a fatality at the scene. He wasn’t my patient (although he was everyone’s patient, really), so I’m not the one who got the long report. I didn’t know each and every one of his injuries, but I knew the only one that was relevant at the time—his liver was badly fractured and he was bleeding out. His abdomen was hugely distended and firm. He was cold to the touch, and his skin bore the expected pallor of a man in shock.
We worked the way we always work in such situations. That is to say we were relentless; we were vigilant and indefatigable. And fastidious . . . when he eventually woke up, balancing sedation and analgesia with his blood pressure was a delicate task.
It’s hard to describe the workings of a trauma team in a way that doesn’t feel overdramatic or clichéd. In hindsight, especially, I’m often surprised by how smoothly things happen—by the way we slip into roles and never leave slack, by how orchestrated things seem, and by how much is shared in the briefest of exchanges. We work together with such focused intensity. As a team, we become incredibly bonded through these efforts.
We didn’t think this man would live. It wasn’t something we talked about, but I remember the moment we acknowledged it. He’d temporarily stabilized. The trauma surgeon, with nothing left to do, had stepped away. My colleagues and I stood back and took stock.
The patient looked terrible, so soiled and grossly swollen that he would have been unrecognizable to those who knew him. I recall becoming suddenly aware not only of the state of the room (trash cans were overflowing with discarded tubing and blood administration sets, soiled equipment and cords were everywhere) but also of the likelihood that everything we’d done had been in vain.
In that moment, and in the locking of eyes with the nurses who stood across from me, there seemed to be a universal acknowledgment. And while the interventions didn’t change, the mood in the room certainly did. Gone was the air of frenetic desperation that had driven us, and we wondered aloud if the chaplain had found his family.
He lived for another 14 hours. Those precious hours gave his family time to reach the hospital. They had the chance to say what they needed to say, confront the situation head-on and make difficult but necessary decisions. And although I can’t say whether they achieved peace or closure by making it to his bedside in his final hours, at least they were spared the misery and regret that often accompany the unknown. At least they were there.