It was very late on a Friday evening as I sat in the trauma bay of our University hospital. I was about halfway done with my trauma-shadowing shift when the infamous blue lights above my head began flashing. I felt the same surge of adrenalin I remember feeling as an EMT when our page tones would startle me awake. It unfortunately meant that someone was very sick or injured, but it also meant that we were getting the very real opportunity to help someone.
The M3 student that had been so incredible at guiding me around the hospital all evening had a pager that alerted her that it was a delta trauma patient with a gunshot wound we were about to receive. The delta classification is reserved for the most injured patients, so we prepared accordingly. My M3 instructed me to don the full range of personal protective equipment: gloves, gown, face shield, and mask as practice for the future. As just an M1 shadow, I wasn’t expected to actually participate in the case, just watch.
Within the span of just minutes, approximately 40 people descended on the trauma bay. Doctors, nurses, paramedics, radiology technicians, and social workers arrived all prepared to respond to the needs of our critically injured patient. About that time, two paramedics came bursting through the door: one at the helm of the stretcher, the other on top of it actively performing CPR on a patient who was clearly loosing blood quickly.
Following right behind them came the attending trauma surgeon of the evening. She took control of the crowd of healthcare workers as if a conductor leading an orchestra. Each individual knew their role in caring for the patient, but her job became coordinating the combined efforts of the entire team. It became quickly apparent that radical measures must be taken to give this patient a chance to survive, leading the surgeon to perform a bedside thoracotomy. This is a procedure done to open up the chest, often so that compressions can be done directly on the patient’s heart, which is much more effective than regular CPR. A paramedic student jumped at the opportunity and began pumping the patient’s heart, a procedure known as cardiac massage.
After 3-4 minutes of this process, the paramedic student became fatigued and needed someone to take his place. A trauma nurse at the head of the bed yelled, “We need a sub on cardiac massage!” and it seemed as though all 40 people in the room looked around for anyone who was gowned and ready that could fill the position.
I stood at the head of the bed, still taking in all of the activity I was seeing for the first time when another paramedic grabbed me by the shoulders, shouting “Everybody move, cardiac massage sub coming through!” I had nearly reached the bedside before I realized that I, in fact, had been drafted as the person to begin squeezing the patient’s heart. I looked around as if to say, “Does everyone here realize that I’m an M1? We just finished genetics, I have no idea what I’m doing!” But after an encouraging nod from my M3 chaperone, I approached the patient.
The attending surgeon stood directly opposite of me, and gave me quick instructions to insert my hands into the patient’s opened chest cavity, and to squeeze the patient’s heart fast and hard allowing for complete recoil after each compression. Without thinking, I began doing exactly as she instructed.
Lots of things go through your mind while you’re pumping someone else’s heart for them. “Am I doing this right?”, “I’m actually holding a person’s heart”, and “I wonder if we can actually save this person” just to name a few. I also began to realize that the patient’s heart was attempting to beat in my hands, in between the compressions I was doing. This activity wasn’t organized enough to support the patient’s life, but the feeling of a beating heart in between my fingers was somehow more profound than anything I had ever experienced before. I realized that I was holding the very thing that is most important to life on a minute-to-minute basis.
My attitude instantly changed from that of an observer to that of a man who was personally invested in an underdog that had nearly insurmountable odds stacked against them. After more medications and shocks from the team, the patient’s rhythm changed from disorganized to normal, creating a heart that was beating independent of my intervention. It felt as if the patient had made a full court basket with seconds on the clock to tie the game. I knew we were not out of the woods yet, but we may have a fighting chance.
As rapidly as the newfound pulse came, it left yet again, and it became quite apparent that our efforts were no longer in the best interest of the patient. The attending surgeon made the decision that we would not continue resuscitation efforts, and announced the official time of death.
What does this all mean? In the span of 20 minutes I transitioned from someone who was enthusiastic about science and healthcare to a person who was intimately involved in the last moments of someone’s life. When a case like this happens, my mind instantly jumps to thoughts like “What didn’t go well? What could we have done a little better?”, but the truth is we did everything that could have been done. All 40 people in the room performed their job to the highest level of accuracy, and yet we were unable to make any difference in the outcome. It’s a hard lesson for a first year medical student to learn, but a necessary one nonetheless.
I did learn some insightful things about myself though. I love the process of decision making under pressure, in the face of unknowns. I love the true team effort that occurs with trauma patients. I love the ability to make a real difference in a patient’s life right now as opposed to over weeks or months. I learned that I thrive in these high intensity, make or break situations. I learned that trauma surgery is where I belong in the world.
- Alex Simmonds