Today I experienced yet another level one trauma. This one was equally as terrible as the very first one I ever saw but in a different way. It was a 40 year old male in a car accident, he was t-boned. He came into the trauma bay making a gurgling sound and was not responsive. He had femoral pulses on arrival. We intubated him almost immediately. About three minutes into the trauma his vitals started to tank, we lost his pulses and his blood pressure. We activated the code protocol. At this point the attending decided a thoracotomy was this man's best chance for survival. For those of you who don't know what a thoracotomy is it's when they cut open a person's chest paralell to the ribs and spread the ribs to allow access to the heart. A procedure of this nature is typically done in the OR but today he did it in the middle of the trauma bay. As soon as he cut open the chest wall buckets of blood came spewing out all over the floor and all over everyone within five feet of the patient. The doctor then cut open the pericardial sack which contains the heart. As soon as that was open it blood came spurting out of that. The trajectory of the blood was similar to that of water coming out of a hose when you put your finger part way over the end of the nozzle. The doctor then found a hole the size of a nickle in this mans left ventricle. His heart was literally pumping all of his blood out of his body. The surgeon threw a few sutures in the hole to plug it as best he could. It was too late though. Even the internal paddles, cardiac massage, and internal compressions wouldnt restart it. He called it...
Once it was called the room cleared out as quickly as it had filled. There were only 10 of us left. The doctor called for me to come over to him and the patient and had me manually "search" through his thoracic cavity and identify all major organs and any injuries to those organs. It sounds gross but it was a unique learning experience that very few people get. He then said that I was going to do one more thing and it was something that I would never forget. He told me to sew the patient up completely and make him presentable for his family to identify his body. Sewing him not only meant closing his gaping chest wound but also sewing the whole closed in his heart. It was a pretty cool thing to get to do. It is probably the only time in my life that I will ever get to sew a heart and one of the few times that I will get to sew a chest closed.
Suturing him up was a at first an exciting and cool thing to do but as I went along the reality of the case started to hit me. I looked down at his face and eyes were still open staring right back at me, his arm was out to his side resting against my hip and then I looked at his hand. This man was wearing a wedding band, he belonged to somebody. We did not know who he was yet. He was probably supposed to be somewhere an hour ago and never arrived and they were wondering where he was. His poor wife was about to be blind sided with the worst news imaginable. Having this thought in the back of my head made me take extra care when closing him. I stayed till the very end, even assisted with putting him a body bag. That too was a first for me and hopefully the last. I really don't understand how people can do this type of medicine everyday and not have major psychological issues.
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