I did it!!!! I made it through six weeks of trauma surgery at Hershey! Looking back on the whole thing I cannot believe I made it. Even falling asleep at night was difficult because I knew what I was going to have to face the next day- a butt kicking beyond anything I had experienced. There was no real way to prepare for the next day. You never knew what kind of traumas would roll through the doors. And you never knew what random topic you were going to be quizzed incessantly on that day. And when I say quiz I don't just mean "asked a question and if you don't know the answer big deal just look it up". I mean if you don't know the answer that's license to get in your face and rapid fire more and more questions until you have been reduced to a shapeless blob of pond scum. Some days by the time they were done with me I didn't even know my own name. Strangely this form of so called teaching actually worked for me. I think it worked because I was absolutely terrified of the humiliation that came from not knowing the answers.

The traumas themselves were challenging as well. From a medical standpoint it wasn't too bad because you just follow a specific algorithm that has been beat into your brain. The difficultly arose when you let your mind wonder from it's preprogrammed path to allowing it to process what exactly is going on from the human standpoint. In other words I got into trouble when I let myself feel. I only did trauma for six weeks so I never developed the ability to be unaffected by the events that had just unfolded in front of me. Many of the trauma attendings, PAs, and nurses have developed this. I don't think I ever want to get to the point where the loss of a life is routine. During my time at Hershey I saw at least a dozen level one traumas and a whole lot more level twos. There are three that stick out in my mind. I remember everything about them; the smells, sounds, injuries, and outcomes. I even remember the feeling after it's all over. It didn't matter what time of the day the trauma came in. When they were bad I always walked away in a state of numbness. I walked through the remainder of the day just going through the motions. I was afraid to allow myself to process the trauma in it's entirety until I was home in the comfort of my room and usually talking it out on the phone with a friend.

It may sound like it but I don't regret doing trauma surgery. I have come out on the other side a stronger person with tougher skin. I've learned how to take a beating and still hold my head up. I've matured as a PA was well. I feel more in control now in situations that seem out of control than I ever before. And finally I've learned that you can do well in any situation if you are willing to work hard enough for it. The best things in life are the things you sacrifice for.

Tragedy Strikes Again

Friday started out like any other day. At 6am I'm checking in on my assigned patient followed by signout at 6:30 and case studies at 7:30. We were just finishing up our case studies when the trauma pagers went off. It said "Level 1 trauma. Response STAT. Multiple adult and pediatric traumas." This was the first time I had seen a page like this. The most I've ever seen at once was 2. As usual we all stopped everything and ran downstairs to the ER. We got there and learned that there was a car accident and five teenagers were traumatically injured. All of these kids were in the same car and were on there way to school when they collided head on with another driver. Four of the five victims were unconscious and had to be extricated from the car. They were being flown in. A trauma of this nature required that every ATLS trained person in the entire hospital respond. I would guesstimate that around 50 people were involved directly in these traumas. It sounds like complete chaos but it went amazingly smooth. I was super impressed with how well orchestrated everything was. Every room had someone in charge and also had someone responsible for communicating with the other rooms about who's patient was the sickest and needed CT scanned first or the first available OR, or needed the massive transfusion protocol activated. I apparently drew the short straw because I ended up in the room with the sickest kid. He had major head, chest, abdominal, and orthopedic trauma. I was in the middle of this trauma when a nurse yelled that I was being paged to the OR by one of my attendings. I stopped everything I was doing and passed off my responsibilities to someone else and bolted upstairs to the OR.

I walked into the OR and the attending had already opened up and told me he needed another set of hands and to go scrub in. At this point I still had no idea what was going on because as far as I new this doctor was running a trauma two doors down from the one I just left. I got all scrubbed and joined the doctors at the table. Here the patient has was operating on was the driver of the car in the major accident. He required IMMEDIATE surgery to save his life. The boy had demolished his spleen among other intrabdominal structures and was actively bleeding out. I will spare you all the gory details of the procedure but let's just say it took around 3 1/2 hours to do what needed to be done. I'm happy to report that we were able to stop the bleeding and do adequate damage control to save his life. I haven't heard anything since I left the hospital Friday so I'm not sure of his current status.

This was the first time I had ever been paged to the OR to assist in a life saving operation so I was feeling pretty good about myself. However like most good trauma related feelings this was short lived. Once the urgency was over and things had stabilized the reality of what just happened set in. This was a 16 year old kid, he has a sibling in the OR a few doors down undergoing a similar operation. This family was just turned completely upside down in a short second. In fact four families were turned upside down. When I go into the hospital tomorrow I'm going to have to face these families. That is perhaps the hardest part, seeing the look of despair and sadness on the parents faces. As a student I usually do not have to talk to the family but I still have to be in the room when the doctor does. Hopefully tomorrow the questions that the families ask will have positive answers. I'm going to keep the attitude that they are kids and they bounce back quickly! Only three more days of trauma, then it's off to take care of kiddos who are not teetering on life's edge.

*the picture at the top is a grade 5 splenic laceration, one of the injuries we were repairing

Only by the grace of God

Yesterday was a busy day in the trauma bay. We had four between 7 and 12 alone. There was one trauma that really stood out to me more than all the others. The patch we received said that it was a 19 y/o female involved in a motor vehicle accident, tractor trailer vs Mitsubishi galant. They said she was merging into traffic and merged directly under the trailer of a truck!! We did not receive much information about the status of the patient except that she was self extricated. She came into the trauma bay in the usual way, on a stretcher on a spine board with a c-collar on so you couldn't really tell how serious her injuries were at first look. Once we got her unloaded and began examining her it became apparent that her only injury was a laceration on her forehead and another on her chin. We took her to CT where it was confirmed that she had ZERO injuries!! While she was being CT'd one of the paramedics on scene showed me the pictures of the accident. The front drivers side of the car was completely caved in. There was no cab anymore. The picture I uploaded in an actual picture from the scene. It doesn't really do it justice though. The pictures the paramedic had looked a lot worse because he was right up on the other side of the truck. According to the driver of the truck the car became stuck under the trailer and was drug a mile before he was able to completely stop. The car had caught on fire as well. Too look at the accident you would never think anyone would come out of that alive let alone unscathed. We were talking to the girl later and found that she was not belted and there were no air bags deployed either. This story was becoming more and more unbelievable. She told us that she saw what was coming and dove over across the front seats trying to make herself as flat as possible. This move is what ended up saving her life. I've seen several car accident victims die in the last four weeks from accidents much more minor than this one. I'm sure she walked away from this with a new appreciation for life. I know I did. I guess it goes to show that it's not your time until it's your time. (Profound I know, haha)

I'm Going to Need Counseling After this One

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.