Running a little late...

As I begin to explore the concept of compassion fatigue - and, later, moral injury - I’ll be bringing up some stories from way back. This one I wrote shortly after this case, which I believe was in 20

So, it’s a beautiful spring morning and I’m on call for the Trauma Center OR. I worked as a Cellsaver tech in the OR (AKA autologous blood transfusion), which saves tons of money and – more importantly – tons of lives. Unfortunately, it’s often needed for the very worst traumas, in which there is heavy bleeding, and seconds – and cells – count. It’s for those make-or-break deals.

On this morning, I’m posted aside a lake, close by the hospital, just in case. You know that thing people, shrinks, Deepak Chopra tell you? “Live in the moment. Don’t try to guess what’s coming.” Well, with a latte, my journal, and the warm grass of the lakeside park, I succeed for about 12 minutes. Then the pager goes off. Semi vs. bicycle. OR 6. I kegel, pound the rest of the latte, and start for the car. OR 6 is where the big stuff happens – the stuff you see on the news. Many very bad traumas go in and many fewer come out.

I’m parked, in scrubs, gloved, masked, and in the OR in 7 minutes. Start setting everything up before the patient has even gotten there. Do my checks, everything sterile, ready to go. The patient is wheeled in; a young Latino male – probably 22 or 23 years old. He’s awake and seems very non-chalant, which makes me even more nervous. The OR staff are trying – in broken almost non-Spanish – to explain what happened and what’s about to happen. He’s confused. I tell the anaesthesiologist that I’m fluent and can help translate. “YES, PLEASE.”

Apparently, this guy was riding his bike to work (up a part of the access road), when a semi made a wide-turn away from him, and the rear swung out and clipped the patient, blasting him off his bike. I was told that he argued with the medics, insisting he “was fine” and (!!) had to get to work.

I introduce myself to the patient as the team is prepping him; opening chest trays, loading units of blood into the Level II. I can see the surgeons outside scrubbing in – more urgently than usual. Nothing makes sense – only the very sickest people get this stuff and the patient – we’ll call him Franky – is not only unbothered, he’s pleasant, with an easy way of speaking that’s actually comforting to me. “Hermano,” he says, “I need you to call my boss and give him a message. Tell him that I’m sorry that I have to be late, but I got hurt and the doctors are about to fix me, and then I’ll come right over.” I sharpie a name and number on my scrub leg. He asks me “why they’re doing all this?” I explain that – when he fell down – he may have hurt a part of his back and abdomen. The doctors think that there may be some bleeding in your stomach, so they have to look inside and see if anything needs to be fixed. Franky seemed satisfied with this and asked “how long will it take.” I told him I could see he was a hard worker, that I’m sure his boss would understand. He told me he was working extra hours to bring his mom to live with him.

It felt like there was a cinder block in my stomach.

The surgeons came in and did a quick time-out.

What Franky didn’t know was that the FAST exam indicated an injury to the vena cava. I asked him if he wanted to give me any other numbers, if there was anyone else I should call. He told me to just call his boss; that the boss knew how to reach his family. He told me “God bless you,” and that – when he was out, I should stop by his work and he’d make me a special carne asada for helping him. I kept talking to him while he was induced. The last thing he drowsily said was “Pleeeeease….remmmmmmberrrrrr……to calllll….myyyy….booooooss.”

I went back to my station, Franky got intubated, draped, chlor-hexed, did the sterile pass-off of the suction to the surgeon, and they were ready to go. The surgeon made the usual incision for an ex-lap. I looked down at my paperwork just long enough to note the procedure start-time and I heard what sounded like a mop-bucket getting dumped on the floor. It was Franky’s entire blood volume, gushing out of his belly in what seemed to be just a couple of seconds. The surgeons and scrub nurses were spattered, stunned, disappointed, and chillingly-final looks on their faces. I had heard of – but never seen – that happen. Apparently, poor Franky’s vena cava had been torn in the accident, but – because he was young, strong, and healthy – his body has tamponaded the wound. Opening his belly removed the pressure for the tamponade. Like pulling the drain on the tub.

You could almost hear the hearts cracking in that momentary vacuum of a room. The blood loss was so profound that resuscitation wasn’t even attempted. “It wouldn’t have done any good,” they said.

I went to Franky and spoke into his ear: “No estas solo, hermanito. Me quedo contigo hasta el final y le llamo a tu jefe en seguida.” “You’re not alone, little brother. I’ll stay with you until the end and call your boss right away.”

To be honest, a part of me died with that hardworking kid on a warm spring morning. I’m ashamed of never having told his story until now, as it’s a story that deserves telling. Probably now more than ever.

“Remember to call my boss.”