What happens is this. I go to work and I see things that most people shouldn't see. I see men who have spent the better half of a week sitting in their own feces, women who have sent the San Francisco police on multiple fleet high-speed chases, kids that fall out of windows, elderly with one foot literally stepping into the other side, criminals that are sweet but just got busted with rifles (plural) in the trunk of their car so they are handcuffed to their gurney, drunks who have lacerations to the temporal, occipital and frontal portions of their skull but are so wasted, they can't remember what happened or who they are, domestic violent cases where jealous boyfriends raise a full bottle of wine just so that it can crushingly meet the front of a girlfriends face, car accidents, motorcycle accidents, bike accidents, construction accidents, suicide attempts, suicide success...the list goes on.
As most of you know, my intention was to literally document every moment in that trauma center. To relive every story as a chapter that would soon regurgitate my award winning bestseller. But something happened. I would come home, sit in front of this electronic white square, and try with all my might to spew to you my interactions with the craziness that is San Francisco. It was a blank. white. screen.
Nothing came. Nothing came the next day. Nor did it come on my runs, or while I was trying to fall asleep. When I would ride my bike, my once constant mill of commentary was silent. Every detail that I soaked in at work seemed to dissipate in the foggy air the moment I stepped outside, as if the lives and happenstance of my patients was theirs, and theirs only.
But then my French neighbors, who are soon to be my french roommates, hosted a barbecue on this fine breezy night. They bought cheap meat, I made a salad and we set out the array of dishes, spoons and wine glasses that chime bienvenu. Various people came, mostly friends of Damien and Pierre who work with them in the bistro. The most riveting of the group was Pierre's' girlfriends' mom. Her name is Pie...as in...a piece of. Pie is a Native American Buddhist lesbian from Seattle who works at the University of Washington as a recruiter for the medical school. So naturally, she was a character. As she is telling me about the disparity of her native people, she removes a 'one hitter' marijuana pipe from her pocket, lights up, tells me that the reason she is in town is to harvest pot up north, and doesn't skip even the littlest beat in her story of struggle.
Maybe it was the Chardonnay, the possible swine flu symptoms I feel glossing over my body or the unintentional hot-boxing of our garden experience but as I sat and watched Pie, in her black leather cowboy hat and baggy black t-shirt, my love for Blind Karma stories flooded over me. People are so interesting...and I must go write about it!
So, in honor of Pie encouraging me to be a strong, independent woman of this world and a solid fear that she was hitting on me, I set down my wine glass and sprinted to the black and white keys. I sit now...the fingertips are on fire.
TRAUMA INDIA
Ironic that the most significant trauma patient that I have had, has the name of the very country that has hosted some of my most traumatic experiences. In the world of emergencies, everyone is a John Doe. Everyone has O blood type. Everyone could have HIV, a pneumothorax, a head bleed, cervical spine fractures, a family. So in order to keep them in order and a way to find uniform in chaos, we use the military alphabet (Alpha, Beta, Charlie, Data, Echo...and so on). Each case a letter with a crisis.
The morning is underway. Paramedics are floating in and out, dropping off patients, chatting with the nurses, looking hot...per usual. One starts to tell us that a white truck has been reported as driving off the embankment of the Bay Bridge. The initial story we got was that this poor man had been submerged in the glacial cool of the Bay water for nearly 20 minutes. Apparently, the first medical personnel to arrive on scene, didn't have the proper gear to retrieve him, so they had to wait for backup. Paramedics don't transfer dead people to the hospital, contrary to what television depicts, so we had to wait to see if the man pulled from the dredge would be a likely candidate for one of our trauma letters.
And not 10 minutes later, a 30-35 year old ice cube makes his way into room 1. His rotund belly gives evidence that he is not in the healthiest shape. His three layers of chin second that notion. His skin is pale and frigid. The chest wall inflexible at best. Compressions are underway as to mimic his absent heart beat. His mouth exploding with rubber breathing tubes.
I stand to his right in a crowd of about 25 people...everyone wanting a slice of the action. I am in charge of the IV. It is my job to find a vein that has not yet retreated to the inner space of his frosty limbs, to attach tubing and to aggressively pump the absolute warmest fluid into his body by way of the Level One. The Level One is like the Cadillac of IV pumps. In just 60 seconds, you can infuse an entire liter of fluid...including blood. His first temperature; a nippy 32 degrees Celsius (that's 89.6 Fahrenheit you lowlifes). Game on.
I tie the tourniquet high on his arm and watch the paleness turn mottled. Usually, when body temperature decreases, the vessels in your body constrict. Like what Pakistan is to India the country, Vasoconstriction is to India the trauma; a worst enemy. But, this man had a slight glimmer of the vein angels flying above our surgery lights, because I was able to perfectly place a 16 guage (big) needle into his ante-cubital.
In slow motion I see movement everywhere. Gowned fiends with blue latex gloves, scurrying about, dousing antiseptic fluid over the mans body as if he were a canvas and this was an art project. I am about to infuse liter number 11 and while on auto pilot, I think about his hypothetical wife and what she is doing at this exact moment. The same moment her chubby husband lies lifeless amongst strangers. While she is sitting in traffic, we are warming her frozen life partner. While she is tuning the radio, I am seeing blood spurt from her lovers mouth, and watching it run into his eyes. I then think about his hypothetical boss and how pissed he must be right now wondering where his chubby employee is. Why was he late? He is never late? OR He is always late. And as he lays with a fake pulse, at a temperature too cold to sustain life, he is simultaneously getting fired. It is all playing out in my head, the revolving door of Trauma India's life. How sad. How devastating.
Another Level One is rolled in for overtime. Bilateral chest tubes are inserted in hope that circulating warm fluid around the thoracic cavity will do the trick. But because we are a county hospital lacking a few essential resources, like the tiny connector piece that keeps the system in check, we gerry-rig some tubes and voila. Water starts spraying everywhere. It looks as if my esteemed colleagues and I are taking part not in a life saving procedure, but rather a wet t-shirt contest on spring break. The pressurized system had water spraying like sprinklers, people are slipping, bandages are getting soaked. Chaos ensues and a few laughs escape because sometimes, we just have to laugh about the reality of our reality.
By liter 22, it is clear that Trauma India is not being reincarnated. His blood pressure in nearly non-existent and his temperature never rose higher then 33 degrees. Laws state that not only do you have to be dead, to be dead, but you must be WARM and dead. We worked on him for nearly two hours. Trauma India was dead. Time of death 10:02:37.
We later found out bits of the story. Trauma India drove his white Toyota off the embankment somewhere near the Bay Bridge. When the coast guard boat sped up to the window, they encouraged and yelled for the man to get out of the sinking vehicle. It was slowly sinking and he had time. He turned to them, shook his head and locked the door.
This 'accident' was intentional. He wanted to end his life and went about doing it in the most dramatic, traumatic and expensive way possible. I am not sure the exact statistic, but suicide attempts are more common then successes. It is rare to treat such a success. And there I was, infusing liter after liter, expelling all my emotions on this man and his hypothetical life. I was physically draining every ounce of my energy to bolster every ounce of his that he had left. As I read about it on the cover of the paper the next morning, I couldn't help feeling less sorry for him then those back breaking moments while trying to save him. And my thin skin feels guilty about that. Because it wasn't just his loss, it was a loss of a trauma team. That was one we didn't get back.
Crazy huh? What's crazy is that it all seems to be falling into place. It just took a little Pie for me to figure it out.
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