Lazy Sunday
It’s a real weekend, a normal Saturday and Sunday without the pressure of working overnight in the hospital, looking for clean underwear, or wondering what day it is. I’ve elected to sit tight this morning and wait for Meet the Press. The coffee is tasty, the sunlight through the windows bright, and I’m out of bed. It’s a pretty good start.
Laundry was a pressing concern, so I gathered up the stuff and wandered down to the basement to see if the machine was available. I have a fairly normal routine when it comes to washing my clothes, which is to let the water fill up part way and mix up with the soap. Then I sift through pockets collecting loose change and bills that typically accumulate there (not a fruitful search today) and throw everything into the soup. It’s a relaxing process for me, not to mention that I usually (not today) wind up with a few bucks for burgers.
I had clothes that needed washing from work, specifically a pair of brown slacks with blood on the front pocket. It sort of slips by during the work-week, these little details of leaning over a table during a procedure in the commotion of a crackling trauma room. The patient was a middle-aged man who had been crushed by his truck after being ejected, and the story was evolving to suggest that he had been awake in the ambulance and still had vital signs as he was wheeled into the trauma bay. At the point I walked into the room, 25 people were either actively helping with the normal sequence of addressing a trauma patient, milling around without much purpose, or simply gawking. I had been seeing patients in a different area of the ED, so my role was much more of the latter two, but with the caveat that I’m almost obliged as a student to be involved, even if it is only to watch. The patient lost vitals on the table about the time I edged into the room, and one of the ED residents was carrying in a thoracotomy kit. Similarly to the other night, the surgeons decided to crack this patient’s chest in hopes of finding a source of bleeding or relieving pressure around the heart. The resident made an incision from just below the nipple and extended it laterally down to below the armpit to the level of the table. He then bluntly dissected the intercostal muscles with a pair of Kelly clamps, and then inserted a set of rib-spreaders. This is all done on the left side of the chest for the sake of providing the best access to heart, and in a matter of moments. The pericardium was then incised (with care taken not to divide the phrenic nerve) and observed for blood, fluid, clot, etc…his was clear, and the surgeons decided to extend the thoracotomy to the right side, a procedure known as a “clamshell” in the trauma world. Another resident during this time had inserted a chest tube on the right side with extensive blood gushing from the tube, and it was assumed that the patient was hemorrhaging from some sort of shearing injury. It didn’t matter, though–the patient had no pulses, the bleeding couldn’t be stopped, and after a few minutes, the effort to resuscitate him ended. I had worked my way to the head of the table by this time, which is where I leaned in for a better view for the bilateral thoracotomies and the resulting anatomy lesson. I’m still not sure why I’m so objective about all this. For students and residents, tragedy simply evolves to education, often without reflection.