“Hey, man, I’ve been getting destroyed all night running four OR’s and haven’t eaten. I am going to eat dinner before I get out of here. If anything emergent comes up, I can help out. Just let me know.“
As I wash my hands right after I hang up the phone, the overhead call come out: “Attention. Your attention, please. A Level 1 trauma code has been activated in the adult emergency department.” It was a gun shot wound to the right chest. I rinse my hands off, and head down to the ED… just another night in A Doctor’s Life.
Ready. Rinse. Repeat.
Ready. The patient arrives.
The patient sounded like they were in a bad place before they even got to the ED. Massive transfusion protocol in place. The patient arrived as unstable as they sounded. They were already intubated and on pressors. Bags of blood hanging as part of the multiple transfusions received. The patient had obvious neurologic and vascular injuries.
After a quick work up, it was determined that the patient was coming to the operating room for an attempt at emergent operative intervention.
Unfortunately, the injuries were devastating. Our resuscitation couldn’t keep up with the injuries he sustained despite a cross-clamped aorta; and despite our massive transfusion through large-bore venous access.
After realizing that we had already lost the battle, we stopped.
The patient died on the table.
I hate these situations. I always like to talk to the family after a bad event happens in the OR. It’s probably helpful to them to see the people who helped try to save their family member. And, God knows, it is helpful to me in processing these events.
After staying two hours later than my shift should have ended to care for this patient, the family still was not present. He had been transferred to us. Wanting to talk to the family, but not knowing when (or if) they would arrive, I headed home. It was well after midnight by this point.
I obviously cannot go into specifics on this patient’s case, but it never ceases to be any less devastating. No matter how many patients we lose.
I lost several in training, and this was my first as an attending physician. Though there was little I could do and the deck was stacked against my team, it hurts none the less.
I just hope and pray that the family is okay and will make it through this.
I want to rinse this bad night off
As we wrapped things up in the OR, I looked my residents in the eyes and asked if they were okay, and asked if they needed to talk. As with any debrief, we talked about what happened. We discussed if there was anything we could have done better. We all agreed that the outcome would have been the same regardless of what we did.
As I leave, still having not eaten dinner, I drive home with the windows down. Its 40 degrees outside. I just need to feel the air in my face while I think. It had been a busy night. The short drive at this time of night isn’t long enough to process it all.
I arrive home to find my front door is not only locked, but so is the storm glass door (to prevent my 19 month old from running out the door, I am sure). The key for the storm door is different, and I don’t have one. I call my wife multiple times.
Finally, I check the inside garage door. It’s fortunately unlocked, and I walk inside.
I brush my teeth. Get in bed. Lay there for an hour trying to fall asleep while thinking about what happened. It’s now 1:30am. With my eyes closed and my heart heavy, sleep finally comes.
The next morning
I wake up the next day to the morning hustle and bustle of helping my wife get our three kids out the door.
After my family leaves, the quiet sets in again. And, I realize that I get to do this whole thing called being a doctor over again tonight. I often feel like an imposter being a doctor, but it really is a privilege and an honor. It’s also really hard sometimes.
Ready. Rinse. Repeat.
Working in medicine is tough. We don’t always acknowledge that, and expect everyone to just keep moving along. What have you found to be helpful in these tough situations? Leave a comment below.