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Birthday Gift

November 01, 2017

The trauma bay is overflowing with people, masked, gowned and gloved, before the ambulance arrives.

EMS rushes in through the automatic doors bringing with them a blast of warm summer air. The ER is kept at a frigid temperature and there are no windows. No clues as to what is going on in the world outside. It’s impossible to tell the weather, the time of day or year. The patient is code blue — cardiac arrest. One EMS personnel is pushing, another doing awkward chest compressions while standing on the side of the moving stretcher. They are calling out what they know to bring everyone up to speed.

Teenager on a motor bike hit by a truck. Found down in the street, unresponsive. Extensive injuries to his head, chest, right hip and leg. Blood everywhere. With each compression more pours out of his mouth, nose, even ears. I catch a glimpse of his face through the circle of residents, nurses and doctors surrounding him. He is young, maybe the age of my little brother. So many things happening at once but everyone keeps their composure. They have a system — a sequence of steps to complete when someone’s heart stops.

There is a line forming for compressions to switch out every few minutes. I’m CPR certified and I’ve done compressions before but something about this patient makes me hesitate to get in line. They are breathing for him, pumping his blood for him, buying time while they try to bring him back. They give him medications through his IV, shock his heart, periodically check pulses and use the ultrasound machine to check if his heart has started beating on its own. The longer this goes on the less hope there is. Everyone is still going through the motions but you can feel the sense of urgency diminish.

Almost an hour they work on him. The attending doctor: “Does anyone have any other ideas?” A quiet murmur: “No.” The attending: “Does anyone object to stopping life support?” Again, “No.” The attending: “Time of death- 6:22 pm.” There was little chance of saving him. He had a fatal head injury. He wasn’t wearing a helmet and hit the pavement hard. Part of his body had been run over by the truck. He was gone before he arrived at Temple. They contacted his family, which was now in the family room awaiting news. One of the residents would tell them.

I am standing nearby in another patient’s room when the family is told. It’s a big Hispanic family, at least 7 family members in the room. Suddenly the yellow zone is filled with guttural, raw howls- not a noise that a person can make intentionally. Their pain is palpable, vibrating in the air. It’s not true, they don’t believe it. They want to see him. I leave the other patient’s room and stand frozen in the hallway. More commotion. The sound of furniture being thrown. Security rushes in. The grandmother faints. More healthcare workers needed to control the situation. They wheel in a stretcher. Ten minutes at least of screaming. Everyone can hear. I have goosebumps and a pit in my stomach. Such an unimaginable, private moment shared with the entire ER. The family had lost another son last year. Not again. It can’t be happening again they cry. He was a good boy. He got the bike as a gift for his 18th birthday. It was his first time riding. The screaming is replaced with loud and uncontrolled sobbing. The men and women both. What is there to say? What will I say when it’s my responsibility to break this kind of news?

I’ve seen people die this summer. It happens every day in Temple’s ER. It has never really disturbed me. Even the first time I was fine. Seeing blood and guts doesn’t bother me either. Right now I feel disturbed. Not because I just watched a mutilated 18 year old be poked and prodded for an hour. Not because blood was dripping out of every orifice of his body. I’m wondering if that’s what my family would sound like. I feel like an intruder listening in on their tragedy. This death suddenly seems so much more personal when pairing it with the reaction of the people who will miss him the most. It seems like many of the hard parts of medicine become second nature if you practice long enough. I don’t think this is one of them.