A two week stint on trauma is part of the general surgery rotation that all third year medical students complete, and the trauma service at a level 1 medical center can be disillusioning to say the least.
With gunshots, stabbings, assaults, and hit-and-runs all too common, you begin to wonder how people can be so awful to one another. Yet with those detractors comes an energy, a rush of adrenaline and anticipation as you wait for the next patient to be rushed through the doors, that makes it all worthwhile. In one place you get an incredible cross-section of society – after all, anyone can be in the wrong place and the wrong time – and a spectrum of cases, from tragic to comical, all thought-provoking and full of lessons to be learned.
It was a Friday afternoon, and I was a mere 15 minutes from being able to go home when, like clockwork, my pager went off in response to a code yellow (a trauma emergency) that was on its way to the hospital. Less-than-thrilled at the fact that I’d be hanging around for a few more hours I made my way down to the trauma bay, a fully-equipped room within the emergency department where all the action of an arriving trauma case went down.
Word had it that the incoming patient was an en-route transfer, who had been re-directed after it was deemed that a head laceration he’d suffered after falling from standing was too big to be dealt with at a lesser-equipped hospital. Per the EMT’s, he was not only intoxicated to the point of imbalance, but also to the point of belligerence, and was particularly aggressive.
And indeed, upon his grand entrance into the trauma bay – replete with punches, racial epithets, and expletives yelled in broken English – it was clear this guy was going to be a special case. In the same organized chaos that accompanies any given incoming trauma case, the patient was surrounded by a hoard of trauma staff – nurses, X-ray techs, attending physicians, medical students, etc – each with their specific tasks which were to be carried out in the most timely manner, such that no time at all be wasted.
The initial surveys were completed, blood draws taken for labs, IV’s put in place, X-rays shot, despite the fact that all throughout the patient had resisted, pulling on any wire or tube he could get a hold of, swinging and kicking at those of us who attempted to his frail, yet powerful frame down. In broken English and occasional bursts of accented Spanish he repeatedly yelled that he wouldn’t let us kill him. To no one’s surprise, he was also less-than-helpful when answering basic questions about his past medical history and the events that had precipitated current visit to the ER.
At one point after the initial hubbub had calmed down, the attending trauma surgeon, an Eastern European woman for whom English was a non-native language, asked aloud, “What are his allergies?” leading me to relay the question to the patient in Spanish. His response was quick and pointed: “Tu madre,” he replied. Those who heard and understood it burst out laughing, as the attending looked on in confusion.
“What is he allergic to?” she asked again, noticeably frustrated at the ongoing difficulties. “This guy’s mother” a nurse chimed in, pointing in my direction. “But I don’t think the electronic medical records will recognize that specific allergy” she continued.
Somewhere between grinning from the ridiculousness of the preceding incident, being slightly offended at having my mother insulted, and gagging at the horrendous smells emanating from the patient (a mix of urine and a special form of halitosis known as trauma breath), I continued to hold the patient down and talk to him the best I could. He was violently writhing and trying to break free, once again pulling at anything he could get his hands on (at least 3 pulse oximeters saw their demise that day), all the while letting us know his displeasure with being there.
And then, as if in a miraculous moment where the skies above parted and a booming voice said, “LET THERE BE ATIVAN!” our riled up protagonist received a bolus of sedative and finally calmed down. His muscles relaxed, his pupils dilated, and he finally lay back in a quiescent ambivalence to what was happening around him.
In this moment, without me even prompting, he began recounting his journey from Cuba decades earlier, and telling tales of his childhood on the island before that. And although slurring, sedated, and still very, very intoxicated, he managed to convey a distinct overtone of humanity in his stories.
Unfortunately, everyone in that room had witnessed his worst; yet another belligerent drunk causing trouble in the ER, lost to the world and himself. But as the sole Spanish-speaker with him at that moment, I was the only one to hear his story, and see him at least partially redeemed. But hey, that’s life… or at least, that’s trauma.