The Other Shoe

I should have been waiting for the other shoe to drop after a "fun" trauma. And boy did it drop today.

First patient: 14yo boy in a car accident. Intubated at the scene. Arrives in a c-collar (neck brace) thrashing around because he needs more meds to sedate him/paralyze him/take away his pain. It takes at least 15 minutes to get an IV in him to give him any meds. I felt for this kid the entire way. He ended up having a pretty significant bleed in his head and a number of other things but will hopefully do ok. Naturally it didn't stop there...

Second patient: 20yo man ejected from his car. Intubated at the scene. Helicoptered in. Went into cardiac arrest literally while walking in the door of the ED from the helicopter. His pulse came back for a while, then went away again. About 45 minutes of pushing meds, doing CPR, putting in 2 chest tubes, 2 femoral lines, and finally cracking open his chest and beating his heart for him, he was pronounced dead. If that wasn't bad enough, it was at that point turned into what I'll call a "teaching opportunity" for all the residents, students, and anyone else who wanted to to put their hands in his chest, learn the anatomy, etc. I politely declined to participate, but in reality I am immensely offended that this took place. He did not consent for his body to be donated to science, we were not doing anything to try to save him at that point, and while I understand some people would argue that if he died he might as well be "useful" to teach and learn on I do not agree. I heard stories about this at the beginning of 3rd year (ex. practicing intubating on a patient who had just died, etc.), and always thought "oh that would never happen and I would just say no anyways". Well, it happened today, and I did say no (which I'm proud of), but I'm afraid that it might come back to bite me ("she passed up a great learning opportunity", "she doesn't care about becoming a great doctor", etc.). Even if it does, I'm sticking to my ground and respecting this incredibly unfortunate young kid who died today. I hope everyone will be reasonable and respect my decision.

Didn't really want to tell this story, but it's the first time I've had a patient go from "alive" (with a pulse) to dead right in front of me. It was especially hard with it being a young guy. He was married (wedding band). Just heartbreaking. Definitely shed just one tear for him in the trauma bay before having to pick up and go back to my other patients with a headache and abdominal pain. Puts everything in perspective. Hard day, but I guess if I can't take it I shouldn't be doing this. No choice but to pick up and carry on.