I previously wrote about my specialty change from Obstetrics & Gynecology to Anesthesiology. I had no idea what I was getting myself into trading in the speculum for a laryngoscope. My first hands-on experience with trauma was as a first year anesthesia resident. It was 3 in the morning and I was paged to immediately set up the trauma room for a patient who was shot in the chest and coming straight to the operating room from the ER. I remember scrambling in the OR, drawing up drugs and making sure there was blood available for transfusion. The patient was brought to the OR and we swiftly transferred him to the operating table, secured the airway and worked on obtaining access for monitoring and resuscitation. We placed an arterial line in his wrist to measure blood pressure and check labs, and a central line in the neck to administer blood and vasopressors (powerful drugs to raise blood pressure).
The surgeon gained access to the chest via clam shell thoracotomy incision to identify the source of bleeding. A bullet had transected the aorta, the largest blood vessel which emerges from the heart. We initiated a massive transfusion protocol — an emergency release for blood — to keep the patient alive and buy time for the surgeon to repair the injury. During this time, the patient’s blood pressure dropped to dangerously low levels requiring us to administer CPR doses of epinephrine. The lab values showed significant acidosis (pH 7.1 when a normal pH is 7.4) indicating that many end-organs were already beginning to fail due to the lack of perfusion. The heart began fibrillating on the monitor and before our eyes. We shocked several times to no avail. The surgeon exchanged glances with our anesthesia team, and there was an unspoken understanding that our efforts were futile as the injury was irreparable. “Time of death, 03:43,” he said as he removed his surgical gown and walked out. I turned the ventilator off, cleaned up my workspace, and walked out soon after.
I had a similar experience as a 2nd year resident, however this time the patient did not make it out of the ER. The surgeon opened the chest in the trauma bay and performed cardiac massage in attempts to restore circulation. I drew up epinephrine and instead of administering it intravenously, the surgeon asked me to inject directly into the heart. After several rounds of CPR, we intently observed for signs of cardiac activity. No fibrillating, no movement. Electrical silence. “Time of death, 07:37.”
The above two examples are not uncommon occurrences at Level 1 trauma centers. We become desensitized to the blood, anguish, and loss of human life over time. Why? Because stopping to think about what transpired is often unbearable. The cohort of inconsolable family members are a reminder that every victim is someone’s child, sibling, parent, or significant other. They are loved by someone regardless of any circumstances that may have brought them to their death. Until the American people and supporters of the NRA truly realize the consequences of their “right to bear arms”, the value of human life will continue to depreciate. Until then, the show must go on.