A story from shock trauma

In January, I spent two weeks on Shock Trauma. The schedule was grueling: overnight call every three days. It seemed that once you had stayed up all night, the post call day went by quickly and then you were up all night again. I always enjoy a good trauma show on TV, and those shows led me to believe that there would be a constant stream of horribly mangled bodies, constant action, gowns and gloves being tossed around as the patient is prepped immediately for surgery. There was a little of that. But one of the very surprising things about trauma was how pedestrian it could be. A gunshot wound or motor vehicle collision could come in and leave the same day. Yes, there were a few times when there was a mad rush, with everyone in the building crowding around the bay, hoping to get a glimpse of the action. But often a patient would come in on a stretcher and the resident would calmly take notice and get up and do what needed to be done. All the same, you remember the sickest patients best. Here's one I remember in particular.

He was an elderly man who shot himself in the forehead. When we looked at the CT, we could easily see the destructive path the bullet had taken through the skull and brain. The pieces of shrapnel glowed brightly, and the ventricles were filled with a gray haziness, the blood diverted from the brain tissue, emptying from the inside. And yet the wound in the forehead was a small, ragged thing, like a burgundy crocus. The patient was put on ventilation, and his vital signs were quite good. But all the same, the neurosurgeons told us there was no hope for recovery; the only thing to do was to allow the family to say goodbye, then stop the ventilation and allow the patient to die.

Soon, the patient's son came; he wore a long, wool coat, looking as though he had just left a business meeting. From across the room, I could see the absolute blankness on the son's face; it was the face of someone who cannot begin to fell, who had to see everything in perfect clarity first. And then, only minutes later, he left, walking quickly, his face consumed with grief. Later, the resident told me that when he went to talk to the family, they were arguing. Some maintained that they could never imagine Dad doing something like that, that he had seemed fine. Another protested that she knew something was wrong, that Dad had been preparing for this for the last few months, that he had been giving away his possessions and making funeral arrangements, that it should have been no surprise at all.

The patient was extubated and the curtain was drawn around the bed. Two nurses kept watch at the patient's bedside. Not long afterwards, the nurses started to clean the bay, and I saw that the tracing of the electroencephalogram was flat.

In medicine, it's the small glimpses into the lives of your patients and their families that give your work meaning. From a strictly physiological standpoint, this was a simple case: a bullet, a brain, death. But seeing the patient's son, hearing about the family's quarrel: these conjured up whole worlds of grief and pain that revolved like planets around that hospital bed. One bullet had changed a thousand lives irrevocably. When I think about that, I realize that medicine isn't about the bullet or the brain. It's about those thousand lives that change when you place your stethoscope on a patient's chest or when you scribble a prescription. And it's about the thousand-and-first life that changes: your own.