Trauma

One of the poignant things I've noticed on this rotation is human fragility. I get an incredibly skewed view of things because it is the surgical intensive care unit, but nevertheless, the view from here is grave (that eternal pun). The patients here fall under two general categories. Some patients are responsible for their dismal situation. I'm taking care of a young mother of two with bad hypertension who stroked while smoking crack cocaine. She had been admitted several times in the past for crack use, but this one was devastating; she's now in a coma, intubated, her skull removed to relieve the pressure on her brain. Another gentleman who will likely pass away today was drunk driving and crashed into a parked car. The stories go on and on: a man in his twenties involved in a gang fight, shot in the side of his head; a drunk woman who flipped a golf cart; a drunk man who crashed his car into a pole (drunk motor vehicle accidents are a recurring nightmare).

But I actually feel the most emotion regarding the other set of patients, those who are here completely by accident. We have a driver of a horse-drawn carriage whose horse stopped abruptly when an errant bicyclist sped in front of them. The driver, unrestrained, was thrown off the carriage and now has severe brain bleeds. Another previously healthy Cantonese grandmother was hit by a truck; she lost a leg, her pelvis was crushed, she's now septic (infection of the blood) and we're fiercely trying to resuscitate her. Yet another man was a long distance bicycle rider wearing a helmet, involved in a crash with a severe skull fracture and brain bleed; we're not sure he's going to make it.

Today we're transitioning two of our patients to comfort care; that is, we've felt that we cannot reverse what's happened and we're going to withdraw care and let them die in peace. The family is at the bedside. They're sobbing, praying, pleading, confused about this unexpected and terminal change of events. I feel an unease, distraught and miserable that a perfectly well person, on her way to a game of golf or driving home after a night of partying, can in a matter of moments, end up here in the intensive care unit, where despite "heroic" measures, we cannot salvage their lives.