Trauma I

A previously healthy young man is a passenger in an awful car crash, an accident that cleaves the car in two. All three other occupants in the vehicle die at the scene. The patient is thrown out of the car, and the impact of landing causes so many facial fractures that his nose and palate - the roof of his mouth - are essentially free-floating, their moorings released. He breaks his scapula, collarbone, and femur. The injury I find most disturbing is a ruptured globe - the eye is under so much pressure, it starts swelling out of the socket. We spend eight hours in the operating room fixing the eye, pinning the facial fractures, closing lacerations, performing a tracheostomy to breathe, pinning a femur, and nailing the hip.

In a separate accident on this MLK long weekend, a mini-van is T-boned at an intersection by someone running a red light. When I go down to the emergency department, I find the mother rushing between three rooms to see her two sons and her husband. One of them, a 10 year old I get to know well, is rushed to the operating room for a broken femur. While under anesthesia, ophthalmologists also have to clean glass shards out of his eyes.

The car crashes do not stop. A woman driving down the freeway, distracted by a cell phone, hits the median and flips the car. Her daughter dies at the scene. Her husband has a severe bleed into his skull. He's rushed to the emergency department where the emergency physicians cannot get a breathing tube in him. We hear an overhead page: "anesthesia stat to the emergency department trauma bay" and rush down. We manage to get a breathing tube in, but then the harder - perhaps hardest part - is talking to the wife who, stricken with guilt, must decide whether we should take her husband to surgery. From his symptoms, imaging, and labs, the chance of meaningful survival is nearly zero. We hold her hand as she decides to withdraw care from her husband.