An Evening On Call

Trauma pager goes off and everybody drops what they are doing to assemble to receive the patient. Standing around waiting while conflicting reports float around as to what the injuries are. Then the sound of the helicopters can be heard. Moments later the techs run out to get the injured. Not just one but two soldiers…the team splits into two teams to evaluate our new patients simultaneously. I take the more critically injured. Over the moans and cursing, the team efficiently goes to work like a racing pit crew, each with their own task as I assess whether or not the patient needs to be rushed to the OR, now …later…or ICU.
The other team leader comes over to me to let me know the condition of the other patient. I give a few instructions and advice, then back to my patient. “Get him to the scanner” I say in as calm a voice as I can muster. Blood pressure, heart rate, breath sounds, O2 sats, all change from moment to moment. Good one moment, crappy the next. I turn to SPC T and say, “Have the blood bank get 4 Units ready for when we get back”. Off he goes. They load him on the scanner and after working through a few “kinks” in the system (sucking up valuable time) the whur of the CT machine reveals the images that bring great relief to me…No intraabdominal bleeding, but, the back is shattered. “How can this guy still be moving his legs” I think to myself. I send up quick prayer thanking God for the use of his legs and plead with him that we don’t make things worse in all the transfers he will need until that back gets fixed in Germany.
“Where’s the blood” I ask slightly annoyed that there is no blood waiting for us as we pull back into the trauma bay. “It’l be here in 10 minutes, “ I hear from some random voice behind the frenzy of activity. “ I asked for it 20min ago, it should be hear by now”, I think to myself.
“His pressure is dropping and now we don’t have IV access” the nurse says with a sarcastic smile, knowing that Murphy’s Law always strikes in the trauma bay. “Get me a central line kit!” I say to one of the internist that desperately wants to help but stands there like a man standing by a raging river afraid of where the current would take him if he were to jump in. “What size gloves?” the nurse says. “Seven and a half” I respond without thinking about it. Less than 2 minutes later the central line is in just below the clavicle sutured and dressed. Another prayer of thanks goes up, as the FP doc pats me on the back and says, “Nice job with that line.”
The blood arrives and is slammed in. His pressure rapidly responds….back to normal. Thank you GOD!!!
“Let’s get him to the ICU and get him warm, and get a CXR to check that central line.” I say as I step back to let the pit crew do their thing. Moments later they are on their way with the young patient to the ICU. I look at the chest xray…the moment of truth…is it in the right place….did I drop the lung…nope! Thanks again GOD.
I walk over to the bedside of the other patient and am given the report from the other team leader. Sounds like he is fine. “Can you admit him?” I ask the other doc. “Sure,” he responds.
In the ICU the nurses are getting his repeat labs and cleaning the patient up. “Seems like his stable for now,” I think to myself and go over to the desk and start documenting. The hour goes by punctuated by little requests here and there for miscellaneous orders. I check the patient and the labs. “More blood, he needs more blood” I think to myself and let the nurse know that he is going to need more blood. 10min later the blood is there and being transfused. The pain medication is kicking in and the patient is comfortable. Time to fill out the medivac request and get the helicopters coming. After all the paperwork, the word back is, “It’ll be 3 hrs. till they get here.” Time to sleep. I stop by the ICU to let them know to page me when they pack him up for the flight.
0500hrs I get the page and I put my fleece jacket on over my scrubs and go to the ICU. I walk in to see the patients brigade commander at the bedside. I introduce myself and summarize the situation for him. He thanks me and we all go out to the flight line to get him on “the bird”. I watch and pray as they load him. The commander says, “Keep up the good work” then turns and walks away, leaving me alone to watch the helicopter take off. One last prayer for safety for them and that I did all the right things. I look at my watch, 0855. I turn around and walk to church alone.
This is how things can be for me.