January 29, 2007

About to Die

"I'm going to die!!! Help me! I'm going to die!"

We heard this before we saw the person screaming these fateful words.

Those are dreaded words in the emergency room. You see, somehow, and I have never understood how and probably won't until I am the one making that proclamation, a person knows when they are about to die. Now I'm not talking about the "yea I have brain cancer and my doc says I have 3 months" I'm about to die but rather the "There's an elephant on my chest and I can't breathe" I'm about to die. They know...

So this guy, late 20's, staggers through the ER doors Saturday night holding his hand to his right neck. One look at the guy and you knew he was in some serious trouble.

He had the look of a battle-worn street soldier. Wife-beater, sagged hip-hop-inspired black jeans, black nylon do-rag, Timberland boots... And tats everywhere, including a couple of teardrops on his face.

But I didn't notice the tats, nor the clothes, until later. All I saw was blood.

He staggers in and flails himself across the triage desk. He is holding his right hand to his neck, trying ineffectively to keep the blood from pulsing out of his body.

Blood is everywhere. His clothes are saturated and dripping. Bloody boot-prints, blood squirting onto the floor and desk and our registration clerk...

The triage nurse called for help, and we got him on a stretcher and pushed him into a resuscitation room to save his life.

He was screaming when he walked in, but he's now just a whimper of a man as the nurses start to cut off his clothes. I do a quick inspection and note that he's been shot in the right neck, no apparent exit wound. His pulse is thready and his blood pressure is dangerously low.

I intubate him rapidly and then place a large-bore IV into a central vein to begin giving him blood. A tech holds pressure on the wound to control the massive hemorrhage. His blood pressure rises to safer levels...

The trauma surgeon arrives and takes him to the operating room. Total time in the ER - 13 minutes!

Almost 3 hours of surgery later, the man is alive and the damage is controlled. He'll be on the ventilator for several days until the swelling is no longer a threat to his airway. But he'll live...

In Birmingham the violent crimes have been increasing over the last several years. The homicide rate is trending up, reversing several years of decline. Noone knows why. I don't pretend to know why.

But I've seen way too many kids and young people and innocent people fall victim to this increasing violence. I've seen 12 and 14 year old girls riding in the backseat of a car get shot and killed while their mom pumped gas. I've seen a 2 year old kid get shot and killed while sleeping in her bed. Just recently I pronounced dead an 18 year old girl, 9 months pregnant, who was stabbed to death by her baby daddy's ex-girlfriend.

It's tragic. And there's no easy solution. Take away guns, but they don't disappear. Lock more people up, but there always are others to take their place.

Respect. Treating others as you would be treated. Realization that it's a big world, and you are such a minor player. Somehow the solutions have to lie somewhere in these concepts. But how? How do you get people to think before they act? To respect?

I don't have the answers... I wish I did.

I'm tired of hearing healthy young kids tell me they are about to die...


Bike Chick said...

I'm sorry you have to hear that. I don't know how you do it. But I'm glad you and other do. Thanks.

TJ said...

wow... i don't think i could deal with those issues on a daily basis.
i don't know the "fix" to the violence issue either, but it does seem to be more prevalent everywhere.

Shelley said...

Amazing...I don't know how you do it, but for them..it's great that you do!!

Star said...

You must get very introspective on your long runs and rides. For me (I'm an LMHC), tri's are MY therapy!

greyhound said...

I wisely gave up medical school dreams while still a kid, knowing beyong certainty that I could not practice medicine--especially emergency medicine--with any kind of sanity or humanity. I don't know how you do it.

Tri-Dummy said...

I've seen alot of the things, discouraging things, that you've seen...except as a cop.

Our society is growing more violent and I don't really know why.

Is it video games, poor parenting, no parenting, lack of discipline, too much discipline, medicating too much, not medicating enough, the media, the legal system?

It's way bigger than guns. I think its a totality of a lot of different circumstances.

Whatever it is, it makes both of our jobs harder.

Kylie said...

We are lucky there are people like you around who can handle it.

Donald said...

You hit the nail on the head with "respect". There's not nearly enough of it when everyone is blinded by their own self-interests.

Thanks for the job you do.

Laurie said...

You're right, there are no easy answers. We live in a dangerous and depressing world. Yet there is hope if you look for it. Thanks for being there for all of the people who are in need.

momo said...

you are in such a tough profession. you see people at their very worst and it is sometimes so senseless - as in this case.

i often wonder how people in jobs like yours deal with the emotional stress - perhaps its a really good thing you have this forum to get it out and let it go?

thanks for sharing such a personal account and thanks for all that you do to give your patients the opportunity to see another day. hugs.

TriJack said...

t-dum, agreed... defintely more than guns, although they probably are the easiest to blame

Bigun said...

watching the news just last night in tampa - 3 dead from stabbings - I think that if you want someone dead, it's gonna happen - "nice" thing is that at least with stabbings it stays personal, and usually theres little collateral damage. Its a good thing there's folks like you and Jay out there - I can give an IV, but still get way too squeemish around blood. Hang in there and go for a punishing run....thanks!

ironjenny said...

TriJack - I can just repeat all the above comments. I don't know how you can keep your cool in moments like that. But in the 13 minutes that this man's path crossed yours, you saved his life. He will never thank you, but I and the rest of your triblogger friends will..;-)
There's a gravity in realizing that you came into that stranger's life for a blink of an eye and forever changed it.

Regarding the increase in viloence... I don't know what the answer is, but I see a general mean-ness permeating our society. For instance, lately everybody's talking about American Idol and how funny it is watching people's dreams die. Really!?

Clearly many contestants are mentally challenged, and many are just regular Joes with a dream; yet a record number of viewers are loving the "entertainment" of watching them get ripped apart. I don't get it. That's enjoyable to watch? Reminds me of the Coliseum in Rome - at some point it became entertaining to watch others get literally eaten alive... so far in out society it's still only "figuratively", but for how much longer.

All He ever asked of us was to love one another, and we can't seem to do even that.