Every time our HASTE (Hospital Alerting System Tone Encoded) alarms, my ears go up, the adrenaline surges and reality strikes — someone who never expected to be in an ER today is barreling towards their date with destiny.
“Attention Emergency Department. Medic 3 is en route with a Trauma Alert. The patient is a 23 year old male, gunshot wound to the chest. Vital signs are unstable”
Game on — Activate!
The patient arrives steeped in his own sweat; he’s ashen and cold. His eyes lock on mine — desperation — then roll up and disappear as we transfer him from the rescue stretcher.
Circulation: absent radials and femorals; thready carotid
Exposure: GSW right anterior chest above nipple; GSW right upper back
The trauma team collects this data in less than a minute. Our seasoned trauma attending, Pete, expertly orchestrates our plan of action. Airway team intubates. Surgery preps the chest for chest tube insertion and possible thoracotomy. I’m on large bore IV access on the right, my medic partner, Jim, is going for the same on the left. It is a horrific scene yet, there is a beauty in the seamless teamwork.
“14 gauge right AC”, I call out six seconds before Jim calls the same on his side. I’ve got a high flow line banging in saline on a pressure bag cranked to 250 mmHg. That’s when I notice mostly clear fluid bubbling from the chest wound. The bubbling stops when I clamp the IV line. “Pete, I got saline coming from the bullet hole”, I yell. Simultaneously, the ER senior resident announces “I can’t feel a carotid”. Pete turns to me and says, “Put on an extra glove and stick your finger in that hole”. “What?”, I ask and he repeats himself in his cool, calm and collected manner. 1mg of Epinephrine is called for as I plunge my left index into the wound. Jim’s hands go on the patient’s chest to start CPR. He does the best he can but I’m kind of in the way. Jim tries to reposition when I realize I’ve got a bounding pulse at the tip of my submerged finger. I scream, “I’ve got a pulse!!!” to which Pete responds, “Don’t move that finger – – We’re going to the OR”. The only way to maintain my tamponade in transport is to climb onto the stretcher and “ride” the patient; It’s the longest OR transport I’ve ever taken but my resolve is firm — I want this guy to live!
In the OR, the orchestration continues — It’s different than my world but just as beautiful (and they’ve got a whole lot more instruments to play!). Each member gets set. I get a three count and withdraw my finger. The patient’s chest is opened in a blink and the repair of the injured blood vessels gets underway.
“You gave that guy every chance”, I’m told as I walk back into the Trauma Bay. It’s one of those weird things we say to each other after intense resuscitations. It hits me though because I’m thinking about chances — second chances. This is the sum of what Trauma Nursing is. This patient is someone’s son, brother, husband, father, friend. Beating death may give him the opportunity to love more, to learn more, to live more. He gets a “do over” if he survives. I can only imagine what the ripple effects of a second chance mean for this man. I know what they’ve meant to me.
The patient makes it out of the OR to the SICU by the time I end my shift. I’m off for five days following that night. Everyone’s still talking about it when I return thanks to my hype-man Jim. I’m in early so I walk up to the SICU to check on my patient. The charge nurse tells me “he’s gone” when I inquire to his whereabouts. My face falls and I get choked up before she clarifies, “He got discharged! He got discharged!” Relieved I ask, “What was he like?” “Quiet, freakishly quiet!”, she replies.
“Good” I say to myself. I hope he’s hung up on second chances too!