Death Actually

It is all around us. This is what happened.

Last night a boy got into a horrible argument with his mother. She had sensed something wasn’t quite right, that they had become distant somehow, and she was devastated. She somehow found a stash of pot in his room. They fought. They cursed. And he left.

About six AM he got into a horrible car crash. At seven AM he arrived in our trauma bay. We spoke to his mother and father at about ten. We told them that he had suffered a massive brain injury and that his chances of survival were essentially zero. The pain and the guilt in their faces were devastating to witness.

The only things left to do were the brain death exams. As a trauma team we tried to elicit pain by pinching his nails; we dripped water into his eyes to see if he would blink; we brushed gauze against his corneas to see if he had any sense at all in his eyes; we blasted cold water into his ears to see if his brain was active enough to sense the temperature change; we turned off the ventilator to see if he would breath. Another physician came and did the same exam with the same results – our patient was dead.

Another women came in a few hours earlier. She was young, too young to have already survived high-grade breast cancer, and the chemo-radiation and surgery and subsequent reconstructive surgery needed to do so. She had regained her life, and was working with mentally challenged adults, helping them get to and from whatever activities and appointments they needed to life a somewhat normal life. The other day a man fell on her, and hurt her arm. Over the next day her arm became swollen and tense. Her heart raced, and her blood pressure dropped. She came into the ER with a very palpable radial pulse – that’s the one you can feel on your wrist just above your thumb. It’s the one people try to sever when they commit suicide. This morning she lost the sensation of that pulse, which meant the internal pressures in her arm were so high that it they were occluding the blood from flowing into her arm. And so we took her to the OR to explore her arm.

Her arm was dead. All of it. Her muscles, her fascia, her nerves, even her veins….all dead. We went into the operating room thinking that we might make a couple incisions and relieve some excess pressure – we ended up disarticulating her shoulder joint and amputating her entire right arm, putting on a temporary dressing, and transferring her to another hospital where they could treat her with hyperbaric oxygen – a last ditch effort to save her life.

Sometimes I feel my own pulse, just to make sure it’s there. I place my left first two fingers on my right wrist and feel the pulsations transferring from one wrist to the other hand. I think that it’s so odd, that here is the place where I (well, where others) would take their life, and it is here where I (yes, I) feel to confirm life.

It’s nice to know I have a pulse, even as death actually is all around us.