Separation

The other morning a paramedic crew called into the ER and said they were bringing in a terrible motorcycle accident victim. How terrible? They said they would be bringing in his leg as well.

The 38 year-old man was wheeled in to the horror of everyone who watched. True to their report, he had no right leg – a young EMS student was quietly carrying it. The patient’s right arm was unrecognizable as an arm except that it was where an arm was supposed to be. His left arm was mangled but at least it looked salvageable. His left leg had some terrible gashes on it.

And the worst part? He was perfectly conscious. He gave us his name, address, social security number. He looked terrified.

We quickly intubated him for his own protection and began the process of our trauma evaluation. Amazingly enough, he had no significant internal injury.

There are some things that are supposed to be together – attached for all time. Needless to say one’s legs and arms fall into that category. And there is just something so unnatural about seeing that forced separation. Seeing his leg – the same leg that had helped him climb onto his motorcycle just that morning – felt surreal. That leg – that thing – used to move, and feel, and be alive. Now it’s nothing. In its place is literally nothing. And it will never be the same. Never. No matter what, he will never have his leg back.

What happens when you rip something apart? What happens to the pieces that are left? We wrapped the leg in a red “hazard” bag and sent it to the pathology lab, which is really one step above throwing it in the trash. We put some IVs in the patient, threw some gauze on the wounds, and shipped him to the OR where a trauma surgeon, orthopedic surgeon, and plastic surgeon were waiting for him.

They were able to do amazing work. Our patient is alive, and doing quite well. Of course, he’s short one arm and one leg, but he is alive and in good spirits. And I guess that’s really the important thing. Because as unnatural as it may be to undergo a separation, sometimes these things are just completely out of our control. Nobody wants this sort of trauma, but sometimes traumatic things happen. And when they do, as terrible as they are, we have to choose how to deal with them.

Separation is not death, as this patient taught me. It is not the end. It is an end to some things – some really important things – but not everything. And it may yet be the beginning of something else.