I admit it – I’ve spent hours
watching the reports of Malaysian Flight 370.
It’s bizarre and fascinating to me that, in this day, a Boeing 777 could
just vanish. How does that happen? How can something as big and strong – as vibrant,
event – as big jet airplane just go away?
In the world of trauma, we’re pretty good at keeping people
around. You may not be as good as when
you first came to us, but…still, we tend to keep most of our patients alive. People generally just don’t go away.
But the other night that wasn’t the case. An elderly man had a heart condition that
necessitated a very powerful blood thinner.
His old, loyal cat got stuck on their roof, and for some reason this man
decided to go after it. He slipped and
fell off, breaking his back in this process.
He had been a heavy smoker, and when people when bad hearts and bad
lungs break their backs they get really sick.
One by one his organs began to rapidly fail him, until we were keeping
him alive with a ventilator, massive amounts of blood transfusions, and
vasopressors.
The problem is that when someone gets such a massive amount of
fluids, their intestines and abdomen get incredibly swollen. This man’s swelling got so severe that it was
affecting his breathing. It’s called
abdominal compartment syndrome, and the only cure is surgery to decompress the
abdomen. Unfortunately this man was too
sick to even transport to the OR, and so we had to bring the operating room to
him.
And that’s just what we did.
In a flash of nurses and techs, a small, mobile OR was brought to the
man’s bedside. His skin was rapidly
cleaned, I got scrubbed, and before anyone even knew what was happening I was
opening his belly. I made a huge
incision – from his pubic symphasis all the way to his xyphoid – as quickly as
I could. I cut down past his muscles,
through his fascia, and into his abdomen. His intestines burst out with a rush
of fluid as the pressure was released.
And quite rapidly he got better. His oxygenation improved, and his blood pressure
and heart rate normalized. He was so close to death – so close to vanishing –
and now here he was, showing us he was alive.
We got some supplies that we could use to temporarily cover his abdomen
and went back to work, thinking that we had at least staved off death for now.
But then he started bleeding. Just as I was finishing we noticed blood
welling up from beneath his liver. His
blood pressure started to drop, and I had to open up my closure. The blood thinner was still in his system
(some cannot be reversed, and this was one of them), and he was bleeding
out. When patients have a discrete injury
it can targeted and ligated, but this patient was just bleeding from
everywhere. We tried to compress the
bleeding but it didn’t work. Dissecting
just seemed to make it worse. We packed
and packed his abdomen to try and stop it, but all that did was stop the blood
flow back to his heart. Within a few
short minutes his heart stopped.
And that was it; he was gone. He had been a vibrant man – a husband, a
father – just a few short hours before.
And in a flash he had disappeared from his family forever.
The family was gratefully for our efforts, but clearly
devastated. And so was I.
I don’t really think we did anything wrong – I think he was
just a really sick man who had a bad accident, and it was just too much for
him. And sometimes that happens. Sometimes people vanish off this planet
without a more satisfying explanation.
