Blood, Sweat and Tears

Having to change out of a set of bloody scrubs once during a shift is an occupational hazard. Twice becomes somewhat of a nuisance, and after three or more, you’re “that person”. I was that person.

Saturday nights during the summer (or “trauma season” as we affectionately refer to it) is when everyone brings food and their A-game. Last night was no different. To celebrate Cinco de Mayo, we had a lovely Mexican spread and lots of chips, and one “hit” after another.

The environment is always one of controlled chaos. Nurses, doctors, aides do what they know how to do best, and somehow everything turns into a smooth, carefully choreographed routine. In that sense, last night was no different. Everyone had their own patients that they were involved in, but since I was carrying the team pager and dealing with bowel regimens and repleting phosphorus and magnesium, I only took one “hit” and my night was broken up by four bloodstains.

One of the first patients that came in was mine. Typical enough story. A gentleman who swore he never drank came in after the curb broke his fall. The first responders at the scene were kind enough to put a gauze bandage on his forehead, giving away immediately where the point of maximal impact was. He had no injuries elsewhere, so we turned our attention to his head. We applied gentle pressure as we unwrapped the gauze bandage which got more and more soaked the closer we got to his skin, until we saw the gash from one of his eyebrow to another.  His skin was adherent to the last piece of gauze we removed, revealing an actively pumping vessel underneath.  We covered it hastily with a fresh piece of gauze, realizing that we needed more tools to address “the pumper”, but not before the front of my scrub top looked like a cheap impression of a Jackson Pollock. And surprise, surprise, his blood alcohol level was a little more than four times the legal limit.

As soon as we were done suturing him up, and as soon as I was in a fresh set of scrubs, we got a call about two motorcyclists. We divided up into two teams with most people involved with the sicker of the two patients as he would need more hands on deck. The less sick of the two patients came first. Just as he finished telling us his name, the next patient rolled in with an EMT straddling the stretcher while performing chest compressions. I’m ashamed to admit that my first thought was that it must be a nice day outside if people were motorcycling, and that I had no idea since I had fluorescent lighting to keep me warm. I took a deep breath in and I knew it was going to be one of those nights. I also knew that as soon as I was done taking care of this patient, I was going to help on the other side of the wall.

By the time I got there, large IVs, a breathing tube and chest tubes were already in. They just needed help with compressions.  CPR was the natural choice given the fact we couldn't feel a pulse. But there is nothing “natural” about pummeling into someone’s chest about 100 times every minute or feeling someone’s breastbone (sternum) crack under the force of your body, or seeing them change from warm and dying to cold and dead. There is no worse feeling in medicine than doing everything you could and having that no be enough. Defeated, drenched in sweat and spritzed with blood (yes, again), I went to get a fresh set of scrubs, hoping for either a brief lull or a good save.

My prayers were answered shortly afterwards. The good save came in next. It took the form of a gentleman who had fallen and was bleeding profusely. There was a stream of blood that outlined the route to his bed. He was ashy grey, unable to speak to us and struggling to stay awake. There’s a saying that all bleeding does stop eventually, but we didn't want this patient to be discharged to heaven as well.  After we put a breathing tube in, we turned him to take a closer look at the site of his bleeding on his back. Still paralyzed, thanks to the anesthesiologists, I turned him towards me so that my colleagues could get a good look at him and try to stop him from exsanguinating. I struggled to hold him still while my colleagues put in a few stitches, while his hand, caked with blood, flopped over the side of the bed and cupped my behind. After laying him back down, I needed (you guessed it), a fresh set of scrubs. His blood was all over the front of my pants where I was leaning on him to hold him steady and there was a bloody partial hand print on my behind.

Changing for the third time, I slumped over in the locker room and let myself be tired. Other people had been able to survive this before me, and there was no reason I couldn't  Granted, I was 20+ hours in without any rest. I had operated all day and responded to about 200 pages already. I was in desperate need of a shower, and I couldn't remember the last time I had a chance to pee. But with each passing minute, the end got nearer and nearer. I downed a big glass of water, prayed I wouldn't get a kidney stone and headed back to work.

I saw a crowd of people standing in the corner and so I went to investigate. A new patient had just arrived. He was complaining of pain in his scrotum, and once we pulled down the sheets it was easy to see why. His "manhood" was approximately the size of a cantaloupe, beefy red and tender. I had no doubt that he needed to go to the operating room to get control of this infection. Debridement of Fournier's gangrene is probably the least satisfying operation possible. Yes, it's a surgical emergency. Yes, my hands get rid of a potentially lethal infection. But taking electrocautery to a man's family jewels to evacuate pus and dying tissue hardly ever feels satisfying. The thick smell of burning skin, hair and infection is smothering and ligers for hours. The anatomy is never really clear cut and you're left with a giant hole to patch up and a patient in excruciating pain.

We cut, suctioned and sent cultures. We dodged spurts of blood and cut some more. It wasn't pretty. I left work two hours later numb, exhausted and immensely thankful that I had remembered to wear a visor for that last case. The only remnant was a solitary drop of blood on my right shoe.