Dichotomy

It was really cool.

EMS called in a major trauma, and arrived minutes later with a critical patient.  A severe motor vehicle collision with prolonged extrication resulted in an almost complete arm amputation and significant blood loss on scene.

It had all the makings of one of those rare, made-for-TV moments.  The humerus, broken in half, had its jagged edges separated by several inches as both ends of the bone poked out of bloody messes of muscle and tissue joined only by a thin stretch of intact skin.  Blood hung from the rapid infuser, and the emergency transfusion protocol was initiated.  Kneeling at the head of the bed, I held c-spine while the attending struggled to pass a bougie.  Trauma surgeons doused the patient in betadine before inserting a femoral line.  With a pressure barely holding in the 70s, we ran the stretcher through the department and up the elevator to the OR.

Returning to the trauma bay to clean up, my scrubs sprinkled with blood, I was amped up on adrenaline for the rest of the night.

* * *

It was really tragic.

Only a year or two younger than me, she was on her way to pick up some friends from a party when a drunk driver slammed into her car at 70mph.  From the moment she arrived in the trauma bay, we all knew it didn't look good.  

Her body was cut and bruised, but it was the bloody stump of an arm barely dangling from her shoulder that made everyone worry.  The black and red of exposed flesh contrasted with the ghostly pale coloring of her skin.  Kneeling at the head of the bed, my face only inches from hers, I could see the dried blood caked in her blonde hair and listened to her moaning while we waited for the nurses to draw up paralytic medication.  With her pressure dangerously low, we rushed her up to surgery, wondering how long she would last on the table.

Sadly, it wasn't long.

* * *

The wannabe ER doc inside me eagerly took in the gross anatomy of the amputation, the practiced ease of the emergency interventions, and the calm and deliberate manner in which the team worked to stabilize the patient.  Truly bad traumas like this one are relatively uncommon, and after working in the ED for a few years now, I rarely feel my heart racing like I did here.  Excited as I was in the moment, however, I was crushed to learn about the story behind the patient, and later that she didn't make it.  I felt guilty for getting pumped up by the gore factor.  I try hard not to let the adrenaline junkie take over, but sometimes it's a difficult balance to strike.