“Please, God,” I said.
“Please.”
“Please don’t let this kid die with me being the only doctor he sees.”
I was kneeling in the back of an ambulance, my gloved hands pressing gauze and bandages onto the chest of my patient.
In spite of my best efforts, blood continued to pour through my fingers and onto the floor. Audible blood loss as they say in trauma speak—blood loss so heavy and so fast that it makes noise as it hits the ground.
As the ambulance rocketed down the streets and sped around corners, I remember watching the pool of blood at my feet crest into a wave that washed onto the wall and splattered, speckling the inside of the vehicle in a dark maroon pattern.
“Hang in there, bud,” I said to the patient, “stay with me.”
I was talking to the patient, interacting with him, attempting to stimulate him a bit, with the vague hope that maybe this would help.
But he was fading.
And he was young, maybe 22 or 23 years old.
We had picked him up at his house. The 911 call had come through from his girlfriend—per her report they had been arguing on the phone when she heard the gunshot—and our arrival was greeted by a scene I’ve never forgotten. The patient’s mother on the front porch screaming and shaking, the first responders on the ground working on the moaning patient, a large divot in the wall from some sort of firearm blast, and so, so much blood. The blood seemed to be everywhere—blood splattered all over the walls, blood sprayed across the furniture, blood splashed on the ceiling.
I’m sure you’ve seen the movies and watched the news reports, but in reality, a scene like this can’t be accurately portrayed by Hollywood or described by the glib TV personalities. There’s really no way to adequately put it into words. It’s other worldly, and it makes a lasting impression.
According to law enforcement at the scene, it was during the argument with his girlfriend that the patient placed the barrel of a 12 gauge shotgun to his chest and pulled the trigger, the blast barely missing his heart but leaving a fist-sized hole in his upper thorax.
I stood for a split second in the doorway of this scene trying to take it all in, listening to the screams of the patient’s mother and watching as the blood poured from the patient like a stuck faucet, soaking through the dressings of the first responders and saturating the carpet in a steadily widening circumference.
It was a nightmare.
We quickly loaded the patient into the truck and began our trip to the trauma center.
As the ambulance sped away from the house, my paramedic partner started an IV and began pouring fluid into the patient’s collapsing vasculature, and I—a mere three months removed from medical school—continued holding tight compression on the blast wound with hopes it would slow down the flow, about the only thing I was really qualified to do in that moment.
I’ll never forget the feeling of helplessness.
My ID badge said “MD,” but the truth was that at that time in my training I knew almost nothing about real patient care. No beginning intern really does. I had graduated from medical school just a few months before and while I had a head full of medications, and pathophysiology, and anatomical minutiae, this patient was one of the first critical patients I had actually ever taken care of. I was looking into his face as his life was seeping out of him and with a wave of dread I realized there was not a thing I could do to really help.
Watching this kid fade, his answers to my questions becoming whispers, his blood pooling at my feet, I began my silent prayers because I didn’t know what else to do.
“Please.”
So I prayed, holding pressure on his wounds until my arms cramped and I couldn’t feel my hands anymore. I prayed a very simple and desperate prayer—that this kid survived at least long enough to get to the emergency department (ED) where he could see a “real” doctor.
“Please, God.”
I pressed my full weight onto the bloody mess of the kid’s chest, hoping it would stymie the hemorrhage just a little bit. I felt the mush under the dressing give a little.
“Please.”
The ambulance roared up to the doors of the ED and we tore into the resuscitation room.
Our colleagues were poised and ready to receive our patient, who was still alive but not by much. Dozens of hands now worked in unison, packing the wound, starting a large bore central line to pour in blood and more IV fluid, protecting the patient’s airway by placing an endotracheal tube into his trachea, and then, minutes later, wheeling the patient up to the operating room (OR) where the surgery team would try to patch all this mess back together.
A well-choreographed performance honed by thousands of hours of training.
When it was over, I leaned up against a nearby wall, taking in the now empty trauma room. Papers and packaging were strewn about, the floor littered with emptied cartons, splotches of betadine, and bloodied half-used drapes and bandages. It was not dissimilar to a scene on Christmas morning after children finish unwrapping presents, except instead of tinsel and bows you had carnage and gore.
“Thank God,” I said to myself.
Moments later, I stood outside the ED—my muscles trembling from exhaustion and my sweat and blood-soaked scrubs clinging to my body—as the ambulance crew took a hose and washed out the back of the truck.
That ambulance ride, and all that transpired, was my first real initiation into the world of emergency medicine.
Standing outside the hospital and watching that blood-stained stream wash out of the back of the ambulance and onto the asphalt, I knew I had a lot to learn.
But I was on my way.
Wow! That’s all I can say! Not only did God give you the gift of helping people in medicine but man, can you write! That was awesome!