Monday, November 13, 2017

Baby Trauma Scrub

I walked into the hospital this morning at 6:15. It was Monday, and I was right on time. My Nectar lunch bag was full of perfectly portioned, prepped meals for today and I had my gym clothes in my backpack for after my shift. There are a lot of unknowns in my job, and today was going to go however it went, but at least I would start the day prepared. I swiped through security into the surgical Scrubex hall and dialed in my code for a pair of powder blue scrubs. Between the walls of NICU and ICU and CVICU is the surgical wing. Labor and Delivery is around the corner, and the other hall faces the hospital library and main entrance. A direct elevator would take me to the ER one floor below my feet.

It was Monday, and I am a heart scrub. So I changed into my surgical dress, pulled slip covers over my tennis shoes and a bouffant over my hair. I clipped on my access badge, lined my pockets with pens and slips of sterile paper. I logged into my Volcera radio, and put my cell phone in my back pocket.

It was 6:25 when I stowed my food into the lounge and took a glass of water to start the morning. We didn't have any heart cases pending, and that typically meant I would end up as resource personnel for the day.

But today, it meant I was the trauma scrub. I was handed the trauma pager and a checklist for the trauma surgical suite. There hadn't been any traumas the night before, but I still went through the operating room inch by inch, lying out my sterile gloves and gowns, verifying every piece of equipment was present, functioning, and on standby; meticulously combing the equipment lockers and spreading my case cart for whatever the day would bring.

But it was hardly 6:35 when the alarms sounded and my first trauma red came in. I'd never had such a fast start. It was too early for rush hour traffic and too late for drinkers. What kind of trauma awaited us on a Monday morning at dawn?

It was a crush victim. Male. 50. Pinned between two dump trucks; coding on the field. ETA five minutes out.

I found my trauma nurse and we were buddies for the day, so together we took that direct elevator ride down into the ER silver zone, trauma bay one. Staff were responding from multiple departments - emergency room, radiology, anesthesia. Everyone donned PPE - lead suits, face splash guards, masks, latex-free gloves. This could be a blood bath.
Then we waited.

The trauma surgeon on call was three hours from the end of his 24-hour shift, and he looked it. Rough from being woken from sleep, barefoot in his leather shoes, rubbing his tired eyes. There were a dozen people in the bay, but only two of them mattered to me - the charge Paramedic, and my Trauma Surgeon. The first would give me information on the complications we would encounter on my sterile operating table. The second would give me direction on which route to proceed. The rest of the information was just background noise.

Except we didn't make it to the OR. We never made it to the theatre of sterility and perfection. The paramedics brought in the stretcher and put the patient on the bed and we took over the chest compressions they had initiated almost 30 minutes ago. His chest was nonexistent; the crepitus and fragmented ribs giving away like butter to the firm, relentless surges of CPR. Free flowing blood billowed like waves on the ocean under his skin, flowing from chest into the distended abdomen and then back into the chest again and again, no skeleton frame to stop it, organs shredded to pulp.
It was strange because my field is a beautiful landscape of blood. But there was not blood here. Just a body on a table. Bruised, broken, but unopened.

We continued CPR for ten minutes and two rounds of epinephrine, but it was only a heroic effort in intention. He had died pinned between those dump trucks, and his soul was long gone.

We were released from the ER to go back to our home upstairs. The body would be bagged and taken to the morgue. But I watched the Paramedic and Charge Nurse go through his wallet looking for information on who to call. He was wearing a wedding band. He had decals as a veteran Marine Corps on the leather folds of his wallet. He had probably kissed his wife good morning and drove to work not even an hour before, and she had no idea he was dead yet.

I felt the tears fall as I walked back upstairs.

What a crappy start to this week. What a crappy first hour on shift, on a Monday morning. What a crappy failure to save a life.

On the TV in the hallway, the news was just breaking of the accident but didn't have any information on the condition of the victim that was rushed to the hospital. I knew; but knowledge didn't bring any relief. It just brought sadness.

I'm a trauma scrub today, and I walked to the lounge to make myself a cup of coffee and take a moment to refocus, hoping my pager didn't go off before I got the chance. My job is about being strong and focused and flawless. And I'm very good at my job. I love it.

All the pain, all the victories, all the losses. Did I say it was easy? It's only 7:45am. Another ten hours on this shift, another hundred chances to try again. Someday, I want to be a lady surgeon. Someday, I want to be the one calling the shots to save that life. But for now, I'm a surgeon's right hand. I'm the scrub nurse, the assistant, the one learning and perfecting and preparing.
It's Monday morning, and someone died already. We can't control our time to go. But we can make the most of the time we are given. That was my thought this morning, that followed me into my next cases. How can I make the most of the time I'm given this week? How can I really matter to something bigger than myself? The only way to find out is to try.