First Trauma

A million years ago in a hospital way up north.

A snowstorm. Evening, and two snowmobiles, racing across a frozen lake. One slams into an exposed rockface.

Our first warning is a call from the OPP, a heads up. Accident, paramedics on scene, severe trauma, unresponsive. No whys or wherefores.

So we wait. My first, Rosie jokes deadpan, but it’s mine. I’m nervous, but my exterior is insouciant. I pretend we won’t be holding this patient’s life in our hands. If I think about the reality, I’m afraid I will lose it. I pretend I’ve done this before. I pretend, no sweat, I can do this. This is how emergency nurses are supposed to be. I’ve been socialized well.

We prime lines, ready boluses of crystalloids, hang blood tubing, dust off the fluid warmer, look for the Pentaspan, alert xray: a trauma is coming. The chaplain wanders through. Charge asks him to hang out for a while, just in case.

The EMS patches. Twenty minutes out. Police escort down slippery back roads. Twenty-seven year-old male. No history. GCS of 3, intubated, boarded and collared, large bore IV started.

We wait.

Then EMS arrives and suddenly the entire department is in the Trauma Room. Chaos, yet not chaos, care orchestrated complexly like a ballet, every move an iteration of Airway, Breathing, Circulation Disability, every treatment and diagnostic a search for stability.

Cardiac monitor. Assisted respiration. Lung auscultation. Another large bore IV, foley catheter, logroll the patient, I support the head — “On my count”, I say, then after stat shoot-throughs, portable chest films, pupils fixed, dilated, chest tubes, blood running through the fluid warmer, nasogastric tube, a tube in every hole, the saying goes, bloody dressings on the floor from a bleeding scalp wound, empty bags of saline count, one, two, three litres in. Hypotension. Heart rate at first rapid, compensating, now slowing.

Then the films. The doc looks at them and sighs. Shakes head. C1 fracture and dislocation. The spinal cord has been severed where it meets the brain, snapped clean like a dry stick by the force of the impact. There is nothing more. He’s dead. His body, his heart and lungs, strong and young and athletic, are receiving no signals from the brain. They just don’t know it yet.

He goes out to talk to the wife. Out of rote, we watch the cardiac monitor, sinus rhythm, watch his blood pressure begin to drop, his heart rate in slow decline.

His wife comes in. The charge holds her up. She says little. Her face is taut and pale, a declension of grief now and to come. No tears. Later, maybe, I think. She takes his hand and speaks softly to him. We can’t hear her words.

As she holds his hand, his heart slows more, the rhythm becomes idioventricular, irregular, then slows more again and at last, stops. One agonal breath. It’s over.

(And later, I reflect, and still ask myself now, when did death take him? When he struck his head against the cold lakeside granite? Was there any remnant of consciousness, when we worked on him so frantically? Having watched scores of deaths, why do I still wonder?)

After, we hear the story. She told Charge, dry-eyed, while waiting to speak to the doc. A lesson: there always is a story. Married three months. Pregnant. A fight. He and the boys liked to snowmobile. A lot. She didn’t want him going out on the lake, in the dark, in a snowstorm. She thought his friends were assholes. She told him not to come back that night. I hate you, she said. His back disappearing into the dark, snow closing behind him.

After, we prepare the body for the morgue. I’m breathing again. Rosie closes the door and we crack wise darkly. Another ritual. We tie off IV tubes, leave the other tubes in place. Nothing can be removed until the coroner has examined the body. Plastic crinkles as we heave the bagged body on the morgue cart.

We collect up the torn and shredded clothing, meaning to return them to the family and then this happens: pieces of brown glass fall out of the left pocket of his heavy brown coat. We look in the other pocket, and find a bottle beer, whole and uncapped.

Rosie quickly scoops up the tinkling pieces of glass from the floor, and throws them with the beer bottle into the trash.

The porter comes for the body, to take it to the morgue.

I am callow and green.

We need to report this, I say.

Rosie smiles. No, she says. What’s the point? He’s dead. Knowing won’t help anyone, now. Not him. Not his wife either. Why add to her grief?

There is no answer, just the creak of the morgue cart as the porter pushes it out of the department.

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  1. #1 by JennJilks on Friday 29 January 2010 - 0944

    This is a powerful post. Thank you for writing it. I have linked from my page.

    I’m not sure it helps those who regard the highways and open or frozen lakes in My Muskoka as their private Nascar track. It is the family who suffers. It is the EMT crews who pay the price, as well.
    Thank you for all you do.

  2. #2 by torontoemerg on Friday 29 January 2010 - 0953

    Jill, I’m grateful, and glad you like it.

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