Why you should care
TV doctors and hospitals run heavy on the George Clooney and light on the blood, guts and messy deaths that are part of one doctor’s daily deal.
The page I received at 11 p.m. on the Fourth of July was unlike any I had received before.
It was my third night on call as chief orthopedic resident at a large urban trauma center in Northern California. With eight years of medical training under my belt, I was ripe with confidence — the program pretty much let residents take care of everything, and the chief resident was king.
I had four junior residents and a couple of interns running interference for me — when things went down, my juniors would go to the emergency room, order tests and perform exams. Once all the pieces were in place, they would present the situation to me. By the time we were in the operating room, I would know every detail of the case and walk in ready to roll.
Tonight, though, was different.
The number on my pager was that of an operating room extension, but there was no code indicating which of my residents was paging. I called, slightly irritated by the breach of protocol.
“B, get your ass down to Room 7, pronto. This guy is bleeding to death!”
The voice on the phone was not that of another resident, but that of the attending trauma surgeon: Dr. K, a bigwig with a national reputation. I sprinted down six flights of stairs and was in the operating room in about 90 seconds.
His entire elbow joint was gone, along with most of the lower arm muscles.
The hallway looked like a scene from a horror movie. A trail of blood led from the elevator to Room 7, and there were a half-dozen interns and orderlies rushing back and forth in a panic.
I went into the room, where a cluster of residents and the attending were frantically pawing at a large abdominal wound stuffed with sponges. Two anesthesiologists were squeezing bags of blood to get them to pump into the IV as fast as possible. The floor was a bloody swamp.
“B, we’re working on this liver but the guy is bleeding to death. The tourniquets aren’t slowing the bone bleeding. The left leg is the worst.” I could see blood dripping at a pretty brisk pace out of the gaping wound on the guy’s left thigh.
While I quickly scrubbed and gowned, the surgical residents filled me in — the guy had detonated an antique cannon packed with black powder at a July Fourth party. He was basically squatting over the 3-foot cannon when it went off, sending shrapnel through his legs, his right arm and his abdomen.
I went to work on the left leg. The shrapnel had passed through his medial thigh about 8 inches from the hip, and taken out about 5 inches of his femur, 7 inches of his femoral artery and so much of his femoral nerve that a strip of muscle and skin was all that connected what remained of his leg to the rest of his body.
There are ways of dealing with bone loss, but without blood or nerve supply, the leg was not going to make it. Even in the best of circumstances, it’s a 12-hour operation with a very high failure rate. I told Dr. K, “I don’t think this leg is gonna make it.” He snapped back, “The whole body isn’t going to make it if you don’t get the bleeding to stop!”
I realized at that point I had not called my own attending to tell him I was performing an operation that he was going to have to sign off on. I asked the circulating nurse to make the call.
It took only about 10 minutes to amputate the leg, swing the flap of living muscle over the bone, close the wound and pretty much stop the bleeding. I figured if I could fix up his right leg at least he’d be able to walk with a walker — he was only about 45 and muscular, so there was a chance…
The right leg looked pretty good until I looked at the back of the knee. The shrapnel had blown off every bit of tissue, including most of the joint surface and all the nerves and arteries, and the wound was charred. So I amputated that leg as well, mid-thigh, and the bleeding stopped.
As the trauma surgeons were wrapping up the liver surgery, my attending stumbled in, sputtering and horrified, as the orderly carried the second leg out in a plastic bag.
“B! What the fuck are you doing?” he screamed. Dr. K took him aside and explained what was going on. He went out and scrubbed, and came back to assist me with the right arm. The entire elbow joint was gone, along with most of the lower arm muscles, and what remained was horribly burned.
“This is pretty much what the legs had going on,” I explained. My attending glumly admitted that there was no saving the arm. I amputated just below the shoulder joint.
What was left of the poor man was taken to the intensive care unit, where he continued to require 8 units of blood every 24 hours because of bleeding from his abdominal wound, which could not be stopped. His suffering grew even worse when he regained consciousness more than 48 hours later only to learn that his two teenage sons had been killed in the explosion.
He asked that we stop transfusing him. Shortly afterward, he succumbed. It was July 7 now, and he was gone, and now I had to go too, to get some sleep. Tomorrow was, for the living at least, right around the corner.
*Bob Wilson is a pseudonym.