Trauma Season

The pager rouses Alex from a dreamless sleep. He groans and rolls onto his side, the blazing overhead lights burning his retinas. He pulls the pager to his face and checks the time: 6:24 am. He then reads the words on the tiny screen: “Rm 728 asking for Tylenol, ok 2 order? Call back x9217”

He lifts the receiver of the bedside phone and dials the number. “Doctor Jackson here, okay for Tylenol for room 728.” He rubs his eyes with the heels of his hands and sits up, his legs dangling off the side of the call room bed. He rakes his fingers through his short dark curls, noticing he’s due for a haircut. Through the small streaked window, the sky resembles a glowing cotton candy swirl, the sun barely emerging over the buildings in the distance. What a lovely July day for sleeping, Alex sardonically thinks to himself.

He shoves his feet into his light gray sneakers and stands up, stretching his arms overhead. He reaches a hand into the pocket of his scrub top and finds a sheath of mint gum. He frees a square from its plastic cage and pops it into his mouth, the poor man’s attempt at a teeth cleaning. He then leaves the call room in search for the incoming intern.

Alex finds Tasha seated behind the first computer at the nurses' station. He feels a pang of jealousy at her well-rested appearance: her braids are neatly pulled back, and her wire-rimmed glasses are clean and free of smudges. Her right hand scrolls the wheel of the computer mouse, and her left hand palms a large coffee. She squints at the screen, her face just a few inches from the blue light. Alex rests his elbows on the counter in front of her and leans forward. “Good morning,” he whispers.

She looks up at him, then focuses back on the monitor. “Hey, good morning,” she replies. “Hope you got some rest. How was your first 24-hour trauma call as a capital D doctor?”

Alex smirks. “Pretty chill. Sunny skies until now. Still have 30 minutes left though." It really had been fairly calm for a summer trauma call: he had been warned by the seniors that the hot weather tended to bring outdoor parties, and arguments, and guns, and knives. But they only had two minor trauma codes to address, and he spent most of yesterday writing notes and changing dressings.

Tasha looks back at Alex. "Have some time to help me get the vitals together?"

"Yeah, sure," he responds. But a moment later, his pager trills again. He unclips it from his scrub pants and studies the glowing green screen: “Trauma code, ER.”

“Tasha, I gotta run.” Alex’s heart begins to race as he takes off to find the nearest stairwell. He bounds down the stairs to the emergency room and finds the trauma bay. The 3 trauma rooms are filled with stretchers of patients, and he eyes his chief resident, Maria, in room 1. The floor is already strewn with stray supplies and bloody gauzes, and nurses and techs surround the stretchers like pit crews. “Alex, thank goodness you’re here,” she exhales. “We’re gonna get slammed. Someone pulled a gun at a party and did some damage.” She yanks on a pair of purple gloves and heads to the nearest stretcher.

Alex follows her and looks at the patient’s face. He can’t be older than 19. His eyes are peacefully closed, his thick eyelashes still and unmoving. His bare arms are covered with sleeve tattoos. He notices a tattoo of a woman’s face beaming at him from the left pec, the word “Mom” written in cursive underneath. A gaping hole oozes nearby. “Okay, what can I do?” he asks, donning a pair of gloves.

“Remember, ABC, right? Airway, breathing, circulation,” Maria instructs. “Mister John Doe's not gonna do well at all without an airway, so I’ll intubate. You get an IV going and draw some labs.” She looks up at the monitor. “Pressure’s terrible, 70 over 30. He needs blood and fluids.”

Alex grabs the nearest trauma kit, a staff-made yellow kidney basin stuffed with a large bore IV, tubes for blood samples, and gauzes. He digs out a tourniquet, ties it onto the kid’s right upper arm, and feels a sense of relief when a large blue vein appears. He slides the IV in and sends off the bloodwork. In lockstep, a nurse hands him some IV tubing, and he starts running a bag of saline. As the fluids infuse, the blood pressure climbs slightly, to 90 over 50. He recalls the next step in a code. “Maria, I’m headed to get blood,” he announces.

“Don’t,” she commands. “This guy needs the operating room. You have to prep him for surgery. Someone else can go get the blood. I have to go make sure the others are stable.” She tears off her gloves, tosses them in the trash, and disappears.

Alex stands dumbfounded, like the time he got lost in the airport in the second grade. He walks over to the open doorway. "Maria?" he yells out into the hall, his voice muffled by the beeps and the pings and the clangs of the ER. "How do I do that?" He then hears a nurse in the room clear her throat. He looks over to see a tiny Filipino lady wearing pink scrubs. Her smooth face suggests that she's young, maybe in her 40s, but her wizened eyes communicates that she knows things, and has seen things, in her years in the ER. In a polite voice, she says, “I think you call 8961 for the operating room.”

“Thank you,” he pants. He picks up the wall phone and dials the number. “Hi, I have John Doe coming for exploratory surgery.” Once the details are set, he replaces the receiver and leans against the counter, the sudden silence in the room somewhat unsettling. The brief moment of peace is interrupted by a sharp screeching from the monitor. A flatline appears; John Doe has no heart rate. Alex notices that the patient’s tattoos have faded, his mother's face a ghoulish gray. Alex's eyes widen and he runs to the bedside. He squeezes the last drops of the IV bag into John Doe's veins. “He’s coding!” he yells. “I need help!”

Maria appears in the doorway, her once-fresh scrubs now rumpled and spattered with blood. She grabs clean gloves from the box on the wall and looks at the nurse. “Joan, get the crash cart and the ultrasound machine,” she directs. “Alex, come over here and help me with compressions.” Alex starts CPR while Maria prepares syringes of medication. “Let’s give some epi,” she says. Alex feels the slightest sense of relief when Maria is able to re-establish a heart rhythm. Joan brings over a portable ultrasound machine. “We need to check to see if he has a ventricular injury from the gunshot wound,” Maria says. She places the probe over his chest and sees the blackness of free fluid. “Sure enough, there it is. A hole in the heart. Okay, we need to do a bedside thoracotomy,” she announces.

Alex looks at Maria, his eyebrows raised with disbelief. “What?” he croaks. “One minute this guy was about to go to the operating room. Now we’re going to crack his chest right here in the trauma bay?” Maria nods and Joan opens a thoracotomy kit.

Within seconds, Maria has opened John Doe’s chest. “Pack and we need suction,” she commands. Alex stands motionless, staring at the open cavity filled with thick, dark blood. Maria snaps at him. “Alex, let’s go!” she insists. “I can't see anything. I need your help!” Alex startles then, and begins to place sponges into the wound to soak up the blood. Someone passes him the suction, and to his dismay, the canister fills too quickly. One of the techs brings 4 units of O negative, and they start transfusing.

“What’s next, Maria?” Alex asks, his voice wavering.

“We have to oversew this hole,” Maria says with conviction. “I’ll retract, you put a suture in. Okay?”

Alex suddenly looks up. “What?” he exclaims. “You want me to do it?”

Maria stares back at him, her face stern. “You can do this,” she reassures him. “You have to: you’re the doctor now, remember?”

Alex nods slightly. “Okay, I can do this,” he repeats softly. He takes the suture from Maria and peers into the chest. He sees the tiny hole causing the terrible trouble. He examines it: the bullet has torn the heart tissue into shreds. There’s just the barest trickle of blood emanating now. He drives the needle into the muscle with a shaky hand, and it rips immediately. He tries again, but the suture won’t hold. “Maria, I can’t,” he says, his voice shaking. “It won’t work. The tissue is too badly damaged.”

She takes the needle from him and throws a stitch. No luck. She looks up at the monitor; the blood pressure reads 10 over zero, and the heart rhythm reads flat again. She purses her lips and clucks her tongue. “Nope,” she says, shaking her head slightly. “This guy is done. We tried, though.” She peels off her gloves and throws them on the instrument tray. She starts to head out of the room. “Tell the family, will you? They’re in the waiting area,” she instructs over her shoulder. “The patient in 3 needs a chest tube, meet me there when you’re done. Oh, and this guy’s real name is Frank Myers.”

Alex stands with Frank, the man with the ruined chest. Alex feels his own chest heaving, and a tidal wave of dread rises inside of him. For what feels like the millionth time, he tries to figure out the next step. He notices Joan standing across from him. Her ageless face looks solemn, and her dark eyes are heavy with pity.

She seems to read his paralyzed mind. “Use the quiet room,” she says softly. “You can talk to them there.” She leads Alex to the waiting area, a funeral march. Alex looks around and notices the face he recognizes from Frank’s chest. He pictures her immortalized wide smile fading away. Now, her eyes are wild, mascara streaked down her cheeks. “Is it Frank?” she asks in a wobbly voice. “Is he okay?”

Alex gently places a hand on her shoulder and guides her to the quiet room that Joan pointed out. He closes the door behind them, and Alex instructs her to sit on the couch next to him. A lone tissue box stands on the end table, and he grabs it out of instinct. He sighs, then looks at her, the tissue box sitting neatly in his lap. “Ma’am, there’s no easy way to say this. Unfortunately, we lost Frank.”

Her eyes widen and she shakes her head back and forth. “No, no, no, that’s not possible,” she starts. “He’s okay, right? He’s gonna be okay?”

Alex is speechless for a moment, and rifles through the files in his mind, searching for the textbook answer. But his professors never taught him how to break someone's heart. They only taught him how to fix things. How to use the tools that others had invented in order to heal, and to mend. He wasn't supposed to do harm; he took that oath on his first day of medical school. “I’m so sorry, ma’am,” he says with a deep sadness.

Alex then reels back as Frank’s mother emits a guttural, primal wail that sends chills throughout his entire body. He instinctively places an arm around her, and pulls her to him. He feels her shaking and sobbing, and hot tears well in his own eyes. He purses his lips together, and shoves his sadness down into a deep, dark place, where no patient or family member will ever walk. He hears a soft knock on the door, and feels relief when a social worker enters and takes his place. He silently steps away and closes the door with a gentle click. For a brief moment, he leans his head against the smooth wood, eyes closed, the sirens and screaming and chaos a blur in the background.

When he opens his eyes, he checks his pager: 7:12, no new messages. His call is over. He trudges back through the emergency room, his bones suddenly weary despite last night’s sleep. He hears someone call his name, and turns around to see Dr. Higgins, the trauma surgery attending. Her blond curls are pulled back into a tight bun, and her moss green eyes look more tired than usual under the harsh fluorescent lights. Her hands are shoved into the pockets of her long white coat. “Hey, Jackson,” she says quietly. “You did good today. We can’t save them all, you know? You did your best, and I hope for you, that’s enough. Sometimes it has to be, just so we can keep going.” He nods a silent thanks, his lips pursed in a tight line.

Alex changes out of his scrubs and makes the bed in the call room. When he exits the hospital through the automatic glass doors, he discovers that the sunrise that glowed an hour ago is long gone, and a sheet of rain deluges down in its place. He stands in the torrent for a few minutes, hoping to wash away the last 24 hours. He raises his face to the sky, and lets the water stream down his cheeks and soak his clothes. When he looks down at his shoes, he notices that his sneakers are still streaked with Frank's blood. Those stains will need more than rain to clean, he thinks to himself.

As he drives home in a daze, he prays that at some point he'll unsee those fading tattoos. Alex will learn, though, over the years, that every surgeon lives with ghosts: memories that flitter around the graveyard in their heart, and like to moan the loudest on the nights when the sky is an endless swath of stars, and the tree branches stand perfectly still, unbothered by the dearth of wind.