It was 28 minutes door to door. Arrival to operating room, although if you were us it seemed like eternity.
“Is it like ER or Scrubs?” The question I have been asked time and time again. It’s a little but of both.
But I remember that trauma like it was yesterday, although years have passed. I remember each trauma. Each stabbing, each gunshot wound, each homicide….. “I thought you were in pediatric emergency….. people would say. This is pediatric emergency medicine. Up to age 18. The kids you take care of in a trauma situation are mostly 15-18 year olds.
You get advanced notice for 99.9% of traumas. When the EMS crew is picking you up, someone is giving us a head’s up. We are preparing. Level I blood warmer. Intubation meds. Chest tubes. We think of everything we can to prepare. My IV supplies are out, pre ripped tape lines my trauma gown. We’ve designated the roles we will take, often I was bedside nurse, which depending on the trauma could get pretty crowded.
That particular night the trauma bay was getting hit, which truthfully is like every other night. Just when you thought the sh*t was hitting the fan something else would be on the way. Get that woman to ICU, why won’t they accept her…… the politics inside of the hospital can be horrendous. But at the end of the day our team took incredible care of you, and we gave it 110%.
In this particular patient rolled and it was a traumatic injury to say the least. On the backboard bundled up, luckily the paramedics had already intubated, we have a secure airway which is sometimes half the battle. Trauma, ortho and vascular teams were all present, and I fought like hell for my spot at the side of the bed. My initial role is to get a line, get labs, connect to the monitor, help roll, get the clothing off….. give the meds…… all at the same time.
In the moment you don’t even think. My heart rate I guarantee stays below 50. Another nurse is there working with me. We can communicate without even talking.
“We are going to need blood”. A doctor calls out. The other nurse looks at me, I answer with my eyes. I have already prepared the level I warmer, a machine that delivers units of warmed blood in seconds. Manning the thing is a job within itself. On a good day there is a third nurse documenting, recording the shouting out of assessments, of meds given, keeping track of everything.
“Pressure is dropping….” Someone calls out. More fluid, more blood, more meds, pack the wound. They are bleeding out faster than I am infusing the blood. The blood goes all over the floor. It looks like a war zone in the bay.
You think we work hard? An emergency dept environmental services employee works just as hard. (The cleaning people). There is blood everywhere, the floor becomes the garbage.
Speaking of working hard, the administrative staff, they are the glue. We don’t have a name for this patient so they become Trauma A. Then they begin the work of trying to figure out who this is.
“The OR will be waiting.” Someone says “We are ready for the scanner.” Seamlessly we pack up the patient and together wheel them to the CT scanner. Doesn’t always happen like that. Before they operate they need to see what’s going on inside of you. Internal bleeding, that kind of thing. You can’t just open someone up and see if they’ve sprung a leak. It’s a bloody mess inside your body.
The trouble with the level I warmer is that it’s not portable. I take the cooler of blood units and run with the gurney, squeezing the blood in by hand. In the CT scanner I stay…. to manually squeeze the blood in. Forget the lead gown, it will just get in the way. We don’t do that to be heroes…… we just know the chain reaction that happens. Blood inflow slows down and doesn’t match the bleeding that is going on. Blood pressure drops, hypovolemic shock takes over and pulling someone out of that mess is not worth a little radiation exposure. It’s easier to stay and be exposed.
We all take too much exposure, sometimes we just don’t have time.
The scan goes relatively quickly and I am the only one in the room with the patient. The trauma team and my nursing teammate are standing behind the glass. She and I hold eye contact, just because. You don’t feel the fear, the anxiety, you just go. You just move.
Another trauma is called in. Not pediatrics. We lose most of the team. It’s me, a doc and my other nurse. I feel relieved. It’s easier with less people. Vital signs begin to destabilize, we get to work. We need to stabilize before we roll down the hall and into the elevator to head to the or. We don’t want to be coding in an elevator.
It’s a 1 minute journey, but we bring everything with us. defibrillator, meds, everything. It’s all prepackaged and ready to go. I am on my 9th unit of blood. I am squeezing the bag, flushing and replacing. Repeat. Repeat. repeat. Hope.
stabilized…. the OR is ready. Go time. The three of us haul ass down the hall with the patient. This kid will never remember us. He will never really know about this 28 minutes of his life. He will never know of the amazing teamwork that goes into a situation like this.
Into the elevator it seems like forever until the doors close. We are holding steady. We say nothing, we don’t need to. Doors open and we are at the OR door. Swiftly the doors open and here we are, the blood covered trauma team in the sterile OR. If you look at the three of us it looks like we stepped out of a horror movie. We wear trauma gowns and glasses to protect, but we still get covered.
We roll into the OR where they are set up and waiting. The transition is smooth, the patient is in their hands now. We wheel the gurney out into the hall, place all of our bloody sheets and equipment on top of it and head upstairs.
That’s when the gravity of it all hits for me. About 1 minute after it’s done. It feels like my heart will jump through my throat. Holy sh*t what just happened. The three of us feel the same way but we don’t talk about it. It’s just a series of heads shaking, and deep breaths being taken.
Doors open, we roll our gurney back down to the trauma bay where thanks to the incredible environmental services worker, it’s sterile, clean, shiny. Where the events of the past 30 minutes have vanished. Except us.
“Nice work.” Our resident says to us. We smile. We nod. That was good work. “28 minutes door to OR”. Good lord it felt like eternity. It felt like 28 minutes ago I inhaled and now I just exhaled.
And all of that just happened in the blink of an eye.
We walk back to pediatrics where a mother immediately begins to lay into us that she is hungry and wants something to drink. Another wants a prescription for Tylenol. Another has been waiting thirty minutes. The unit was a little behind because two of us were in the trauma bay. But that’s neither here nor there. We jump back in and move on. That’s what we do.
Or what I did.
Do I miss it? No. Not at all. I am glad I did it. I loved it while I was in it. I watched a lot of kids die. I watched kids kill each other. I held parents who lost their children. I have done a lot of CPR. I have seen things you can’t comprehend. Some things even I can’t comprehend.
Morning would come, and I would drive home, and come into the house and hug the guys tight. They had heard the stories but they didn’t understand the gravity of them. They didn’t understand what it was like to be in the middle of it. I would be able to sleep just out of sheer exhaustion.
Later that day I would turn on the news. See how my patient was doing. They made it through surgery, all would be well.
This is why…… I am the way I am. This is why I don’t sweat the small stuff. This is why I allow my sport to be the fun stuff, why I don’t get caught up in dramatics. Someone tried to pull me into dramatics last week, I just don’t have the time for that kind of stuff. My father often jokes that I am bullet proof to that kind of stuff. I am.
This is life. This is what really happens. I have ten years of reality checks stores up within me to keep bringing me back to that.
It was hard to step out, but I don’t miss it. I don’t miss the adrenaline rush. I don’t miss the insanity. I have been there and done that. I am so grateful for those ten years, I learned more about life within those walls than I will ever lean on a bike. I learned more about teamwork than I ever will on a swim team. I learned more about doing the right thing….. than I ever will in church.
Believe me when I say life is precious. Believe me when I say things can change in the blink of an eye. How many times did I stand in the nurses station knowing that a child has an inoperable brain tumor, and look through the glass to where they were sitting and waiting. I had this knowledge and they thought their child was here for something different, something simple. Knowing that those moments they were sharing right now were the last normal minutes they’d ever know as a family. I remember feeling the horror as the Oncology doctor arrived, sat at their computer, and looked over the screen at them…… thinking the exact same thing.
I remember a young boy who came in very sick……. we needed to intubate him and we needed to sedate him. He was awake and alert. He looked at us and told us he was scared. And we reassured him, his mother was right there. He died later that night in the ICU.
That right there….. fear…….. is the emotion that rocked me each time. I could handle pain, I could handle anger, I never handled fear well.
Do we cry? You’d better believe we freaking cry. There have been many a time where a child was pronounced dead, and we’d try to keep working. Letting go, stopping was the hardest thing to do. Even if it was beyond repair, we never wanted to stop. We’d resuscitate all day long if you let us.
When we stopped is when the tears would come. A feeling I can’t describe. somewhere between loss and pain and feeling that we failed. It was the worst.
This is the first time I have really been able to write about what it was like. It’s so big. It’s so deep that I can’t adequately write it all out right here. But this is why. This is why I am relentlessly positive. This is why. There’s a dimension to my life that no one sees. While I have stepped out of the trauma life…… I am in a whole new world of nursing that again, brings that dimension.
That dimension, that balance is why I can never stop being a nurse. It’s who I am, it’s in my blood. It connects me to life as it really is.
It’s a cross between ER and scrubs to be honest with you. It’s a world you just can’t even imagine.