I'll admit it: I was furious.
It was also completely petty. After all, I'm the newbie in the group, the lowest man on the totem pole. And SOMEONE had to deal with the stress of Christmas Eve. AND don't forget about the back-up horror known as Christmas Day.
On Christmas morning, I was rounding in the ICU postcall. I was exhausted from staying up all night. As the families gathered at each bedside to hold their holiday vigil, I was nowhere near exhausted. It was 4 p.m. by the time I finished updating everyone, placing orders, reviewing labs and CT scans, writing notes, and fiddling with knobs and gauges. Before the phone rang, I had just enough time to hurl a hoverboard at each of my niece and nephews, complete with a ribbon and bow. At the hospital, it was my on-call partner.
Is it true that I'm still in the hospital?
No? Is it possible for me to return immediately away?
Mr.B, a tall, skinny man in his fifties, drove his family between in-law Christmas feasts while belting out carols at the top of his lungs. In the downpour, a missed turn and an abrupt swerve resulted in tragedy. T-boned, spun, and rolled into a ravine, his automobile was totaled. Mr.B was airlifted to our trauma center after his wife and children were checked and released from a local ER.
I was at home opening presents when Mr. B arrived at the trauma bay. My 8-year-old niece was gasping and tearing off wrapping paper while Mr. B was panting and clutching his right chest. My 8-year-old nephew kept his new toy at arm's length as the on-call surgeon did a double-take on Mr. B's CT and couldn't believe his eyes. When my partner's voice, preternaturally calm over the phone, asked for a hand in the OR, I was joyously videotaping my nephew almost face-plant on his new motorized skateboard.
Yes, of course. I'll be there immediately away.
As I gloved and gowned, Mr. B was prepped and draped. His stomach appeared strangely sunken and carved out, as if he were a POW rather than a man on his way to his second Christmas supper. In one swift and steady stroke, we opened the skin, midline, breastbone, and pelvis. We went inside the belly and scooped buckets out.
His blood pressure was starting to plummet. We packed the liver where it had been pulled away from the anterior abdominal wall with gauze and regained control for the time being. The anesthesiologist increased his blood volume from above, but the torrent continued to pour down from his abdomen's upper right corner. Feeling for another laceration over the top of the liver... feeling... feeling...
I could feel my lungs. A frothy billowy tongue of lung that is undeniably soft and spongy.
Wait. That can't possibly be correct.
The diaphragm, a thick layer of muscle that covers the liver and separates the chest cavity from the abdomen, should be present. However, this was not the case. I dug down into his right chest and extracted— little intestines. Colon. Where his now-collapsed lung used to be, half of his abdominal contents were floating in the blood bath. Finally, I discovered the diaphragm, which was entirely crushed behind the liver.Anteriorly, the rib cage and liver have been totally avulsed. Total annihilation. I lifted my head out of his abdominal region to meet my partner's surprised stare and applied more packs to stop the flow. Take a big, long breath.
What should I do now?
When the diaphragm tears, which is uncommon, it usually rips down the middle. Backstitch one side of the diaphragm to the other. But there was no diaphragm to stitch it to on the underside of the rib cage. We'd have to sew it directly to the rib cage. We made twenty-one 2 mm stab incisions along the bottom border of the right rib cage, through which we pushed a suture, seized a piece of the diaphragm muscle, pulled it up, and knotted it beneath the skin. We closed the belly and he stabilized.
We removed the breathing tube this morning, the day after Christmas, with his wife and children gathered around his bed. He held his daughter and encouraged her to be kind. He removed his gown to reveal a curved row of tiny pinholes over his right flank, sealed with skin glue and looked for all the world like a shark had paused to bite him before moving on.
It was better than the year I bought guinea pigs when I was ten years old.
Better than my girlfriend's silver pearl wrist watches, which she gave me when I was twenty-two.
This Christmas, I had the opportunity to save a life.