Flint, MI (Fall 2017)
I stared silently out the window and took in my surroundings. The sun was slowly making its way into the sky, stretching as if waking up from a long slumber. The gold and pink tones of the sky were still hiding behind clouds, not quite ready to come out from their covers. I took a sip from my coffee, the strong scent filling my nostrils and the hot liquid running down my throat, warming me from the inside. A nice breeze from the window hit my face and I pulled my sweater tighter over my body. I checked the time and realized I should get going, as the reality of my day set in: my first twenty-four- hour shift.
I walked into the hospital and my heart raced—I was excited to be here. As much as the hours exhaust me, this is what I love to do. I dropped my things off in the student lounge, got into scrubs, and picked up the trauma radio. I wonder what my 24 hour shift will bring. I hope I get to see some interesting traumas! I then realized that seeing some interesting traumas would mean that someone would have to get very hurt for me to learn. This is one of the biggest struggles of a medical student. We want to learn, but we learn the most from the sickest people. It is hard to tell someone that you are appreciative that you got to learn from them, when they are knocking at death’s doors.
I feel that medical school tries its best to teach empathy and compassion; however, sometimes it truly is easier to separate one’s own emotions from the situation at hand. Little did I know that this would prove to be true later on in my shift.
Most of my day was filled with fairly minor traumas: a sixteen-year- old in a minor accident, a forty-eight- year- old who hit a pole with his motorcycle going about twenty miles per hour, and a young woman that sliced part of her finger off with a knife while cooking dinner.
I finally decided to get some rest around ten that night. I laid down on the couch and slowly drifted into sleep. Suddenly, around midnight, the trauma radio went off. Level 1 trauma, patient is a young adult, was hit by a car going 45 MPH while patient was on his scooter. Patient was unresponsive upon arrival, attempted to intubate but failed. BP 80/42, pulse 134, contusions to head, swelling and possible right tibial fracture, bruising diffusely on body. ETA 2-3 minutes.
I jumped off the couch and shook myself out of my sleepiness. I ran down to the emergency room, past the area of overflow patients, and to the trauma bay. It was already packed with people- nurses, emergency room physicians, the trauma surgeon I was working with, residents, physician assistants, and x-ray technicians. As I was trying to wake my brain up from sleep, my heart racing but my mind still drifting off, I saw the stretcher quickly roll into the bay. Almost immediately, people started working to remove the patient’s clothing. I snapped out of my daze and started to help. I thought of how impersonal of a process this was and how exposed this kid was, laying on the stretcher with no clothes and unconscious. The surgeon attempted to intubate but was unsuccessful. He then decided a cricothyroidotomy would be the next best step to access an airway and motioned for me to come over. The process was so quick, and I only recall my hand being on the blade with the surgeon’s hand on top before I was pushed out of the way so a tube could be placed.
He was then rolled off to get x-rays and CT scans of his whole body. Once it was established that he had broken his right tibia and there was increasing swelling, we decided to perform a fasciotomy. I was again allowed to help with this, with the surgeon’s hand above mine. This time I was more alert and less frazzled from the stress of the trauma. After the fasciotomy, I looked up at the patient’s face and noted how young he was. His skin had acne on it, his body was thin and long, and his hair was messy and so long that it was pulled back with the neck brace. I thought that this boy looked as young as my little brother. This could have been my little brother.
We walked to the CT room to review the images once the patient was more stable. “This looks like a teapot fracture. He has herniation already, I don’t think anything will fix this.”
“What’s a teapot fracture?” I asked, curious and still not fully grasping the outcome of this trauma.
“It’s when a person has multiple fractures in the skull. Look at all of these fractures. Now see here? This is a sign of brain edema and herniation,” the attending replied, pointing to various parts of the head CT. Each fracture looked like a little crack, a small road leading from the skull to the brain. The brain itself had lost the normal contour and looked like it was squished inside the skull, trying to break out.
“Let me call the neurosurgeon on call and see if he can do anything about it,” the surgeon said. Unfortunately, the neurosurgeon said there was nothing he could do. The attending and I returned to the trauma bay to help clean up the area so the family could come in. The patient was pale, naked, and for the most part lifeless. There was blood all over his face, his neck, and his bruised legs. There were bloody bandages on the floor and a bloody scalpel on the tray next to the stretcher. We grabbed a blanket to cover him up and went out the meet the family.
His mom was the first to get up when she saw us. Her eyes were a deep green color, full of worry. As she approached us, her body gave way when she realized we were not returning with good news. She fell to the floor, her pink cheeks becoming pale, and her voice letting out a small squeak. Her husband ran up to try and catch her in time, tears racing down his face as if they could not get out fast enough. They sat on the floor with their heads down as we explained the situation to them. The patient’s grandmother was the only one to remain standing, with her hands crossed in front of her and a calm demeanor. When we were done talking, she simply said, “Thank you for doing all that you could, we would like to go see him now,” in an unwavering voice.
The attending surgeon led the way and told me I could go get some rest. It was about three in the morning, but my heart was still racing and I did not feel tired. I made my way up to the couch in the student call room and sat down. I thought about how quickly this young boy’s life had gone from riding a scooter and hanging out with his friends to a teapot skull fracture and brain herniation. I thought about how his mom could not even bring herself to continue standing when she realized her son was no longer the son she had seen only hours before. With the exhaustion finally catching up to me, I fell back into a deep sleep.
I woke up around six and immediately my mind took me back to the trauma. The night before I had been able to separate the trauma and my feelings about it. Today that was proving difficult. I got into my car after my shift was over and cried. I cried for the patient, for his mom and dad, and for myself. I could not rid myself of the idea that this young man could have been my little brother. They seemed so close in age and I could not in a million years imagine losing him. And yet, a family had to deal with their loss that day. Before I left, I found out that the family had donated his organs. What a beautiful way to honor his life, I thought.
Medical school textbooks and lectures attempt to teach us how to incorporate empathy, compassion, and emotions into our patient interactions. They explain the importance of doing this to build our patient-doctor relationships. But experience teaches us that sometimes it is okay to separate the two.
As tired as I was, I decided to drive the forty-five minutes to my mom’s house. I did not want to be alone. As I stepped out of the car I looked up and noticed the sky. The pink, gold, and purple colors mixed together. No clouds were hiding the beauty of the sky today. The warm colors hugged me, like the sweater I had pulled on tighter only twenty-four hours earlier, as if letting me know that everything would be okay.
GURBAKSH SHERGILL was raised in Troy, Michigan. She attended Oakland University for her undergraduate degree in Biology with a minor in Spanish language. She then went on to Michigan State University College of Human Medicine where she pursued her passion to serve underserved populations. She likes to write, read, paint, and run in her free time. She is currently applying to Pediatric residencies. She hopes to continue to mix her love for writing and her love for medicine to share with others her experiences and to connect with both those in medicine and those not in medicine.