For me...

As many of you can imagine, over the past month I've become quite fond of this blog.  I honestly didn't think that it would become as popular as it has nor would I have expected to have kept it going continuously for this long.  It has been not only a means of communication and sharing my experiences with everyone, but has become a source of inspiration and enlightenment for many; especially for me.  These nightly entries have been therapeutic for me and have allowed me a canvas to express some of my thoughts, experiences, beliefs, principles, hopes, frustrations, and aspirations.  I am honored and humbled that so many of you have chosen to join me on this journey and are able to follow me in spirit.  At some point I will look back at all of this and be able to reflect on my growth, the places I've been and the place where I'm trying to be.  The events of today will stay with me forever...

I was looking forward to a rather uneventful and light day when I woke up this morning-especially after yesterday's fiasco.  I woke up and had my daily breakfast, chatted a bit with the other volunteers, and made my way over to the trauma bay to check on things as usual.  As I walked into the ER I noticed that there were a lot more people there than usual-and many of them didn't look sickly, but they did look traumatized.  I noticed a young woman lying on the floor on a backboard and both of her legs were completely mangled and deformed!  She laid there-not moving, not talking, barely breathing-as if she was saving all of her energy to fight for whatever life was left in her.  I looked at her and then scanned the ER for the nurses or doctors who could tell me what had happened to this lady, when something had happened to this lady, what is happening to this lady right now-or more importantly, what is not happening to this lady right now!  Two of the nurses were talking to each other and another was writing in a chart.  All I had heard from the other patients and observers in the ER was that she was hit by a car.  Apparently this girl was setting up her goods for sell by the road when there was an accident which knocked a car off the road and into her-completely crushing and pinning her legs.  I wasn't sure if everyone had given up on her b/c maybe she had a head injury or maybe a chest or abdominal injury-if they had exhausted all resources and there was no hope of resuscitating her or what!  I kneeled down next to her and immediately found the answer to my question...

There were no vital signs on her. She had only one small peripheral IV. No oxygen. No cervical spine collar. Only some bandages tied around her thighs.  No antibiotics or tetanus were administered yet.  I checked her pulse and it was very fast and thready.  Manual blood pressure was a systolic of 30.  I jumped up and ran to the nurse, put my hand over the chart she was writing in and told her to get over here and help get this lady more IV access and fluids ASAP!  By this time everyone in the ER had been looking on and one of the doctors told me that they were waiting for an anesthesia consult to come see the patient.  At this point I couldn't wait any longer and stopped trying to get answers from everyone-I grabbed three of the onlookers and told them to grab an end of the stretcher.  We threw a sheet over her legs and torso and bolted straight out of the ER, past everyone in the halls and waiting room, directly to the OR!  Some people were following us all the way to the elevator. 

Once we got up to the OR it was like one of those scenes from the movies.  I was busting through double doors, screaming at people to move out of the way, calling for anesthesia to bring this and that, telling the OR pharmacy to bring meds, antibiotics, tetanus, etc.-all seemingly in one breath.  By the time we got into the operating room, we dropped the whole stretcher right onto the table and I started cutting her clothing off.  The anesthesia team was right behind me and everyone started searching for IV access.  I ran to the head of the bed to try and hook her up to the monitor so that we could get some vital signs.  One of the nurses was sent to get some blood for transfusion.  After all of the lines were in and she was hooked up to the monitors and oxygen, I just had the scrub nurse give me a scalpel and I started debriding all of the nonviable tissue from her limbs.  We used brushes and saline to clean away most of the gross debris and contamination prior to moving her from the backboard.  By the time I had gotten scrubbed and done with the surgical prep, I still couldn't believe that I was staring at what used to be young healthy legs.

She ended up with 2 above-knee amputations.  One side was easy b/c she had completely fractured through her femur.  The other one wasn't so easy b/c she had a pretty big leg that wasn't fractured and I had to saw through her bone with an instrument that definitely wasn't made by Black & Decker!  She ended up tolerating the procedure well and remained stable throughout.  During the case, my phone kept ringing b/c today is my clinic day and I was scheduled to see another VIP at 10am....yeah...
I can't tell you all of the things that were going through my mind from the time I laid eyes on this girl until the time I ran home to change my blood soaked clothes before I went to clinic.  Some of the them are only appropriate for my personal journal.  There are obviously some clinical points that need to and will be addressed as a result of this experience.  But even more prominent in my mind was the future psychosocial ramifications of this tragedy in this 25 year old woman's life.  While it was an impressive injury-I'd never seen anything of this sort before (I think I may have said that already in a previous entry..)-I felt pretty confident that she would make it through the surgery once she was adequately resuscitated.  The hardest part is now.  Imagine waking up early in the morning trying to get an early start on your day and make some money for your family and then, in the blink of an eye, your entire life changes...she is supposed to be getting married in less than 2 months...

I didn't even get to round on the floor patients until later in the day after a long day of clinic.  Fortunately there weren't too many upset patients b/c of the long wait today-the entire community had heard about the accident and knew that I was in surgery all morning so they were relatively understanding-one or two were pushing it though.  More interesting stuff in the clinic, but it's not even worth mentioning, as it pales in comparison to what I witnessed this morning.  I was so anxious to be done with clinic so that I could run upstairs to the ICU and check on my patient.  I literally bolted out of the office as soon as the last patient walked out!  She was doing well and sleeping comfortably when I finally got to her.  All of the nurses had heard the story and seen the pile up from the morning traffic and were asking me how the surgery went.  I felt a chill when I pulled back the sheets to quietly check on her dressings so as not to wake her.  My heart goes out for this one...

As I walked through the halls and out of the hospital I felt like everyone was watching me and could see the concern on my face.  The purpose in my walk.  The passion in my eyes.  They all knew and had heard.  I took a deep breath as I finally made my way out after what seemed like an eternity.  I ran into the general adminstrator of the hospital and she told me how the whole community had come to the hospital, including the press and papers to get the scoop.  Apparently it was a mad house out there.  I told her that the patient was doing ok and was stable presently to which she was very pleased.  She was very grateful and I took the time to express some of my concerns regarding the events of the day.

I went back this evening to check on her and she was still resting comfortably.  I went to the accident site today and the involved cars were still there-totalled right in front of her house!  There were numerous people in front of her home apparently having a meeting of some sort.  It's times like these when that whole sense of community transcends all and uplifts...
I'm sure it will be awhile before the cars are moved from the side of the road-they'll probably be stripped and sit there for awhile serving as a reminder of the events that transpired today.  Not necessarily a bad thing.

I usually don't go back and re-read my journals after I write them for some time, but I may read this one daily for awhile.  Even though words don't do it justice, that's all I have to offer myself as a reminder of what's important in this pilgrimmage we call life; and how I feel when I reflect upon it...thankful.

Thank you for listening.

"Not what we say about our blessings, but how we use them, is the true measure of our thanksgiving."

W.T. Purkiser