Cutting for Stone - Abraham Verghese [212]
On a Friday evening, I was summoned to the trauma room, and I reached there just as the ambulance roared in. The crew slid out a stretcher, snapped its wheels down, then raced in with it as if it were a battering ram. The glass doors parted just in time. I thought of these things as minor miracles, everyday efficiencies that were such a contrast to what I'd known in Africa. I jogged alongside. After almost a year at Our Lady, I'd done this many times, but the adrenaline still surged.
“John Doe, MVA, barely breathing at the scene,” one of the men pushing the stretcher said. “Ran a red light, got broadsided by a van on driver's side. No seatbelt—went airborne through windshield … Then, if you can believe this, his own car, spinning around, slammed into his body. Fly ball to centerfield … Kid you not. Eyewitnesses. He landed on the pavement. No obvious neck injuries. Left ankle shattered … bruises on chest and belly.” I saw a handsome black male, clean-cut and no older than twenty.
The ambulance crew had two bags of intravenous saline going wide open. They had drawn blood, and now they handed over the red-, blue-, and lavender-topped tubes to the lab technician, who would begin typing and cross matching for blood before we'd even cut off the patient's clothes.
“There's more to this,” the ambulance driver said. “Reason he ran the red light is because he was in a gunfight with gangbangers. One of them got shot in the head. An ambulance is on its way with that guy. Don't worry … it ain't no emergency. They had to scoop parts of his brain off the sidewalk—kindergarten through fifth grade from the looks of it. This guy,” he said, pointing to our patient, “did the shooting.”
Our patient's skull was intact, but he was unconscious. The part buzzed into his short hair was as straight as if it had been applied with a ruler. It was one of the strange things one noticed at such times. His pupils constricted briskly to the light I shone at them, a crude but reassuring sign that his brain was all right. His pulse was thready and racing under my fingers. The monitor read one hundred sixty beats a minute.
A nurse called out the pressure. “Eighty over nothing.” A few seconds later she said, “Fifty over zero.”
Fluids were pouring in, blood was on its way. There was a bruise over the lower right ribs. His belly was tense and it seemed to be swelling under my eyes.
“No pressure,” the nurse announced just as the X-ray technician arrived with the portable machine.
“No time for this. He's exsanguinating,” I said. “Let's take him to the operating room. It's his only chance.”
Nobody moved.
“Now!” I said, giving the stretcher a push. “Call my backup, let them know.”
In the operating room, I scrubbed for just thirty seconds, while Dr. Ronaldo, the anesthetist, adjusted the tracheal tube. Ronaldo looked at me and shook his head.
I pulled on my gloves while looking at what the scrub nurse had laid out.
“Forget sponges. Let's get lap packs. Open them out. We won't have time to unfold them. There is going to be so much blood. We'll need big basins to hold the clots.”
The patient's belly was more tense than it had been downstairs.
Ronaldo, peering crocodilelike above his mask, shrugged when I looked at him for the signal to start.
“Get ready,” I said to Ronaldo, “ ‘cause when I open, the pressure is going to bottom out.”
“What pressure?” Ronaldo said. “No pressure.”
For now, the blood expanding the belly was serving as a compress, tamping off the bleeding vessel wherever it was. But the moment I opened the belly, the geyser would open again. I layered pads all around. I poured Betadine over the skin, swabbed it off, said a prayer, and cut.
Blood welled out, spilled over the edge of the wound like a storm surge. Despite all the pads, despite my suction hose sucking greedily, the blood lapped over the drapes, onto the table, and splashed to the floor. I felt it soak