“When I was a medical student on my surgery rotation, I was working a twenty-four-hour shift and was with the trauma team. I was ‘observing’ a simple repair of a duodenal perforation in the operating room when my trauma pager went off. I asked my senior if I could leave to see what was going on and he gave me the go-ahead.
I ran into the trauma bay and a young gentleman was brought in on a stretcher with the lower half of his body covered in blood, but very obviously awake and coherent.
He screamed, ‘They shot my balls! They shot my balls man!’
And they had.
He had been shot fifteen times all below the belt, one of which had gone straight through him. We were doing an evaluation on the distraught man when a code was called in the next pod over in the emergency department.
That was weird because they usually don’t call overhead for codes in the ED.
Someone popped their head into the trauma bay and said, ‘It’s the patient who was brought in with this guy.’
Several of us ran away from the stable guy who got shot in the balls and into the next pod to see a young woman lying on a stretcher receiving CPR.
I asked, ‘What happened?’
They responded, ‘We don’t know, she just crashed.’
We went to roll the patient to get her clothes off and noticed she was bleeding out of her back out of the tiniest exit wound.
She was an unintended victim of the drive-by. She was then our patient.
We took her to the trauma bay and immediately took off all her clothes to perform the primary survey. She wasn’t breathing and had no pulse. Once we got her entirely exposed, we saw a very small entry wound right into the center of her chest. The ultrasound confirmed a massive hemothorax. We placed a chest tube and two liters of blood gushed out onto the floor.
Someone suggested, ‘We need to convert to open.’
The resident I was with immediately took a scalpel and created a longitudinal incision along the inferior aspect of the rib spaces and used a pair of medical gardening shears to clip the sternum in half. Basically, the patient has had their chest pried open horizontally in a crazy procedure called a ‘clamshell thoracotomy.’ At this point, we could visualize the heart and notice there was a clean entry and exit wound straight through this patient’s heart. All of the blood and fluids we were pushing were just drained right out of her heart and into her chest. The surgeon attending was performing manual cardiac massage, CPR with your hands on the actual heart.
They said, ‘We need to go to the operating room.’
We rushed down to the operating room with the patient and one of us attempted to sew up the holes in her heart. Just as she was putting the final sutures into the patient, I began to notice the patient oozing blood from every single opening in her body.
She said, ‘Doc I think this patient is in DIC.’
The patient was experiencing a phenomenon known as ‘disseminated intravascular coagulopathy,’ which is basically when you use up all of your clotting agents and just bleed out of everywhere.
The doctor responded, ‘Okay we need to close for now.’
The patient was transferred to the SICU where I monitored her progress for three whole weeks. She had watershed infarctions across her entire brain from how long it went without perfusion. She couldn’t talk or move. We had to have end-of-life discussions with the family about a young woman who wasn’t even old enough to drink. I left the service and followed her progress until one day I didn’t see her name anymore.
The next day, I was in surgery with the trauma attending and she said, ‘Hey our shooting patient went home today. She’s a quadriplegic, but she’s alive.’
I responded, ‘That sucks.’
Fast forward six months and I was working in the SICU again. I brought up the patient to a neurological intensivist attending because I thought it was a cool story.
Her eyes opened so wide and she said, ‘I saw that patient in the ICU and told the family she was going to die. When she didn’t die I told them she would be a quadriplegic. Then a month ago I had a follow-up visit with her and she walked into my clinic with nothing to show for her experience except a scar from her thoracotomy.'”