Agraphia Medical Tragicomedy

Just Hanging Out

After a shift the other night, a few of us emergency residents went to go grab a beer.  We've gotten much less interesting lately; last year we would have elaborate dinner parties, hiking trips out to the local mountains, you name it.  Nowadays we try to muster the energy to pour back a cold one before we pass out in our beds.  The news was playing in the bar.

"... multicar pileup on the freeway today," intoned the news announcer, "all 12 injured taken to the local trauma center where we anxiously await news of their health."

I turned to one of the other residents, who was watching the newscast with vague interest in between sips of his drink.

"Anybody hurt?" I asked.

"One broken humerus and some whiplash, is all," he said.

"That's good," I nodded, "Trauma ICU's already pretty full."

"Yep."

We sat, news blaring, and took another sip of beer in silence.

The Moment I’ve Been Training For

He was a guy my age, in his mid-twenties, and his friend was driving drunk.  When they hit the tree at 50mph he was ejected out of the car, slamming his head into the tree on his way to the ground several meters away.  Initially he was walking and talking - a good prognostic sign for the severity of his underlying brain injury - but quickly decompensated when EMS arrived on scene.

By the time he came to me in the Trauma ICU he was comatose, intubated, and on very shaky ground.  The bleed in his brain was severe, and I wasn't sure if he was going to make it.  A petite asian girl sat in the corner of his room while I did my initial evaluation.  She didn't say anything, just sat there looking at the floor.  After my examination I went over and introduced myself.

"I'm Dr. Zac," I said, "How are the two of you related?"

She didn't look to be more than 23 years old, about his age, and she slowly looked up, a puzzled look on her face.  She looked like she was in shock.  It took her a moment to speak, but when she did, what she said knocked the wind right out of me.

"I'm Jen.  I'm... his wife.  We got married yesterday," she said simply, "I love him."

She twisted the ring on her finger as though it was unnatural, unfamiliar.  Her gaze was empty.  A single tear coursed down her cheek.

I don't normally get attached to patients, especially in the ICU.  I care for them deeply or else I wouldn't be in this job, but getting emotionally invested is dangerous.  I learned that early on.  Your responsibility as a physician is to all your patients, and decompensating from a bad outcome can have devastating consequences for everyone else.

But sometimes emotions take over no matter our intentions.  I didn't know what to say at first, and then it all came tumbling out.

"I'm... I'm so sorry.  I can't imagine what this is like for you.  You have my word that I will do everything within my power to save his life.  I will not sleep tonight."

That night, everything fell into place.  Everything that could go right, did.  I gave countless boluses of mannitol and hypertonic saline to drive his intracranial pressures down.  I drained fluid off his ventricles.  I sedated him into a medical coma and made him hypothermic to decrease brain metabolism, and paralyzed his body to decrease shivering.

For all my efforts, in the middle of the night I realized I was going to lose him. Intracranial pressures spiked, his heart rate dropped, and I had maximized every available option.  I went in and stood, arms crossed, watching the monitors.  Helpless. Just him and the universe, now.

Jen saw the look on my face.  I think she knew there was nothing left I could do.  She slowly walked over and took his hand in hers, kissed him gently on the forehead, and then whispered "I love you" in his ear.

And I watched, astonished, as his heart rate slowly picked up.  His intracranial pressure dropped to normal levels.  She sat next to his bed, a vigil for the rest of the night, but the turning point had been reached.   My treatments became less frequent and more effective.  By the morning his vital signs were as stable as a rock.

It'll be a long recovery, but he should be completely normal in a few months.  More than anything, I'm happy that I've been trained well enough to help him in his time of need.  It's a good feeling.

It was the best wedding present I could think of on short notice, Jen.  Congratulations, and many happy returns.