Working With The Enemy: part 2

This is really late, but better late than never. My plans didn’t really go as expected (as if they ever do) and my work at the military hospital was cut short some time after the second week due to several circumstances. A few things happened here and there, but what I remember the most is the guy who was hit by a car and brought in to the trauma bay.
When I first saw him he was on the couch on the far side of the room; an obese man who was irritated and in some pain, but not much. The doctors were looking at his CT images on the light board. He had been knocked over by a car and the injuries had broken a few ribs, punctured his lung and burst his spleen. I later heard that when he had come in he was so comfortable and not in any pain that the receiving doctor almost discharged him, but then decided to do an Xray to be on the safe side and found half his chest full of blood. I brought over the ultrasound machine and showed the doctors how to do a FAST scan to look for free fluid (blood) in the abdomen. He was the type that we call ‘not ultrasound friendly’, because we could barely see anything at all. 
When I came in the next day, he had been transferred from the trauma room to Room A for critical patients. The surgeons didn’t want to take him into surgery because they thought his spleen injury could be managed conservatively. I took over from the receiving doctor and waited for him to come back from the CT room. They had decided to scan his brain again because his consciousness had seemed to deteriorate. When he came back, he appeared to be fast asleep. But of course, anyone who has worked long enough in an ER knows that no one who appears to be fast asleep is actually fast asleep, especially if they’re snoring. In 10 minutes, he had been intubated and hooked onto a ventilator. For my non-medical readers, he had rapidly succumbed into a coma and could no longer maintain his airways and so we paralyzed him and put a tube down his throat and connected him to a machine that breathed for him.
In the middle of the chaos, the surgeon walked in with his brain CT, and we looked at the huge black area in the back of his brain that had appeared over night. It wasn’t a bleed, it was dead tissue, what we call an infarct. From my non-medial readers, when blood supply is cut to areas of the brain because of a blood clot or injury to the supplying vessels, parts of the brain die and appear black (at first) on the CT. Usually, in the context of trauma or head injury, if there is a bleed in the brain then surgery might be an option depending on the size of the bleed, location, etc. in order to drain the blood out and relieve pressure on the brain. But an infarct (tissue that is already dead) is inoperable, and when the neurosurgeons came in they stated the obvious and walked away. Then the medics came in and decided to treat him as a standard stroke and start him on Aspirin and physiotherapy, and that was it from them. This didn’t quite make sense to me, and the ER resident who came in later confirmed my suspicions. It seemed the initial accident had injured the blood vessels in the neck and there was a tear that was climbing up and cutting off the blood supply. This was something that needed urgent surgical intervention from a surgeon specialized in vascular surgery (blood vessels). But what alarmed me wasn’t this; the doctor couldn’t be sure that the injury to the vessels hadn’t happened after the guy came to the hospital; meaning it could have been caused by the doctors and nurses. At this point I tried to remember if I had ever seen him wearing a hard cervical collar (standard for all trauma patients to protect their spine), and couldn’t. The injury could very easily have happened while transferring him from a couch to gurney or vice versa, turning him over, moving him between rooms, moving him in and out of the CT machine (3 times at least), or anything at all. This was not good.
The guy’s oldest son was 20 something who was moving around in a state of miserable shock, and every time we shooed him or his relatives out of the room he would drift back inside again. He looked terribly young and terribly scared and couldn’t exactly understand what was going on. The whole 3 days that I came and left while the patient was still there, I saw him wearing the same grey shirt and dark grey pants, leaning on a wall here, lying down on a bunch of chairs there. After my last night shift I went up to the cafeteria at 7 am and found him sitting there drinking some coffee. Then he drifted back downstairs again and sat in the waiting area right at the back, looking as miserable as ever. I vaguely wondered when someone would have to tell him the news that his father had died, and how he would take it. He looked too young to take over the responsibility of a family. I don't remember ever seeing the patient's wife, and wondered how old she was. She couldn't be that old either. Then I thought about how they would take the idea that their father was probably in the state he was now because of something that could count up to medical negligence. But again, if this hadn't been the military hospital and they hadn't had insurance then chances are they might not even had found that infarct. They would still be stumbling around trying to get an initial CT and Xrays, running around buying their own medications and equipment, waiting for hours for a doctor to see them and not even dreaming of a specialist or senior doctor to look at the case. So it wasn't all that bad I guess.
Later that week I came back to the hospital to study with a friend because my exams were coming up, and I looked into all the rooms downstairs and the ICU upstairs for him but couldn’t find him. No one even remembered him or seemed to care where he went, but the answer I got was that he was either moved to the main ICU inside the hospital, or he had died, because he definitely wasn’t getting any better. Eventually, I stopped looking for him.
A lot of stuff happened after that and I came back to the military hospital later that week as an attendant this time, since my grandfather was admitted there for almost 3 weeks. It was a miserable time as all hospital admissions are, but this time there were more senior nurses taking care of my gramps and it wasn’t all that bad, Alhamdulillah. The last week of his admission I came to the hospital, late as usual, and had to park my car far from the room because everywhere else was full. Then, I guessed since I was near the cafeteria I might as well get some stuff, so I walked lazily down the yard and entered the noisy cafeteria, got a bunch of stuff, walked back out, made some phone calls and wasted a lot of time. None of this was planned, but of course it was, because as I walked back down the yard I came across 2 gentlemen that I should have known but didn’t really know. It took me a few seconds to remember the one of the left, mainly because he wasn’t wearing grey anymore, and he didn’t look so miserable. It was the son whom I hadn’t seen for 3 weeks or more, and he looked happy. But that didn’t make any sense, because his father should either have died, or would be paralyzed for life or something. I said hi and asked him about his dad, and he told me that he was doing great. He was awake, and talking, and remembered everything, and was eating on his own, and with the help of physiotherapy would soon start walking again. I couldn’t believe it, and kept asking him if he was sure about what he was saying, and he said yes and his uncle confirmed it. It didn’t make sense, but there it was. I told him Rabana had given his father a second chance in life.

It’s very rare in the ER to come across stories with a happy ending, so we cherish them when we find them. Alhamdulillah. 


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