Ultimate Sadness
My friend Mo is a surgeon in San Pedro, California.
Much of the time he loves his job and is happy for the opportunity to help
so
many people.
Sunday was not one of those good days. With his kind
permission, I am going publish the email he sent me yesterday. If the first
line
is something that is very upsetting to you then you should not read
further.
“I just finished sewing up a dead boy.
I pronounced
him dead
at 10:34 PM. It’s now 11:27 PM. I know I won’t be able to get to
sleep for a
long time. I feel like I shouldn’t.
I’m a trauma
surgeon, down here at
St. Mary’s. I was sulking in my call room on Palm
Sunday because I missed yet
another important moment in my 5-year-old son’s
life. A tarantula crawled all
over him at his best friend’s birthday party,
and my wife had e-mailed me a
glorious photo of this big, hairy arachnid on
my son’s face.
The phone
rings, and I am summoned to the ER for a
“gunshot wound to the chest”. That’s
bad, but around these parts, sadly not
a surprise. Then the ER secretary adds,
“…in a 12-year-old.” That changes
things a bit.
As I hurry down to the
Emergency Department, I play
out several horrific scenarios in my head…a
mental exercise in preparation
for what certainly was to be a difficult
situation.
I arrive to a
room filled to capacity with doctors, nurses,
techs, volunteers, firemen,
policemen, and paramedics. The strictly medical
people are swarming around
an impossibly small figure, in a flurry of needle
sticks in search of a
vein, monitor-pad placement in search of a vital sign,
stethoscopes vainly
searching for a breath sound or a heart beat. The
non-medical personnel had
formed a concerned and curious peanut gallery. One ER
doctor blurts out the
important points, “GSW to the chest, pulses in the field
but…” while
another ER doctor is prepping this small chest for an ER
thoractomy.
In English, an “ER thoracotomy” is where you flay open a
chest in a
soon-to-be-dead patient, in the hopes of finding a hole you can
quickly but
temporarily fix. Once that is done, it gives you a chance to give
the
patient necessary things like blood and IV fluids (where they now will not
simply flow out of those repaired holes), and get him to the OR so you can
fix
him properly. It is the trauma surgery equivalent of a “Hail Mary”
football
pass. This is not a “difficult situation”, this is a nightmare.
The ER
doctor sees me, and literally hands me the knife, as if to
say, “Here. It’s
yours.” I think the kid is dead, or if not dead, then he
certainly is
“unsalvageable”, which is a horrible word to use for a human
being. I don’t
think he’s fixable. However, if he is to have any hope of
survival, the ONLY way
to save him is to crack him open and try to plug up
the holes. Cracking open a
12 year old boy is going to tear my own heart in
half, I think to myself, but
this is part of what I do, so I slip the gloves
on and take the knife. There is
precious little skin to cut through, and I’m
in the chest in a few seconds.
His chest cavity is filled with blood,
which spills out of his chest
like a macabre waterfall to the floor. There’s
a shredded tear in his lung, and
a big, ragged hole in his heart. All the IV
fluids that my associates are
pouring into the patient are flowing out this
hole and on to my shoes. I put my
finger in this hole…such a big hole in
such a small heart…but blood and
fluids still flows unfettered. My other
hand finds another, larger hole on the
other side of his heart. My fingers
touch. His heart is empty. Mine breaks.
His family is brought in while I
am bathed in his blood, as “studies
have shown” that this is better for
everyone involved, to be present as the end
nears. I scramble for a way to
just stop the bleeding. I just want it to stop.
It’s spilling over my hands
on to the gurney. His mother is begging me to do
what I can. I know I can’t
do anything. She tells me to take her heart, and give
it to him. I know
that’s not possible, and she knows that’s not possible, but
she could not be
more serious. The first ER doc is sitting alongside the mom,
gently telling
her that we’ve done everything we can do. His mother looks at me.
My hands
are still in the boy’s chest, trying to do something, anything. In her
eyes,
I see a soul that I am about to crush with a little nod of my head. I do
so.
As the howl of unimaginable grief shakes the entire ER, I am filled
with anger. Why do we still sell guns in this country? What is this child
doing
on the streets after ten o’clock at night? Why are we killing our
innocent young
soldiers overseas, and ignoring the merciless
gangbangers…terrorists in their
own right…that are invading our streets
here at home? I try to put these
thoughts away, because now, in front of his
family, I have to sew him up. I have
to close this huge gash in his left
side, that I made.
I place the first
stitch, and as I’m tying the
knot, I look at the boy’s face. He’s small for 12,
not that much bigger than
my son Ben. All the adrenaline is gone. My shoulders
sag. I feel myself
start to cry, and I know that I can’t stop it. I have no way
of hiding
because literally everybody is looking at me, including his mother,
and my
hands are busy, so I can’t wipe the tears away. I make eye contact with
the
mom, and whisper “I’m sorry.” I finish closing his chest up, and shuffle off
to the sink to wash this child’s blood off my arms.
I sit down in
the
doctor’s area, to start filling out the pointless paperwork. Several
nurses and
doctors come over to offer encouraging words, or a consoling hand
on the
shoulder. I want to quit. I don’t want to do this anymore. I want to
quit
because that means I can go home. When I go home, I can quietly open
the door to
my son’s room, and sit on the floor right next to his bed. I’ll
watch him sleep,
that blissful sleep only found in young children. I’ll
watch him for hours, and
tell myself how lucky I am to have him in my life.
I want my son to put my heart
back together.
But I can’t go home, as
I’m on call until 8:00 AM. I
can’t quit. Tomorrow I have patients,
surgeries, rounds…the usual stuff.
Hopefully, I’ll be home for dinner.
When I come through the door, I’ll hear his
cheerful yell of “Daddy!” and
he’ll jump into my arms. He will in all likelihood
never know how much that
moment means to me, but it is precisely that
resuscitative energy that will
restore me. To keep coming back to this sort of
work.
I will sneak
into his room after he falls asleep. I’ll give him an
extra kiss goodnight.
And then, just maybe, I’ll close my eyes.”
Thank you Dr. Mo
for the work that you do even when you
can’t manufacture miracles and thank
you for giving us a glimpse into a small
part of your world.
