Trauma Room Two

by Philip Allen Green

Sometimes when I am bored, when it is all sore throats and dental pains, when I feel more like I am a social worker and a hand-holder than an emergency medicine physician, I play a game. I do not look at the chart before I go into a room. I walk in cold. I enter with no idea who is going to be in there or why. In that very first second, before anyone speaks, I try to guess what the story is, who the people in the room are, and why they are in my emergency room.

On his left wrist, he wears a Rolex. The bands are polished silver and cradle an oyster-white face on which three hands mark the time, the smallest of which ticks along, second by second by second. The outside of the watch face is meticulously trimmed in gold and clearly asserts to all who see it that this man’s time is expensive.

A strong jaw cuts the angle of his face into the space of the room around it. He does not need to smile for me to know his teeth will be perfect and symmetrical and white.

Under each eye hangs a faint dark circle. He has not been sleeping well. I am guessing, of course, but it looks to be more than just work fatigue. Perhaps a struggle outside of work has started to spill over into what must be an all-consuming drive for achievement. Or perhaps it is nothing other than the tracks left on him from another successful merger. I cannot tell—not yet.

Her forearms are bare and hairless, but it is her biceps that stand out. They are small, solid, and precise, like an exclamation point stamped onto each upper arm. Biceps like that shout yoga, Pilates, personal trainers, green smoothies, and a lock on the bathroom door after big holiday meals.

On the floor by her feet sits a purse. Its handle is a bent half circle of bamboo attached with gold and silver clasps to the bag below. The bamboo is polished and smooth. The wood is a blend of browns. A creamy white winds through the handle, somehow offsetting the dark tones and grains of the wood. The purse itself looks to my unsophisticated eye not unlike the color of a wet pack horse after it has crossed a deep stream. It is a different shade of brown from the bamboo. It is like no brown I have ever seen before.

Standing before them, it suddenly hits me. I have made a terrible mistake. They are all just like me.

“Bring it on,” I would say. “Bring it on.” I was fresh from residency, done with my training, a young doctor with a new white coat, ready to test myself and my skills against whatever the world threw at me. “Bring it on,” I said. So the world did. The world did.

Her pupil is blown. It does not respond to the light that I shine into it because somewhere in her brain something is bleeding and expanding, smashing and squishing her potential up against the limited space of her skull. All of who she is and who she could be is disappearing second by second into that abyss.

Cervical vertebrae protect the spinal cord. When the bones move, the spinal cord underneath does too. Spinal cords are not meant to shift about. Sometimes, when exposed to too much force, they do not spring back into place. Instead, the bones cut, sever, or slice the spinal cord just underneath them. My fingers tell me the bone is so far out of place that even if the world’s best neck surgeon were here in our little ER, he or she could do nothing.

The giant medic pushes down as hard as he can. But he has to push against an elite cardiovascular system pumping furiously from adrenaline. Blood does not ooze out like an old lady with a trickling nosebleed. If the medic moves his hands at all, it will spray out like a fire hose at full bore.

walk down the hall that leads to the family room. It is empty. There are no patient rooms or people. I can hear my steps echo on the linoleum floor. The walls have no windows. I cannot look out and dream of the mountains to the south. It is just me, walking down a hall by myself.

I sit down across from them. My right hand begins to tremble. I fold my left hand over it to hide it. I take a deep breath. I focus. I speak.

I watch their entire universe collapse in on itself. It explodes apart in front of me. Their lives disintegrate and scatter, like dust in the wind, into a thousand pieces, a thousand directions. My three words obliterate everything about who they are, who they were, and who they will be.

I will think about this later. Right now I have to keep it together. I am fifty-eight minutes into the start of a twelve-hour shift, day one of a seven-day stretch of work. There are fourteen more patients checking in. We are behind now from dealing with this trauma. I am the only doctor in this ER. I cannot think about this right now. I must not think about this right now.

It is my day off, but for the rest of my family, it is a workday and a school day. They are gone by the time I wake up. I make a peanut butter and jelly sandwich and pack it in my backpack. I get on my motorcycle and ride for two hours up dirt roads out into the mountains. I find a quiet spot that looks out over some canyons, and I make a small campfire. I make some tea—green mint tea, and throw some pine needles into the hot water. When it is done, I walk over to the edge of the canyon, my little tin cup steaming with the smell of mint and pine. I sit down with my back against an ancient tree.

Like precious rocks gathered from the bottom of a river, I hold them up in my head, turning them round and round in the bright sunlight, inspecting them, trying to understand them. They are pieces of a puzzle that I cannot fit together. I try different combinations, different possible matches, but none work. No matter how I arrange them, the edges do not align; some uncomfortable space still sits between each and every one of them. After a while, I stop. I sip my tea and watch a hawk ride a thermal round and round. Maybe the pieces are better left apart. Maybe my problems come from trying to put them together. I think to myself, maybe that’s it, but it makes me anxious to have a box of loose puzzle pieces shaking about in my head.

I stand for a moment staring, alone in the kitchen, my heart racing. The spaces between the puzzle pieces in my head suddenly aren’t quite as crippling as they were just a moment before.

I sip my coffee and watch the raindrops splash down in the puddles of the ambulance bay. It is pitch black out. The security lights cut a white beam out into the rain and fog, disappearing into the dark.

The ER is empty. Housekeeping finished up a little while ago. The floors of Trauma Room Two and the rest of the ER have been scrubbed clean of blood, vomit, and excrement. The black mud every patient and family member tracked in last night has been wiped away. The floors are once again shiny and white, catching the parallel lines that are the reflection of the fluorescent lights buzzing quietly overhead.

They rose and wandered off, one by one, into the rain and dark. They reminded me of the elk I sometimes come across in the mountains just outside of town. As they left they moved slowly, deliberately, and carefully. I realized they search and pick their way through life, each looking for the next meal or drink—the next score. I watch as the last one of them stops just outside the big glass ambulance door. He digs through the garbage can, foraging for glass to recycle, hoping to trade it in for a few pennies or maybe a dollar. But this time there is none to be found. He shakes the rain from his head, reshoulders his pack, and follows the rest of his herd off into the darkness, going wherever it is they go when they leave here.

I lean back, up against the bank of medic radios behind me. After a night of squawking out call after call, they are quiet. I take another sip. A nurse sitting down at the far end of the station looks at something on a computer. A green palm tree and blue sky fill the monitor. She clicks on a banner, surely dreaming about somewhere far, far away.

If you know where to look, you can find peace everywhere, even here.

The deer jumps. It pushes off from the rain-soaked dirt, leaping into the sky. It rises, and it falls, descending directly into the bright white headlights of the oncoming Toyota Camry. To the driver, it appears to drop from above, as if released from a giant’s hand hovering just out of sight above the backcountry road. Its hooves clack on the pavement as it lands, and long legs bend down to absorb its weight. Linear shadows scatter across its flank from the speeding headlights of the oncoming car. The muscles of its back begin to contract in the light, flexing, preparing to launch itself back into the sky for the other side of the road.

The deer strikes the grill. The headlights disappear for a brief instant, replaced with a shower of red-and-white death as the deer disintegrates into the night.

The driver reacts, but it is too late. He turns the steering wheel away from the deer. The deer that no longer exists in this world. The car begins to slide. The driver’s panic takes over, and he turns the steering wheel sharply back in the other direction. He turns toward the road, away from the white aspens now flashing past the headlights like piano keys falling from the sky.

The sliding wheels bite the pavement, and the pav...

When it stops, it is no longer a car but a twisted tomb of steel—dripping oil, bleeding gas, and steaming hot radiator fluid into the cold night air. Three of the four teenagers, ...

I was having a dream about our old dog. He was swimming in a lake for sticks. He never did that when he was alive. I look over at the clock.

Our trauma team at night is four people. When I worked in the city, the trauma team consisted of around twenty different specialists, techs, nurses, administrators, and surgeons. Day or night they came. Many times there were so many people present wanting to help that I had to kick some of them out of the room in order to make space for the patient. Out here the trauma team is different. It consists of a doctor (that would be me), the ER nurse, a respiratory tech, and a floor nurse sent down from upstairs.

I get that feeling in the pit of my stomach that has come every weekend since my kids started high school. The Friday-Night-Pit, I call it. This is the only ER in town. I am the only ER doctor awake in the county right now. Every time the medic radio blares out about a car accident or a trauma, I find myself afraid. One question keeps coming up in my head: “Could I do it?” That is, could I code my own kid?

Jackson Mountain is one of the mountains that sits just south of town. It straddles two counties, both of which are mostly forest. It is not really a mountain in the traditional sense, but that is what all the kids around here call it. Everyone in town knows what goes on up at Jackson. We all know because we were kids once, too. Up the winding gravel roads is a series of creeks, draws, and fields tucked back into scattered forests. It is a huge area at the edge of an even bigger spread of national forest land. It is an ideal place for bonfires, kegs, make-out sessions, and everything else teenagers like to do when there are no parents around.

I loved Jackson Mountain when I was in high school, but dear God, do I hate it now. In the fifteen years I have been back in town, I have cared for more than my share of alcohol-fueled deaths of drivers from the windy roads running down the hills.

It is made to withstand the doing of terrible things, all in the hope of achieving something wonderful.

When people imagine what it is like in an ER, they like to think of high fives, fist pumps, and amazing saves. They think that is what makes doctors, nurses, and emergency personnel such a close-knit group. But it is not. It is moments like this. It is standing around an empty gurney together while we think about our own sons and daughters. We wait. No one speaks.

Over the years I have learned the hard way that each time I throw the switch, it becomes more difficult to turn it back off. If a case is too traumatic, too upsetting, and I close off all emotions, it can be weeks before the feeling part that makes me who I am returns.

She stands with her gloved fingers interlaced in front of her. I realize she is praying that it is not her child. It strikes me that, in an odd way, she is praying that it is my child and not hers. I do not hold it against her. We of the ER face the darkness together in a way few others will ever know.

So here we are. There are eighty-six kids in our town’s only high school. Between the four of us, we have six teenage children in the school. That is even worse odds. That is a one-in-fourteen chance that one of our kids was in that car. The Friday-night fear in the pit of my stomach grows. Those are bad odds.

Amanda relaxes slightly. “We are The Crew,” she says. “The crew that do,” we all say together. It is an old private joke between the four of us. At one time it was hilarious. But now it is who we are, and it is a quiet comfort in the middle of the night.

The medic who coaches my boys in basketball speaks the only words we are all listening for. “Out-of-town kids. Out-of-town kids.” And in that moment, I know that he prayed the same prayer as we did. Only he prayed it racing up Jackson Mountain on the way to the wreck, with the lights and sirens blaring above him. He prayed that it was not his child who was in the accident. But he also prayed that if it was, that he could do it—that he could throw the switch all the way and do what needed to be done, regardless of the cost to himself. He, too, is part of the crew that do.

The sheriff is shaking ever so slightly, but not from the cold. He is the only sheriff on duty in all of Whiskey County tonight. The county that sits next to ours. He, too, responded to the wreck. He shakes. He had to throw the switch all the way tonight.

It was an old car—a beater. A Chevy Nova. It was pea-soup green, dirty, and dented. It was packed full of people. After skidding to a halt, it rocked back and forth from the momentum, teetering on a broken and useless suspension system.

Babies are born to survive in spite of arriving into a hostile world. They are the end product of evolution, evolved specifically to live in a world filled with predators. Predators like wild animals, infections, methamphetamine-addicted parents, car crashes—well, you know the rest. But like I said, they are tougher than you think. Give them a chance, and more often than not, they will find a way to hold onto life.

She wore a black T-shirt that hung loosely on her cachectic frame.

As the blood pumped, I imagined tiny hemoglobin soldiers running as fast as they could with fresh oxygen molecules strapped to their backs. They leaped over other cells, slid through corners, and dived into starving, dying, perishing organs with their critical supplies.

The little gray baby turned pink. Pink. The color of oxygenated blood. Pink. The color of life. Pink. The color of the sun roaring up over the mountains, bringing heat and warmth to those stranded in the snow, far from the ones they love.

Her body torques, twists, and jerks about, like a snake trapped on an electric fence. She flops back and forth on the gurney before us, her pale forehead dripping with sweat and her brown hair wetted black from the effort of muscle contractions that threaten to tear her tiny frame apart.

Her skin turns a pasty gray as her oxygen level falls. Her brain is forgetting how to breathe. If I give her sedation and put a tube down her trachea to breathe for her, I will not know whether she is seizing. But if I do not, well, she may just stop breathing forever. It’s a catch-22, a rock and a hard place, a lose-lose bet with a stacked deck in the casino of the Titanic as it careens into an iceberg.

I look back at her dad. He stares at his daughter, trying to will her to breathe even though he knows by now he has no power over any of this. But try he does. I see it in his face. He has not been drained all the way—not yet, at least. Life is drilling him full of holes as fast as it can, adding another big one today. I see he does not shy away from the horror like most. He is going to fight this to the bitter end, no matter the cost to himself, his sanity, or his soul.

They found him in the ditch. He lay tucked behind the bushes. A brown frayed tarp held together with strands of silver duct tape covered him completely. At first the jogger who found him thought he had discovered a dead body, but then the tarp moved, cursed at the runner’s dog, and wiggled back down farther into the bushes.