As the cold front settles in on Baltimore, the snow begins to fall, and the roads begin to freeze. On this chilly Friday night, bartenders are closing tabs, drunks are falling over, and triggers are being squeezed. As darkness looms, the revolving front doors of Shock Trauma are well open for business.
The first business of the evening is a prisoner who attempted to commit suicide in his cell. Of all the creative ways to kill yourself, tying one end of a plastic bag to the top of a bathroom mirror, the other end around your neck, and sitting on the sink while leaning forward has to be one of the worst idea I’ve heard. This guy was completely fine when he got to me; he was coherent and talking up a storm. He eventually transferred to a bed upstairs. I got a report later in the evening that he attempted to kill himself again. It fascinates me how he could have done this while shackled to the bed with two guards watching over him.
The next unhappy customer was a seventy-nine-year-old active gentleman who rolled a little too far out of bed and landed on his neck. When I first heard the report, I yawned a little; after all, how bad could a fall from fewer than 3 feet be? On my initial exam, he had no feeling below his neck, couldn’t move any extremities, and was having a hard time breathing. I didn’t need to go to med school to know that something really bad was going on here. He was intubated to protect his failing airway. A CT scan of his neck revealed that had essentially dislocated his C4 vertebrae over his C5, completely severing his spinal cord in the process. He would remain a quadriplegic for the remainder of his short life until his family withdrew care the following morning.
A short break for a midnight snack was interrupted by a combative, intoxicated mid 30’s female who smashed her car into a telephone pole. As she was sitting up in her stretcher cussing out the nurses, it was clear her airway and breathing were not going to be an issue. In my head I was debating about giving her some Ativan or Haldol to calm her down. As soon as the thought crossed my brain, I turned and saw anesthesia pushing propofol (a powerful sedative), and getting the laryngoscope ready to intubate her. This happened a couple more times throughout the night, and I learned the lesson that if you don’t cooperate in the Shock Trauma TRU, you go to sleep and buy yourself a breathing tube. All of her CT scans were negative. In the morning she was still intubated at 8am, and at 10am she was discharged. The standing protocol to extubate a drunk seems to be turning off the sedation and decuffing the breathing tube. When they wake up, they naturally pull it out and walk out the door.
Somewhere around 3am a frantic paramedic came through the intercom. The description that followed was a twenty-something-year-old girl found down with a heart rate of 30-40, and a blood pressure that was so low, it was barely reading on the machine. As my vital signs did the opposite of her’s, I quickly reviewed all my pocket resources for how to run a cardiac code. The girl was wheeled in and it was very clear she was severely intoxicated. When we measured her vital signs they were low, but not low enough to wheel out the crash cart. She was intubated and given a bunch of IV fluids. Her blood alcohol level was .350 when she first arrived, about 4 times the legal limit. The surreal part was when she woke up in the morning. This girl who looked like any other early-to-mid-twenties college student was probably in shock when one minute she was walking down the street having a few drinks and the next moments she was pulling out a breathing tube in what looked like an emergency room. When we rounded on her, she was sitting up in bed with tears of embarrassment in her eyes, asking where she was.
Occasionally the University of Maryland brings in a film crew to document an average Friday night at Shock Trauma, and this was one of those nights. They use the footage for, I was told, a variety of things from documentaries to advertisements. As I was doing an initial assessment on a nineteen-year-old involved in a rollover car wreck, there was a giant camera pointed at me with a boom mike hovering above the patient. It made the whole experience feel like I was on a set of some daytime soap opera.
As the night turned to day, the intercom that communicated with the ambulances settled to a pulseless dial tone. The real pain began at 7:30 am, after admitting 27 patients overnight, we had over 50 to round on. We finished somewhere around 2pm. I promptly went back to my shared hotel room and slept for a solid 15 hours straight.