Futility and Rationalizations

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Last night I presided over the death of a child. To the world he was a young man of twenty, but as the paramedics rolled him into the trauma bay, pumping on his chest, I felt a momentary stab of panic. He was the same age as my youngest son, the same build, the same chocolate skin tone, and the same thin beard that my son wears so proudly. The moment passed before I recognized its source and I knew this was not my own son.

He’d been shot in the chest and other than a few gasping breaths at the scene had shown no signs of life in the twenty minutes it had taken them to get him to us.

We started the trauma code and massive transfusion protocols, but he didn’t respond. I placed a tube in his left chest and immediately got back almost 800cc of blood. His EKG stabilized from a chaotic series of spikes to a slow junctional rhythm at 46 per minute; still no detectable pulse, electrical activity only.

I called for the thoracotomy tray. ER thoracotomy is a dramatic, but ultimately futile gesture. Survival after such a procedure is uncommon. After 30 years in this business, I have three survivors. They are rare enough that I remember them all. This would not be my fourth. The bullets had shredded his pulmonary arteries and vena cava. All the fluid and blood we were pumping was pouring out as fast as it went in. I called off the code and his EKG went flat less than a minute later.

We never knew his name. The police had an idea but weren’t willing to say anything until they could confirm it. His parents didn’t hear about his death for several hours and I never met or saw them. When they finally arrived at the hospital, no one told me or asked me to speak to them. The wheels of the legal system were turning and other than carefully clinical statements to the detectives and an extensive dictation for the medical record, I said nothing more.

I am not good at giving families bad news. In this case, I was glad to leave it to a police officer. Nothing I could say would have helped and a clinical description of his injuries and the procedure would only cause more pain. I also know that what I just wrote is a rationalization of my own cowardice and inability to give comfort in the face of sudden loss. Whatever lies you have to tell yourself to get through the night, right?

Thirty minutes later, the team gathered in the same trauma bay for the next activation, a pedestrian struck by a car. The floor was clean, the sheets on the trauma gurney were fresh and white, the room was restocked and ready, like nothing had ever happened.

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