I just finished sewing up a dead boy.
I pronounced him dead at 10:34 p.m. Sunday. It’s now 11:27 p.m. 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 at St. Mary Medical Center in Long Beach. 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 heartbeat. 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 thoracotomy. 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 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 an 11-year-old boy (he was two months shy of his 12th birthday) 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 flow unfettered. My other hand finds another, larger hole on the other side of his heart. My fingers touch. His heart is empty. Mine breaks.