Front Row Seats

From the Buckeye Surgeon archive, original post date 10/15/09

This survey paper from Archives of Surgery in August addresses public/health professional viewpoints on end of life interventions, specifically in situations of severe traumatic injuries ultimately resulting in death. It isn’t much of a paper. Surveys are bogus. I think there was only a 50% response rate. But whatever. Here’s what I want to highlight:

Most of the public (51.9%) and the professionals (62.7%) would prefer to be present in the treatment room as opposed to the waiting room in the ED during resuscitation of a loved one (Table 2). This preference endured even when respondents may witness disturbing sights. If the victim were a child, the preference for being in the treatment room increased to 79.0% of the public and 78.7% of the professionals.

General impressions can be gleaned, which are often just as useful as meticulously parameterized data. And the general impression of this paper—that both the lay public and health care professionals would prefer to be in a trauma bay during the resuscitation of an traumatically injured child—- is just outlandish to me.

On trauma call one day as a 4th year resident, they rolled in a four year old kid from Chicago’s south side who had run out into the street and got drilled by a speeding car (hit and run). He lost his vitals the minute he arrived. He was blond and blue eyed and there was dirt under his fingernails and we were pumping his pale, frail chest and finally the Trauma attending performed an ED thoracotomy. His tiny little pink lung erupted through the wound and his heart fluttered uselessly in its pristine diaphanous sac. There was no blood in the chest. He clamped the aorta and massaged the heart directly. Still no vitals. The next maneuver was a debatable one, in retrospect, but it was almost as if he, all of us in the room collectively, felt the need to do something else, to keep working, anything to avoid stopping, admitting futility. The child’s belly had seemed to distend during the resuscitation. So the attending opened up his virgin abdomen, hoping to encounter hemoperitoneum, possibly to clamp the supraceliac aorta, possibly to find a specific injury to repair or at least temporize. There was nothing. The translucent, parchment-thin bowels bulged through the incision. There was no blood. His little liver was beautiful, I remember thinking. Nothing to fix. The vitals never came back and the kid died right there in front of us all with lung and loops of intestines spilled out everywhere. The attending closed the wounds himself, alone, the curtain pulled shut…

I think I put three holes in the call room wall right afterwards. How can something like that happen? For what reason? I still carry the kid’s newspaper obituary in my wallet, yellowed and deeply creased after all these years. I take it out every so often. It still pisses me off to this day. I don’t want to ever see something like that again…

OnSurg thanks Dr Parks, Buckeye Surgeon author for permission to re-post from his blog.

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