Michael J. Collins - Hot Lights, Cold Steel: Life, Death and Sleepless Nights in a Surgeons First Years

We start here, and we go there. But its not that simple, is it? Our paths may be circuitous or direct. We may gaze excitedly ahead, or cast our eyes regretfully behind. Until we reach our destination it exists only in our own minds. It is what we have imagined it to be. And yet we tend to neglect the journey, which is real, in favor of the destination, which is not.

For too long I neglected this journey. It was an obstacle to be overcome, an ordeal to be endured; for I had never chosen the journey, I had chosen the destination. But now that the journey has ended, I have discovered that here isnt so important after all. I find myself looking back with particular fondness for how I got here.

St. Marys Hospital Emergency Room
The Mayo Clinic, Rochester, Minnesota
June, Year Four

The ER doors crashed open and the paramedics powered through. I trotted alongside them as they wheeled the patient to Trauma One .

Fourteen-year-old kid, run over by a tractor, the paramedic said. He was conscious when we got there, BP a hundred over sixty. His right legs a messopen fracture, dirt everywhere.

Whats his name? I asked .

Johannson. Kenny Johannson.

Hang in there, Kenny, I whispered to the unconscious boy .

I lifted the sheet covering the lower half of his body, and immediately the thick, fetid stink of manure mushroomed up at me. His leg was twisted obscenely to the side. The jagged end of the tibia stuck through a rent in his dirty blue jeans. A spreading pool of blood soaked the sheet underneath him .

As we lifted the boy onto the table in Trauma One, his eyes flickered open. He began to whimper softly as he searched for someone he knew. I put my hand on the side of his head and rubbed his hair gently. Kenny, youre in the emergency room at St. Marys, I told him. Your mom and dad are here, too. Theyre in the other room.

He rolled his head and moaned. My leg. Oh, God, my leg! It hurts so bad.

I know it does, Kenny, and we are going to help you.

BP seventy-eight over forty, a nurse called out. Pulse one-sixty.

I probed Kennys wound. Under the severed end of the peroneus longus there was a bloody chunk of manure wedged against the bone. I picked it up with a forceps and dropped it on the floor. When I found what was left of the anterior tibial artery I clipped it with a hemostat. His bleeding, except for a slow ooze, ceased .

In the next several minutes we did a cut-down, put in a subclavian line, and pumped him full of blood and fluid. Within half an hour we had his pressure up to one-ten over sixty. I told the charge nurse to get an OR ready. As she picked up the phone, she said the boys parents wanted to talk to me .

Mr. and Mrs. Johannson were huddled together on a couch in the far corner of the waiting room. They sprang to their feet as I entered the room. Mrs. Johannson wrapped both hands around her husbands left arm and leaned against him. She kept staring at the bloodstains on my scrub pants .

I introduced myself and then told them that although Kenny had lost a lot of blood, his vital signs had improved and he seemed stable. We are just about to take him to the operating room, I said .

Before I could say more, the door to the waiting room burst open and a young man rushed in. Dad! he said. I found it.

This is my son Eric, Mr. Johannson said. He went back to the farm to look for the missing piece of Kennys leg.

Eric reached into the pocket of his jacket. He handed me a clean white handkerchief in which he had wrapped a dirty, three-inch section of tibia. I doubted we could use it, but I wanted the boy to feel he had done something worthwhile. Thanks, Eric, I said. This could be a big help.

Will you be able to save Kennys leg? Mr. Johannson asked .

At that moment I was more worried about saving Kennys life. The boy was in shock and had almost bled to death. I longed to reassure his parents, but I had learned not to make promises. Mr. Johannson, I said, were going to do everything we can.

Please, Doc. Please.

I nodded, shook his hand, squeezed Mrs. Johannsons shoulder, and sprinted up to the OR .

They had taken Kenny to OR Ten, the largest of the operating rooms. In contrast to the ER, where everyone had been barking orders, shouting for equipment, and rushing back and forth, the operating room was quiet, almost hushed. Voices were muffled. There was a greater sense of control here. We were surgeons. This was our turf .

Against the far wall the laminar-flow machine hummed faintly. The cardiac monitor issued its staccato, reassuring beeps. Two anesthesiologists were wedged shoulder to shoulder at the head of the table. They had just finished the intubation. The scrub nurse stood at the back table carefully arranging her instruments. Two circulating nurses shuttled back and forth with instrument trays from the sterilizer. In the corner, a radiology tech waited patiently next to her portable X-ray machine .