James Cole - Trauma: My Life as an Emergency Surgeon

Authors Note

This is not a work of fiction. The case histories I share are all based on real events. However, I have changed the names of all patients and most of my colleagues and military leaders to preserve each ones privacy. Although a few minor details have also been changed, these are case histories of the actual people and experiences that have shaped my life and my professional career as a trauma surgeon. They are the stories of the patients whose lives I have had the God-given privilege of affecting.

To my wife, Michele, who has supported me in all of my endeavors and adventures throughout our twenty-four years of marriage.
She has selflessly stood by me during our eight separate moves, each time establishing a welcoming home within all of the time zones of the continental United States.

She has been the rock of our family, raising our children during my conspicuous absences while on deployment over a half dozen times, as well as during my internship and residency training, at which time I was too exhausted to function as a parent.

Contents

1. : Introduction

2. : The Early Postgraduate Years

3. : The Junior Surgical Resident

4. : The Training of a Surgeon

5. : The County Hospital

6. : The Worlds Greatest Trauma Surgeon

7. : Albuquerque

8. : Cardiovascular Surgery

9. : The Chief Surgical Resident

10. : Fort Polk Louisiana

11. : Transition to Civilian Practice

12. : The Mutilated Limb

13. : A Mothers Undying Love

14. : Mental Illness

15. : Everyone Has an Angle

16. : Deployment to Afghanistan

17. : Afghanistan

18. : Treating the Full Spectrum of the Ages

19. : The Brutal Disfigurement of a Womans Body

20. : A Senseless Killing

21. : The Benevolence of a SWAT Team Member

22. : One of Many Ways to Ruin Ones Life

23. : Deployment to Iraq

24. : Urban Violence

25. : A Painful, Bitter Ending

26. : It Has Been a Privilege

Acknowledgments

I would like to express my sincere gratitude to my Executive Editor, Marc Resnick, who took a chance with an unknown authors first manuscript.

I would also like to thank all of the staff at St. Martins Press who took my rough manuscript and made it readable.

I would like to acknowledge my father, Dr. James Cole, who inspired me with dinnertime stories of his patients to pursue medicine as a career. His pearls of wisdom still guide me. And to my mother, Ann Cole, who has always supported me and who was the first to read my rough manuscript.

Finally, I remain grateful to my wife and my four wonderful children, who have supported me during the many hours I was holed up writing this text.

The Trauma Surgeon

Introduction

The stinking mans blood trailed along my arm and torso, and then ran down my leg, soaking through my scrub pants. My foot swam in a pool of the sanguineous fluid, which saturated my sock and was welling up inside my operating room shoe. The shoeconstructed of a lightweight, rubbery material that easily repelled all fluidswas keeping my patients blood in close contact with my body as I worked. The cool, sticky sensation was terribly unpleasant, but there was nothing I could do to remedy my personal discomfort at the time.

My gloved left hand was pressed deeply into the gaping gash in the left side of my patients neck. He had only recently been made calm, after an emergency medicine physician accommodated my request to place an endotracheal breathing tube into my patients mouth after I ordered the senior trauma nurse to administer a hefty dose of an intravenous sedative.

Only minutes prior, I responded to a page summoning me to the trauma room. The anxious paramedics arrived with my patient at the very moment I entered the emergency room trauma area; I had no time to don any protective garments other than a pair of gloves. I had never before seen so much blood. My patients head, face, neck, and previously white T-shirt were a bright red confluence. His arms, flailing about as paramedics kept him physically restrained to the transport gurney, were saturated with the substance. The paramedic at the head of the moving cart had blood splattered about his face as he struggled to keep the anxious and very agitated victim from rolling off the moving platform. A large pile of crimson gauze was partially secured to my patients neck with wide swaths of blood-soaked tape, doing very little to control the ongoing exsanguination from the obvious neck injury.

I helped the four attendants move our foul-smelling patient from the paramedic gurney to the trauma cart. I leaned my face as far away as possible from the obviously intoxicated and combative individual, but I could only maintain so much distance from him with my hand firmly pressed into his neck wound. There was too much noise in the trauma room for anyone to hear my orders. Paramedics, nurses, and technicians of every variety were all speaking at anxiously loud levels, completely oblivious to all other conversations. Everyone was speaking above the otherbut no one was really doing anything.

Okay. All eyes on me! I commanded in a firm, but nonthreatening voice. The room silenced, with the exception of the man whose neck I had in my grasp, who continued to struggle and moan in a most unpleasant manner. The stench of his filthy, inebriated body stung at my nostrils. I took a look about and realized that the volume of blood in the room had been a shocking sight to more than just myself. People all around me looked somewhat frightened. They needed direction, and they needed leadership.

I removed the bulky, ineffective dressing from my patients neck and dark blood coughed out like water from an old pump of a country well. I placed my index and middle fingers deep within the huge, bloody wound, and I plugged the source of the hemorrhage. I could not move my hand, as it was the only thing preventing my patient from bleeding out on that trauma room table. But with my fingers in the dike, I couldnt do all else that was necessary to manage my trauma patient. I needed help from my team.

As I had done many times before, I ran the ABCs of trauma resuscitation. I ran the mental checklist as I had done repeatedly on past occasions. My patients airway needed securing. I made eye contact with the nurse and told her to administer the intravenous sedative and paralyzing agents. I told the emergency medicine doctor rubbernecking near the foot of the bed to place the breathing tube. In less than two minutes, the airway was secured. I then asked the respiratory therapist to listen to the lungs. I watched as she nodded affirmatively as she heard breathing sounds on the left side, and then on the right side of my patients chest. I ordered a second nurse to infuse a one-liter, intravenous bolus of fluid, and told the emergency room technician to get me a set of vitals.

Eighty-six over fifty-four, sir, with a heart rate of one-twenty, he shouted confidently. I ordered the charge nurse to get me two units of O-negative blood and to run them in as quickly as possible. As she left the resuscitation room, I looked at the nurse who had hung the bag of intravenous (IV) fluid and asked her to call the operating room and prepare for an emergency neck exploration. She pulled a phone from her pocket and she made the call.

About five minutes later, a swarm of trauma personnel was rushing my patient into the operating room. I never left my patients side; my fingers remained plunged deep within his anatomical defect. Once in the OR, we transferred my casualty onto the operating room table and I told one of our specialty transport paramedics to slide his fingers on top of mine. I guided his two digits into the desired position, losing another several cupfuls of blood in the process. I told him not to move a muscle, and ordered my patients neck preppedparamedic fingers and allas I exited the operating room to scrub my hands.