How a Trauma Death Can Turn Doctors into Better Surgeons
One night as a surgeon in a level-one trauma center changed my life and the lives of many.
On a Friday night in the Fall of 1992, I was the fifth-year Chief Surgical Resident on call at a level-one trauma center in central Connecticut. This meant that, other than the in-house cardiac surgical attending, I was the head surgeon in the hospital at the time. At approximately 11:00 PM that evening we received a trauma alert with the victim arriving in the ER within the next 10 minutes.
I rushed to the ER and was met by the trauma team, which included the on-call third-year surgical resident, a medical student, trauma nurses, a respiratory therapist, an on-call anesthesia resident, and two ER technicians. The patient arrived on a backboard, intubated, with a neck collar in place. There was a large, blood-soaked bandage on the patient’s right lower chest. The head EMT called out his report:
Victim is a 20-year-old college football player with no significant past medical history who was walking to a party in a nearby town when a stray bullet struck him in the back, exiting at the right costal margin (edge of the ribcage near the right flank). This took place at approximately 10:40 PM and we arrived on the scene at 10:50 PM. The event was witnessed, and the victim supposedly sunk slowly to the ground without further trauma. The patient was alert and talking when we first arrived but quickly lost consciousness and was intubated. He had a large wound on his right that was packed with dry, sterile gauze. His vital signs have been variable but mainly stable. We have placed a 14 gauge IV in each arm, and have started normal saline wide open.
I was in charge and after the patient was transferred to the ER stretcher, I ordered a lateral neck x-ray, had the medical student insert a Foley catheter, and I and the third-year resident did our initial examination. The patient had good peripheral pulses, his blood pressure was 100/50, and his heart rate was 150 beats per minute. We turned him to examine the entrance wound, which was just to the right of the spine between the 4th and 5th ribs and 1 inch in diameter.
The exit wound was at the right costal margin and was 8 inches across with perfuse bleeding from the intercostal vessels and the surface of the liver. I re-packed the wound, ordered 4 units of O- blood STAT, and had the nursing staff call the on-call attending surgeon to tell him to come in.
He was 30 minutes out, so I decided to attempt to over sew the bleeding vessels in the exit wound while the blood was being infused. I had the third-year resident load up a 2–0 silk on a needle driver and as I pulled the bandages back, I told her to tie off the vessels that came into view. After two failed attempts, and with her hands now visibly shaking, I told her to get it right this time or I’d do it myself.
Visibly steeling herself she was able to get the bleeding vessels over sewn within 10 minutes. At this point, the patient began to become unstable with dropping blood pressure and his heart going into a rapid flutter pattern. This happened so suddenly that everyone froze in place for a second before I yelled “CALL A CODE” and began to get the defibrillator ready. We gave the patient bicarb, epinephrine, and lidocaine but he quickly went into atrial fibrillation.
I shocked him 5 times, with further doses of epinephrine and bicarb in between, but after 10 minutes the patient became asystolic and I stopped the code. I had the nurses call the attending to head back home, and I went to confront the patient’s family with the news. After telling them that their son/brother had died of his wounds, I next asked them to donate his organs so others might live. They agreed and I called the transplant team who arrived within 15 minutes.
I went back to the trauma bay and found my third-year resident sitting on the floor quietly crying. I sat next to her, silent for a few minutes. She was training to be a surgeon and I knew the last thing I should do is try and comfort her. So, after a few minutes of silence, I said, “So, what did you learn tonight?” Without missing a beat, she blurted out “that I’m not going to be a god-damn trauma surgeon!”
After that, she dried her eyes, and we began to discuss what happened. The patient was stable, the bleeding was under control, and he was conscious and talking at 10:50 PM. By 11:40 PM he was dead and there was nothing we could do to stop that. We discussed what might have happened and in the end, she was calm enough to head back to do the paperwork.
Later I found out that the bullet that struck the patient was a 5.56 high-velocity round fired from an AR15 over 200 yards from the victim. The shock wave caused by the bullet passing thought the victim literally “cooked” the right ventricle of his heart and the only reason he didn’t die at the scene was that he was an NCAA-level athlete and his damaged heart was able to keep functioning for almost an hour.
The third-year resident went on to become a very successful transplant surgeon in Boston, and I became a cancer surgeon.
The victim’s family was informed that 22 people benefited from their son’s sacrifice and their generous donation of his organs. The State of Connecticut passed one of the first anti-assault weapon bans in the country the following year.
That one night in 1992 changed a lot of lives. I still have occasional nightmares about it, though it did make me and the third-year resident better physicians and surgeons.
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About James Goydos, M.D.
James Goydos is an expert in melanoma research and specialist in surgical oncology with an M.D. from Rutgers University. With over 20 years of experience as a Professor, Surgeon, and Clinical Trial Lead, he is a leading expert in his field.
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