Contract almost complete and searching for my next assignment. Where shall I go? Each assignment lets you know the standard procedures that you are going to be required to do. Also, at the bottom letting you know the level of trauma that hospital is rated for. I have never been to a trauma hospital, so I really would like to get that experience under my belt. I begin by asking my recruiter to look for a level one trauma hospital that is will to take someone without level one experience. I wait and see what she can turn up, as I nervously finish up my assignment. It’s very difficult to time the end of one contract and start of your next contract at another facility, often leading to potentially weeks of pay loss.
I get a call from my recruiter a facility in Ohio needs a travel nurse and is willing to take someone with “strong OR skills”, if I wanted to interview. I tell her yes, I will go ahead and interview, at least start getting myself some options lined up as I also search the website for anything else that can fit my needs. The interview was the standard barrage of questions about cases I have done, what my strengths are, and weaknesses. I feel almost like a professional interviewee at this point in my career. I finish the interview and within thirty minutes I get a call from my recruiter. They want to extend an offer. I review the offer and decide if this will make financial sense for myself and my family. I also need that level one trauma experience to open more doors for myself. I agree.
My assignment in Ohio begins with a long drive, and the standard week in the office of orientation information. I get the tour of the facility with everyone giving me the side eye trying to figure out my intentions at their home. Once we finish the tour I’m excited to get into a room. They typically start us out in the standard Laparoscopic Appendectomy case, something easy to gauge our skills, then escalate to harder cases as we prove we can handle ourselves. I breeze through the week, finishing my cases, and aiding any of the staff that I see may be struggling. Greeting people, offering help, and killing them with kindness to break their ice of being mad I make more money than them.
Finally, the moment happens, I am asked to relieve in a trauma. I go in to a young woman for had be blasted with a shotgun in her leg, lacerating her femoral artery, as well as unknown damage to the abdomen. When I arrive vascular is still working on the bottom, attempting to salvage the leg through the blasts of shrapnel that shredded her leg. It was a drug deal gone bad, a young girl, Jane Doe at this point. I attempted to search through her belongings for some evidence of who she was for family contact and only find a drug pipe. I assist general up top in the needs of suture to sew her bladder back together. He sweeps her abdomen for any other signs of damage from her encounter. That was all, vascular closes the leg, general finishes up in the abdomen, and my first partial trauma was complete. I still need more experience; I need to start one.
I doesn’t take long before they begin rolling in, lots of times they have a trauma team on standby, and it isn’t me, as staff take those spots in hopes they get to sit around all day. I will have better luck in the evenings, as I am a mid-shifter. When we got down to just a few teams of help. One evening I hear the trauma page go off the vocera, the charge nurse goes downstairs to assess the trauma bay. We assemble into the trauma room that is prepared with the prep, instruments in room already and pack on the table. We wait to hear if it is going to come up. The charge nurse pages, coming up. We scramble to open everything in the room. Within seconds the ER is at our door, up from the trauma elevator, and a gentleman who had a car crush him while changing a tire arrives.
The man isn’t conscious; they had secured his airway downstairs. It’s within seconds we grab and pull him onto the table. Assessing his body, with obvious broken bones from the pelvis down. We secure him safely to the bed, and splash betadine on his abdomen for general surgery to begin. They sweep the abdomen for any signs of bleeding, they discover a spleen laceration, and quickly an ask for a harmonic and staplers to begin to take out what they can to stop the hemorrhaging. I feel like in these moments I am having a out of body experience, that I am processing massive amounts of information in an attempt to save a life, and detached from the actual brutality of what this man has been through and what we are doing to save him.
The case finishes, and this is not the last time I see this man. The poor man had severe pelvic fractures, both femurs broken. Ortho begins to bring the man to the OR what seems like day after day, repairing one bone, then the next, then onto the pelvic fracture. At this point it is noted that he is also having neurological decline and begins to have IR intervention to assess brain flow. Within days he is developing wounds and massive debridement’s to his trunk and sacrum. I watch as this man loses a limb, loses his penis and scrotum from the crush injury complications. I begin to wonder if this would be a life he would have chosen, if he had a choice if he would continue with all of these surgeries? I would hope the attendings explain all the potential outcomes to families, but I also know residents like to learn and feel maybe that overshadows the actual person’s pain.
I am thankful that I don’t have to have those conversations with patients and families, and I often wonder how I would approach the families if it was me. Would I offer hope to a family in these situations or explain to them that we can attempt to cut and paste on this person for months, and they will likely die from complications in so many months. Do people have the ability to say No to life sustaining measures when given a choice? Biologically our body always wants to live and repair, can our minds push past that, and realize that sometimes dying is the easiest choice.
I saw many traumas while I was at that assignment. I am pretty sure 90% of them died, most of them died in the elevator before they even got to the OR, as I watched people’s chests cut open like a clamshell and residents massaging the heart that had died two minutes prior. Blood all over the floor, people frantically trying to save these people who didn’t deserve to be here. I can now successfully say I am a trauma OR nurse, I feel the skills I gained were less physical and more psychological in being able to navigate the chaos of most of the final moments in these people’s lives.