One of my favorite patients from those early days came in on Christmas Eve. I was now a seasoned intern, having been at it for 5 months now. By that time, working at MLK in the middle of "South Central", I had become accustomed to victims of violence. This was the first Christmas Eve that I wasn't at home with my family, decorating a Christmas tree, listening to Christmas songs and wrapping presents. We had a steady stream of patients that night and I learned quickly that Christmas Eve is traditionally one of the busiest trauma nights of the year. At about 11 PM the paramedics brought in a disheveled man who had been the victim of multiple stabs. He was bloody and drunk, thrashing around on the gurney in a combination of pain, shock and drunkenness. His initial vital signs were not good: his heart rate was high, his blood pressure was low. He had several angry looking slits in his belly, which was distending before our eyes, presumably with blood. We rushed him to the OR quickly, my senior resident barking orders to us hapless interns to, "get me blood, get that IV in...." I was chosen to assist in surgery. To the uninitiated, that may sound like an honor; by this time I viewed it as a punishment: as the intern, I got to hold retractors and watch while the senior resident and attending surgeon did all of the fun stuff.
The senior resident quickly, deftly opened his abdomen with a scalpel. Once inside, it was apparent that he had bled most of his blood volume into his belly. Several of the plunges of his assailant's knife had literally almost split his liver into two. I dug in with a large retractor so that my chief resident and my attending could see well enough to control the torrent of bleeding coming from the patient's portal vein and from his cracked liver. He continued to bleed seemingly faster than the hapless anesthesiologist could pour units of banked blood into his veins and he announced that the patient was barely alive. Hearing this, the attending surgeon announced "We are not going to let this guy die". At this point we had been operating for an hour or so, so it was now Christmas day. I retracted as hard as could, giving them the best view and they dug in, and got control of the bleeding portal vein and bleeding severed veins in the liver substance. Now the anesthesiologist sounded more upbeat; where the patient's blood pressure and been dangerously low, it was now returning to normal.
After 2 more hours, his blood pressure stabilized and we were able to close his belly and take him to the ICU. He had lost more than 2 times the amount of blood that is carried in the human body. Controlling the bleeding and transfusing him with more than 30 units of blood saved his life...for the time being. Patients that lose large amounts of blood, though they can be immediately saved, can die from a secondary response that the body mounts in shock...the body literally releases many chemicals in a last ditch effort to save itself, but unfortunately, many of these are toxic to the system in the long run and can cause the lungs, kidneys and other organs to shut down. We fully expected that our patient would be sick for a long time because of the profound shock he had been in. What happened in the next day or two seemed to be a Christmas miracle. Most patients with his level of shock remain on a ventilator for a week sometimes weeks; we were able to get him off of the ventilator in 2 days. By the 4th day, he was up and about, eating and complaining. By the 6th day we discharged him home, the only evidence that he had been injured were his healing stab wounds and surgical scar.
Before he left the hospital, I was doing my daily rounds and I talked with him and he began to tell me an incredible tale. He said that he remembered his entire operation. At first I was a little dismissive and said "mmmm hmmm". But he continued to talk and he described the operating room, the people in the room, the conversations and then said that he heard us say he was dying and he remembered floating above us, his body, the operating table and felt as if he was leaving the earth. Probably at about the time we got control of the bleeding, he said he heard a voice, like a relative or old friend telling him it wasn't his time and then the next thing he remembered was waking up with a breathing tube in his throat.
I was amazed. I'm not particularly religious, but this seemed to be a Christmas miracle. This guy described his entire operation and recovered faster than anyone with his level of injury than I have ever seen, even after almost 20 years of taking care of trauma patients. I told this story to several people, partly as an inspiration and partly so that I wouldn't forget it. I was amazed.
When he returned to clinic a week later for follow up, I saw his name on the clinic list and reflected on this miracle man and his new lease on life. I imagined that after this experience that he used his reprieve from death to turn his life around, to get off the streets and put himself on a path to do great things for humanity. Once I got him in the room, I realized that this was probably not even close to the truth. He was sitting in the room, bopping to music on a walkman and he was so drunk the alcohol smell was overpowering. I was a little disappointed and the ephemeral image I had of his "miracle" was a little tarnished. After this, it took me a little while to realize that just because a patient doesn't appreciate how amazing it is that he is alive after a serious injury that it doesn't make it any less amazing.
Maybe his Christmas miracle was not just for his benefit, but for mine as well.
