Sometimes they die

Honestly?  I hate traumas.

I can't stop thinking about one I got a while back.  Auto vs. motorcycle.  A nice young man had been driving at dusk - not texting or anything as far as we know - and turned left in front of a motorcyclist who wasn't wearing any gear.  He never even saw the motorcycle coming.  The driver in the car was fine.  The guy riding the motorcycle - another young guy, I never quite learned his age - became our patient.  I was the backup doctor in the room but it still felt like he belonged to me.

Traumas don't go the way you would envision from watching a show.
Some of it's right.  People come in grievously hurt, smashed up or poked full of holes, and they get the full court press just like on TV.  There's a lot of chaos, a lot of tubes and urgent consultations over CT scans and shouting.  Who's got the blood and the tranexamic?  I need a bigger chest tube!  Someone hand me the iStat!  Let x-ray come through, please!  Hey, hand me that suction!  Okay, I've got two units here!  It's all very naturally dramatic.  And a lot of the time people make it through my part - the initial stabilization phase.  From there they often go to surgery, which for me means shipping them to a different institution since my hospital doesn't have a trauma surgeon.  That's one big difference.  Another is that people often have long-term physical issues as a result of any major trauma.  But usually they live.

Sometimes, though, they die, and no one shows you what that's really like.  It's... rough.  I'll spare you the gory details of the code on that motorcyclist, of which there are many.  Suffice it to say that a lot of us worked very hard on him, and he died anyway, and I had to use a lot of hydrogen peroxide on my shoes that night.  

One little snapshot has stuck with me in such a way that I may never forget it.  Me, on my way to the surgery changing area to change clothes and scrub the blood off my shoes, passing the man's widow.  She was facing mostly away from me, talking to a nurse.  She had the sneakers we'd pried off his feet not an hour before - no other personal effects, just the sneakers.  She held them casually in one hand while she rubbed her face with the other, as though the shoes still belonged to someone, as though she were delivering them to someone, someone still alive.  They were completely pristine.  It shocked me down in a deep, unexpectedly fragile place.  Why did she have those?  He died in those shoes, why would she want them?  Why were they so clean when his injuries had been so severe?  How could I walk past her like that when I had been unable to save her husband?  I turned my face from her grief and loss and kept walking.

Now I feel like every time I get in the car, all I see is people riding motorcycles without gear on.  It's a struggle not to roll my window down and yell at them.  Hey!  You want to come into the ER all mangled, is that what you want?  You want us to have to literally mop your blood off the trauma room floor?  You want your family to mourn you in the middle of my department holding your stupid shoes?

I know all my patients will die eventually.  I know I'm not God, to hold a person's life and death in my hand.  I know medicine has limits.  But it doesn't change how hard it is to lose a patient who was literally fine two hours ago.  I hate that.