Arriving at The ER

“Trauma code, ETA 5 minutes.”  My pulse always goes up a little bit with these radio notifications, but in this particular case it went up more than usual.  The paramedic said it was a train versus pedestrian, no other information given.  I could hear the siren in the background and a definite anxiousness in the paramedics voice.  He didn’t have time to give us vital signs–not good.

I walked to the ambulance bay, opened the doors, and waited.  The ambulance came in fast, the driver wasting no time backing up and throwing the back doors open.

“She had a pulse, and a blood pressure, I’ve got an IV started, but no airway, she was talking to us a few minutes ago,” the paramedic fired off.

We all helped pull the gurney into the resuscitation room, and I took a look.  She was about 30, laying flat on her back, eyes closed, clearly not conscious.  I couldn’t see any sign of trauma on her head, chest, abdomen or extremities, but there was quite a bit of blood coming from somewhere.  It was pooling on the gurney.

I quickly put a plastic tube down her windpipe as the nurses tried to get vital signs, and started CPR.  Her blood pressure was completely gone, no pulses at all.  She had died.  We rolled her on her side to examine her back, and found the problem.  The back of her hips, pelvis and lower back were simply gone, somehow torn away from her body when she was hit by the train.  What remained of her blood volume poured out of the wound, and onto the gurney and floor.

Later, we found out from a roomate that it was probably suicide, and that she had been fighting depression.  She had stopped taking her medication.  No one came to the hospital.  No family, no friends.

I picked up the next patient’s chart and moved on.  It was a 20 year old man with an ingrown toenail.  He let me know he was very irritated to have been waiting for me.