Unhappy Birthday
2009; Elsevier BV; Volume: 54; Issue: 4 Linguagem: Inglês
10.1016/j.annemergmed.2009.02.002
ISSN1097-6760
Autores Resumo[Ann Emerg Med. 2009;54:627.] He was driving home from his birthday celebration, dinner at a restaurant with his wife and 11-year-old son. The teenaged daughter wasn't there. She wasn't anywhere anymore, due to a fatal traffic collision last Father's Day. That tragedy was ever present, but fading. Try not to think about the upcoming June (and all future Junes!) when all that pain will return anew. But tonight was different, positive and joyful. Sure, he had a couple glasses of wine, but he wasn't drunk by any stretch of the imagination. A bottle for the birthday boy and his girl; what could be more apropos? Then a short drive home and we can all go to bed. Dad is driving, so all is well. Son stretches out drowsy in the back seat. Didn't we all do this, assured in the absolute safety of the oft-traveled route home? An illusionary parental cocoon. Wife nods serenely at his side, seduced by the inexorable lullaby of the tires and pavement. A siren's song of sleep… Single-vehicle MVC. Car vs. tree. (The tree always wins.) Moderate front-end damage on the passenger side. Minimal passenger-space intrusion. Ten-minute extrication. Three trauma victims. Driver and rear-seat passenger=moderate. Front-seat passenger awake but critical, with c/o chest pain and difficulty breathing. Her appearance in the trauma bay is almost regal. Attendants in tow while a dozen or more souls await. In other circumstances her family members individually would receive such a welcome, but her injuries trump all: r/o flail chest, r/o pneumothorax, r/o tamponade. She has a look of pain, of concern, but not of death. Awake and alert, expressing concern for husband and son. Tachycardic, but normotensive. Surely this one will live. No need to wait for an X-ray as the indication for a left chest tube is obvious. Inertia plus the dashboard combined in a morbid embrace. Ecchymosis and crepitus mean multiple rib fractures at least; pneumothorax is certain. She's awake, so don't forget the pain meds and a quick explanation. Out comes the blood. Too much blood: 400 cc initially and it keeps on coming. Whoever picked the chest drainage unit with autotransfusion capability was prescient. BP is falling and now she's intubated. Seven liters out of the chest tube—that's more than your entire intravascular volume, lady. Pretty soon we'll be doing compressions, so a tough decision must be made. We've all been taught that ED thoracotomy in blunt trauma doesn't save lives, but there's still that desperate chance we'll find something we can fix. Slash and bleed. I'm sorry, but the dress you picked especially for this party is beyond ruination. This end was not foreseen at the mirror this evening when you applied your makeup. (She was older than me then, but I am her age now and have to shake away this phantom when I see my wife at the vanity.) A deep purple deluge spills onto the gurney, and then to the floor. The lung is bruised but not broken, the heart weakly beats. Open the sac and insert the Yankauer, and still nothing to explain the renewing tide. But when the heart is lifted the answer is clear. There is a rent at the junction of IVC and right atrium, which opened into both the pericardium and the pleural cavity, and thus no tamponade. Maybe it could've been fixed if discovered immediately, but probably not. Move on. The driver has bilateral lower extremity fractures, tibial plateau on one side, tib-fib and mid-foot fractures on the other. If he's lucky, he will walk normally again. The son has abdominal pain, which ultimately proves to be from a small bowel perforation. One laparotomy later and he's fine. (The most traumatic event of his life, possibly ever, and it warrants only 2 sentences. The ED has shifted my perspective so far that my own kids won't come to me for their minor [“trivial” to me] injuries. “Dad's only interested if there's an exit wound,” they say. This can't be good for me, my family, my patients.) I'm haunted by a daily gloom for weeks. A life-shattering event that echoes. For me now, it's only sometimes. But this man gets it slapped in his face inerrantly twice every year: “Happy Fathers' Day! Don't forget your daughter died today.” “Happy Birthday, pal. Remember the day you killed your wife.” Like a song that keeps running through your head despite all efforts to blot it out, a phrase recurs to me: died of a broken heart.
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