Narrative Medicine
2019; Lippincott Williams & Wilkins; Volume: 41; Issue: 3B Linguagem: Inglês
10.1097/01.eem.0000554392.82178.f8
ISSN1552-3624
Autores Tópico(s)Empathy and Medical Education
ResumoFigureFigureIt was early evening, and my wife and I were walking our dog in front of our apartment when I heard screeching brakes followed by screams. I had heard the brakes before, but the screams were new. We lived down the street from a sharp turn where the speed limit rapidly drops without much warning. A children's playgroup met just east of the turn. I jumped the fence, and my worst fears of multiple bystander injuries were relieved, but there had been a high-speed, front-end collision into a tree. Two bodies were lifeless in the car. One woman was kneeling and screaming with obvious head trauma. Her scalp had been completely avulsed and was peeled over her face, exposing her galea and frontalis muscle. A fourth man had been thrown from the car and was unconscious with agonal breathing. I felt a strong pulse, and a caretaker from the children's group serendipitously handed me a pocket rescue breathing mask. Suddenly, my wife was at my side and began holding C-spine for the woman. A nurse who happened to be nearby came to assist as well. When we lost the pulse on the man, the nurse and I began CPR. I felt windshield glass cut my palms when performing chest compressions. A bystander offered a jacket as a barrier. Paramedics arrived after five minutes of closed chest compressions, and a thready pulse was (reasonably) not enough for them to intubate. After all, a thoracotomy was the only Hail Mary that could have saved this resuscitation. Two men were dead on impact and another died in the field. The woman was taken to a Level I trauma center and survived. I cannot reasonably say that my efforts as an emergency physician had any impact on these outcomes. Despite the many traumatic deaths I have seen in the emergency department, this one will never leave my memory. The traumas I deal with in the ED have already recovered from dire situations, been transported by EMTs, and arrived in a recognizable trauma package. I had never accounted for the screams and terror of bystanders and the unpackaged gore that happens in the moment. There is no accounting for the humility that comes with a life that is lost moments after impact. When I am feeling particularly optimistic, I relish the fact that I was able to perform resuscitation in unfamiliar terrain. I am heartened by how eagerly amateur bystanders were willing to provide assistance. I am happy that we were able to take a moment of chaos and provide a modicum of control. Still, it is hard to escape the feeling of futility and loss that now haunts this street whenever I walk by. Protective barriers and cautionary signs now protect future pedestrians, but that tree still acts as a makeshift memorial.
Referência(s)