CHAPTER 1 CURRENT DAY The beeper went off at 2 am, the absolute worst time to be awakened. It was too early in the morning to have gotten anything close to enough rest, and too late to take care of business and then go back to bed again before the sun came up. And Steve Boxley knew that he wouldnt be sleeping until tonight, many hours from now. He knew that the beeper only sounded when the resident was in trouble, and he had one of the third-year guys with him this month. By the third year, waking the attending was an admission of failure, a pathetic cry for help. Thus the beeper and Steves certain knowledge that he was in for a long haul before he found his bed again. He called the switchboard immediately. "Good morning, Dr. Boxley," the operator said. "Dr. Land needs you in the trauma room. Ill connect you now." "Dr. Boxley on the line," Sharon said to Mark Land, and Steve could imagine Mark grabbing the phone with a shaky hand to match the uncertainty in his voice. "Dr. Boxley, I have a 50 year-old man with a fractured pelvis, ruptured spleen, and a collapsed lung, all from a motorcycle accident. I cant keep his blood pressure up, and his oxygen saturation is terrible. I need help." Steve told him to intubate the patient and call the OR; he was on his way in. The ride to the hospital in the middle of the night was always relaxing, even when he knew that he was going in for a disaster. The roads were empty, and in central Florida, no matter how hot it was during the day, there was a damp coolness to the night that you could smell. The radio played oldies, and his mind wandered to the upcoming operation. A 50 year-old guy on a motorcycle. What was this world coming to, he wondered? Why wasnt this guy driving a safe family car? He was not a kid anymore, after all. The collapsed lung could be treated with a chest tube, albeit somewhat brutally - a inch hose forced into the chest cavity to re-expand the lung - and the low oxygen could be treated with a breathing tube. The ruptured spleen was the easiest of the problems to repair - just remove it. On the other hand, the fractured pelvis was a big problem. All of the small blood vessels around the bones of the pelvis would be torn and bleeding, and no matter how experienced a surgeon was, he could never stop that particular type of bleeding. The best he could hope for was to stabilize all of the other problems, and then hope that Mother Nature would stop the free flow of the patients blood from the pelvis before he died. He smiled a bit at the thought of Mother Nature in the mix but never getting sued when things didnt go well. His mind went back to the road as he turned into the hospital parking lot. "So, if youre injured as a result of a doctors negligence, or even if you just think he may have been negligent, call us and well review your case at no charge to you. Were For the Little Guy. Morris, Cuney and Howe," the ad on the radio finished up. Steve figured out why his mind had strayed to suing Mother Nature. He couldnt listen to his radio or watch TV without being accosted by a cute little ad from that bastard at Morris, Cuney and Howe. "Someday, that guys dick is going to fall off, and no doctor in Florida will sew it on," Steve thought. Steve crashed through the doors in the Trauma Room, and a nurse threw him a gown to put over his clothes. "John is his name. Thats all we know," Mark Land said. "His BP is 90 over 60, heart rate 110, oxygen about half-normal at 85%. We intubated him and his oh-two came up to 95%, but now he cant talk to us." "Hi, John. Im Dr. Boxley. Im a trauma surgeon, and Ill be caring for you. Do you hurt anywhere?" John nodded. "Here?" Steve said as he pushed on Johns chest. Another nod. Still another with a push on the belly and a bigger nod with pressure over the pelvis. Steve said to Mark, "Did you do a retrograde cystogram to check for a bladder rupture?" "Yes, its OK," Mark replied. "Get a Foley in him, someone." One of the nurses placed a Foley urinary catheter into the bladder, and about 200 c.c.s of bloody urine came back.
"Are you allergic to anything, John?" A shake of the head told him no. Steve asked the charge nurse to tell X-ray that theyd be coming over for an IVP to check Johns kidneys, then she should tell the OR theyd be on the way up. He also told her to tell the orthopedic service that theyd need to come into the OR to stabilize Johns pelvis once he finished the operation for the ruptured spleen. Steve told the resident to stay with the patient, and hed meet them in the OR. He stripped off the bloody gown and went upstairs to lie down. At 46, he wasnt as enthused about the late night cases as he was when he finished his residency. He needed more sleep with each passing year, and he now saw these trauma patients as nothing but a liability to his own health. He closed his eyes and was asleep before his head hit the pillow.
|