The brain tissue had just enough blood around it that it looked alive, but all that blood was where it wasn’t supposed to be, and she was missing that part of the head, which should shield it from our view. There were so many tubes and lines in her that it was hard to believe she’d only been there for a very few minutes. But these minutes of resuscitation would make no real difference for someone with nonsurvivable injuries. I mustered up the whole of my evaluation and reached the only conclusion that made sense: “Please page the neurosurgeon on call.”
The neurosurgeon was a nice guy. He saw right away what we all could see, and he immediately looked like he’d made up his mind. “I know you’ve got the traumas all under control, but since I was already in the building, I thought I’d stop by instead of calling in.” He could see from across the room what was going on, but he looked around at the trauma team waiting expectantly for him to say something, and he was experienced and wise enough to know that he had to put on the show of a physical exam before stating the obvious. He looked around like an uncertain actor, unsure of his cue for one brief moment, then donned some examination gloves and came to the head of the bed, moved around one of the few residual pieces of non-missing brain, and leaned over to me in a subtle way and whispered, “This is by no means a survivable injury, there’s no surgery to be done here, I’m surprised you were able to keep her alive this long.” He gestured towards the ventilator.
The trauma team, despite their often-noisy environments, was surprisingly adept at hearing a faint whisper from across the room, and just like a tennis audience, their gazes all turned in unison from the neurosurgeon to me. “Yes sir, I felt the same way, but I wanted to have an official neurosurgical opinion on record before I talk to the family about organ donation. Her card isn’t signed.”
He perked up at hearing this mature and pragmatic answer, looking surprised because I suppose he’d assumed I, as just a junior resident, was calling him for the save, holding on to false hope that this patient could make it if I just tried hard enough. Or he might have thought that I’d break down and need help at the thought of a nearly dead eighteen-year-old who we couldn’t save. Or maybe the trauma nurse who called him, conveyed that the mother had phoned in frantically and begged that her baby girl not die alone while they were hurrying over to the hospital, and even before hearing that and knowing we’d stabilized her for now on machines, I’d held her hand briefly and hoped that there would be some soulful sign of residual life in her, that she’d take one half breath without the ventilator or open an eye on her own, not just when I’d retract her lid to check the pupils, maybe squeeze my hand back or gesture goodbye as her life left her more fully. But I knew she didn’t have the anatomy for any of this to happen, much of the brain was missing. This poor girl with little trauma other than the all-important brain, would have no more to her story—a patient with a lot of machines but no life.
The neurosurgeon, after taking his gloves off, touched his hand gently yet man-to-man onto my upper arm and looked into my eyes not unlike the way I’d looked into the patient’s, except his look was one that knew there would be an intelligent look back: “You have my full support and confidence, I agree with everything you’ve said, and you can use my name if they want confirmation that we’ve agreed.” I think we both knew that this was disturbing, we were both shaken but sticking to the necessary management needed to make the right decisions. I did the pleasantries, the thank you sir, I appreciated him, then I closed out the curtains, waited for the area to clear except for one nurse who would stay with her until I brought the family back.
As the nurse turned to draw the last curtain, I looked at the patient one final time, at her face that must have been radiant and happy only two short hours ago, at her long flowing light brown hair that must have stunned and taken years to grow. I saw just a snapshot of her essence—the last time I’d ever truly see her when she was still my charge before I’d soon introduce the family into the room to cry and scream and break down and take over the emotional journey of this mortally wounded young woman. It all seemed like the respectful thing to do.
The general surgery resident had already left the trauma suite a while ago, confidently stating that they were going to go update the family while we waited for the neurosurgeon. I walked the short hallway where someone was mopping up blood and the paramedics who’d brought her in were dotting the halls, and from the anxious looks on their faces, hats-in-hand, I knew that nobody had updated them and that they cared a tonne. I continued to look in their direction as I pursed my lips and bent my neck partially down, then shook my head and looked back up at them one by one with the head shake. They understood right away and nodded back without words but with full understanding. One tipped her hat and pointed toward the family waiting room saying the family had arrived, and I proceeded after thanking them for waiting and caring. They took both pride and sorrow from this truth. I steeled myself and planned the correct tone, which I would partially modify based on my read of how they looked when I got in there.
It was a mess, but for the wrong reasons. The resident who was two years my senior, was bawling and the grandmother appeared to actually be comforting the doctor rather than the other way around. The family looked relieved when I got in there and all looked at me, not that they thought I’d have any good news, but apparently the broken-down resident hadn’t really given them any intelligible news yet. I introduced myself and patted the other resident on the shoulder, inviting them to have a chair if they wanted to take a break and I could help out from here. The young doctor chose to take the chair instead of leaving the room, and I’m glad because that resident would tell me months later that this night was a turning point for them in handling work stress and breaking bad news.
Perhaps in part because of the crying doctor, I indeed took the role of realist, slightly authoritative, to let them know I had a thorough knowledge of the patient’s condition, and they absorbed every word intently. But more importantly, with an even larger measure of compassion, I transitioned to reassuring them that she wasn’t alone, we were here, but that it was indeed her time, her premature, unfair time. I would later reflect on this moment, and forged the belief deep in my heart that it almost disrespected the family if I’d stand here pretending that it affected me in quite the same way as it did them, that the grieving portion was my battle and not theirs, or that my connection, even though genuine, was quite the same as theirs.
As they broke down sequentially, the mother first, the father, then the grandmother last, and the many others in between, I still remember the character of each of their handshakes, hugs, intense gazes onto my face, their collective spirits that had lost one integral part tonight. When I’d completed the introductions, the description of the girl’s condition, the comforting and then giving them space, I found the right moment to tell them that I’d bring them over one by one to see her, and I also discussed organ donation. While I stepped out to give them a moment of privacy, their first tears dried, and the dad soon came out to convey the consensus that if something beneficial could come of losing her, then they wanted to honor her in that way as a donor. He also thanked me for being there steadfastly in her last moments, and that it meant a lot to them.
I led them one by one to the trauma suite, and for some reason I still feel today that it’s a secret bond of ours that I know who they wanted to send in first, but soon that time came. I waited at the foot of the bed and as each sequential person joined the procession, I could feel that little bit of separation of the doctor-patient bond I’d felt with this child. Hers was not to be only the story of a patient, but a story of the deceased. And it was the family’s turn to complete that bond, so I stepped away.
What I’ve left out of all this, is that my girlfriend Marissa was a dead ringer for this girl, except a few years older.
After the bustle of the rest of the night, the next morning’s trauma rounds and my full day of work, the twice-showering off of blood and changing of scrubs three times in thirty-six hours, the moments of napping and hearing the trauma helicopter coming in and wondering if they were going to need my specialty, it all culminated in my long-held plans to stop by Marissa’s place that evening.
I played strange and could not shake the fear of losing Marissa. What if the next two hours of her life or some two-hour span in her distant future was destined to be spent dying, fightless, hopeless except for soon-arriving loved ones desperately praying for an afterlife and an honorable memory of her. At that moment of seeing her hair flow over her shoulders, her prancing over excitedly, full of life and giggling on about how happy she was to see me, I held her tight and felt a fragility for her that I’ve never told her about. She sensed I was off, and in the relaxation of her bathtub after we rose from the happiness of her bed, she told me how much she liked feet, and we laughed. There is still a lot of love, but on that one important night I remember how things got so much clearer, after that cleansing in Marissa’s tub.
Born in Ontario Canada, Sam now lives, works, rows, and hikes in Iowa USA. He enjoys crafting around a hopefully memorable core which formed the initial reason it was felt to be worth writing in the first place. Ultimately, even brilliant ideas will have their beauty obscured, if they can’t be expressed with intelligent eloquence – hence literature. His studies have taken him to the east coast of Canada and the US. He’s traveled to England, Australia, and Lebanon – all of which have produced great story material. His poems and photographs have appeared in Vallum, Tiny Seed Literary Journal, Wingless Dreamer, Tower, and others. This is his first publication of prose fiction. He can be followed at https://www.facebook.com/MightySamster