The Human Touch 2013 - University of Colorado Denver

Losing a Stranger
Rachel Skalina
Who loved you?
You’re so young. You look so young, so cold—so dead. Your hand creeps off the
edge of the table; the color is off—pale, grey-yellow. It makes my stomach churn. I
am curious about the tattoo below your collarbone, what it says about the life you
live. Lived? My eyes escape to it to distract me from the pink heart kicking so very
gently in your open chest.
This is what I know:
One bullet brought you here, to this metal platform—“bed” – in the emergency room. I
picture it, smoking through your chest, journeying on through right ventricle, left ventricle,
delicate lung pleura, until it lodged in the meat between your ribs. A gang fi ght, they say.
We were ready. The pager announced your expected arrival in ten minutes:
“23 year-old, gun-shot wound to the chest.” The trauma room was full: nurses,
respiratory therapists, ER doctors, trauma surgeons, anesthesiologists and me, a
third year medical student. Glistening silver tools lay on a stand by the bedside,
waiting to slice open your thorax. The attending paced, ticked off the minutes,
noted your diminishing chances of survival as the clock hand marched forward.
When you arrived, the room whirled into organized chaos around the stillness of
your body. Dr. J commanded it, calmly, intensely. The bullet entry wound was small
and unassuming, belying the massive damage just beneath. One team opened your
chest—“clamshell thoracotomy,” they call it—wrenching open your rib cage, revealing the
beauty of heart, lungs, purple domes of diaphragm. Two more teams worked at your feet,
one drilling into your tibia for intraosseous access, the other performing a saphenous
cutdown: fancy names for a desperate attempt to access your veins and start aggressive
fl uid resuscitation to replace the blood you continued to lose into your chest cavity.
I stood at the periphery. I had never seen CPR like this: “carotid massage,” they call
it. One simply takes the heart in hand and squeezes it to move blood forward. But
with every squeeze of your heart, more blood gushed out through the two holes in
your ventricles instead of to the organs starving for oxygen.
Your eyes are open. I’m not convinced that the glassy stare has seen anything that
happened in this room.
By now, almost everyone has left. A colleague and I stand on either side of you. I am
mostly aware of the quiet and of my own heart thumping in my chest. I am trying to avoid
standing in the pool of your blood by my feet, fi ghting the competing urges to hold your
cold hand, to run from the room and vomit, to sit down and cry. I am thankful for the quiet.
We have closed the fl ap, your anterior chest wall, your upper clamshell. I can no longer
see the muscle that was your heart quivering in your chest. We are using large surgical
suture to sew your body back together. It is the largest needle I have ever used, and
between my shaking hands and inadequate skill, I am working quite slowly. I feel that I
must at least do this right: this is the only way I can honor you, pay my respects to your
body and your life. Dr. J stands with us in the room, instructing us on technique; clearly
we won’t be able to hide the wound, but soon you will just have a closed gash across
your chest instead of the gaping door to your thorax.
Who loved you? Quien te amó? What language did you even speak?
I realize that I don’t know your name. I don’t know how to address you. The team has
moved on; after all, there are other patients to care for and the truth is that you are dead.
I haven’t once seen you blink, heard you sigh. I haven’t watched you pick at a
hospital meal, seen your sister or girlfriend by your bedside, crying or screaming or
sitting, just sitting, and I don’t know the timbre of your voice. All I know about you is
pieced together from symbols inked onto your skin, the rubbery feel of your aorta and
the weight of your heart in my hand. I could try to create a story of your life—I only
know the story of your death.
It feels trite to tell you this, when you lost your life, but at least you helped to teach us.
Your doctor was a brilliant example of both a leader and a teacher: collected, assertive,
confi dent. Your team had the opportunity to practice skills that may save others. Your
body reminded me of the fragility of our existence, of the beauty and complexity of the
human body, of the thin line defi ning the boundary between life and death. Your death
showed me that I will have the stomach for this, that I will be able to care of patients
and feel sick and go on and take care of other patients who are still living.
I never met you, but I believe I will always remember you. May you rest in peace. •
PG 64
PG 65