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Thoughts From the Trauma Bay

Peng, Theodore

doi: 10.1097/ACM.0000000000002638
Teaching and Learning Moments
Free
AM Rounds Blog Post

T. Peng is a fourth-year medical student, University of California, San Francisco, School of Medicine, San Francisco, California; e-mail: Theodore.Peng@ucsf.edu.

An Academic Medicine Podcast episode featuring this article is available through iTunes, the Apple Podcast app, and SoundCloud.

Author’s Note: The names and identifying information in this essay have been changed to protect the identity of the individuals described.

There were things I saw as a medical student that I want to remember. Many experiences, many feelings, many lessons. And in some cases, there are things I cannot forget. I will always remember the 12-year-old boy we lost in the trauma bay.

He’d been playing football with his brothers and had climbed over the fence to retrieve a ball that had gone over. No one noticed when he didn’t come back. When they found him, he had been down and apneic for maybe 10 to 20 minutes, lying next to an exposed electrical wire. He had been electrocuted doing what many of us did as children—climbing a fence to get a ball back. Somehow, they got his heart beating in the ambulance after intubating him, but he coded again when he arrived at the hospital. And somehow again, he pulled through. But when I checked his pupils, they were completely dilated. My attending, Dr. S, shook his head as we wheeled the boy to get a head CT. “My boy is 10,” Dr. S whispered to me. The scan showed diffuse brain swelling, and the arterial blood gas test revealed a blood pH of 6.6. The physician assistant said we might as well place a coffin next to the bed.

Then we told the boy’s mother. God have mercy. There were 10 family members, all holding each other to brace themselves for what was coming. I knew who Mom was right away. The resident gently took her hand, then she broke her heart. I had seen sorrow in the past, but I had never seen this. I could hear the mother’s hysterical screams even after we left. I’d already had tears in my eyes when I first saw this family, but at this point, I could not help myself. I walked out and wept. He was 12.

Afterwards, as I sat with Dr. S and my resident, both asked me how I was. This surprised and touched me—they were constantly rushing around the trauma bay, attending to the needs of patients left and right, but they asked me anyway. They shared with me their own stories from the beginning of their training, what they had felt, what they had seen. Instinctively, as humans, we want to identify a villain, almost as if by finding someone or something on whom to place blame, we can come to terms with what we see. As I learned, it is rarely so easy to understand why a life has ended. Oftentimes, the lack of answers or reasons is stupefying. Who hasn’t climbed a fence to retrieve a lost ball? So, who could take the blame in this case? Who could we be angry at? I looked back at where the boy was lying. A single nurse was standing over him, stroking his hair. It was as if she was keeping watch, so he was not alone.

We were so busy that night; everyone was. Yet residents on other services would just stop by to check on the boy, to ask if there was any improvement. I was so moved. It was simple humanity. Then Dr. S told me something that I will keep with me for the rest of my medical career. He said, “The day that I stop feeling pain for these patients, the day that I stop caring, that’s the day I quit.” He told me to always check to see if I am forgetting why I am doing the job. He told me to remember what I had seen and felt during my early days of medicine. Maybe so that I could relate to and help a medical student someday when I am in Dr. S’s shoes as an attending. Perhaps that is the very art of medicine. Perhaps it is what keeps physicians human.

These are but some of those lessons.

Acknowledgments: The author wishes to thank Dr. Trevor Jensen for his help editing initial drafts of this essay.

© 2019 by the Association of American Medical Colleges