"The Knife and Gun Club" - Part 2

(See Knife & Gun Club - Part 1)

Trauma One was stocked with everything needed for a rapid trauma resuscitation … including a machine to transfuse massive amounts of blood and fluids within minutes, a chest ‘cracking’ tray (used for - just what you would think), an abundance of sterile tubes, needles and catheters used for placement in patient’s heads, hearts, chests and nether-regions. Trauma is brutal, no doubt about it and many times, invasive procedures are performed without anesthesia. The life-saving procedure itself trumps pain management. Thankfully, most trauma patients tend not to have memory of their ER experience and that I believe to be and example of God’s grace.

The trauma team converged on this guy. Multiple gunshot wounds to the chest, abdomen and legs. Doctors, nurses and techs all had, literally, a piece of him. Within sixteen minutes of his arrival to our ER, he was stripped, assessed, monitored, had two tubes that were as big around as some garden hoses inserted into each side of his chest with 'auto-transfusers' attached. Auto-transfusers collect blood coming out of his chest into special sterile, filtered containers so that when they fill, his own blood can be transfused back into him. A foley catheter, multiple IV’s, arterial blood, and other diagnostic blood and urine samples were sent, a quick chest xray and before I knew it, he was out the door (OTD) and en route to the O.R. Although central pulses (groin and neck) were present, at no time were we able to find a peripheral pulse (arms) or get a blood pressure.

What happened to me during those sixteen minutes were the strangest that I have ever experienced with any patient in this shape. It didn’t (and still doesn’t) make sense.

As I was preparing to start my gangsta’s IV, I looked at his face. It's a reflex to warn someone that you're about to shove something sharp into them. Normally, when a trauma patient is so profoundly in shock, they are unable to make eye contact with you but this trauma patient did. “What’s your name?” I asked, not expecting a response. His affect was serene and peaceful. His reply, calm and almost musical, “Michael” he said.

I looked up at a tech who shrugged his shoulders and raised an eyebrow as if to say “go figure”. I then recited a fairly standard statement that I would usually give to frightened, less critical, alert trauma patients…”Michael, I want you to know that we are here to help you, you're in the hospital and you will be feeling better soon. Don’t be afraid OK?”

Much to my surprise, Michael looked straight at me – all the while being poked and prodded (remember the chest tubes?) by strangers and said “What’s your name?” This was a first. I told him my name was Joan. “Joan.., Joan.., Joan” he said slowly. Then he actually smiled and said, “I know where I am and I know where I’m going. I’m OK. I’m not afraid.” I asked him if he was in pain and he said he was not. Knowing that he may not survive, I asked him if we could call anyone for him. He smiled again and said “Cameron, tell Cameron.” I asked for Cameron’s phone number and unbelievably he gave it to me. I had the ER tech write it down.

Michael made it to the OR but died 'on the table'. Should I call his family? Do I call Cameron? Do I really want to get involved with a 'gangster's paradise', so to speak?

Next: Knife & Gun Club - Part 3 

The Harlan Chronicles 9

Harlan's End
Harlan slept a lot. He was too weak to walk very far and spent many hours in his bed. Frequently, before sunset Mr. Something would carry him to the car, drive him to the park, then carry him out to a quiet, grassy area where he could just ‘be’.

On one hand, it was really comforting to be able to have Harlan’s head rest on my lap while we hung out at the park in the sunset but on the other hand, I knew he couldn’t resist even if he wanted to.
We would stay until the sun went down and then carry Harlan back to the car again and go home.

Over the course of a few months, the medicines that Harlan was on did not seem to be working as well. His health was declining and he was becoming sleepier and weaker.

As I was not experienced in ‘end of life’ issues for dogs, Harlan and I returned to the animal clinic. I had a few questions…”Is he suffering?”

The vet’s answer would determine as to whether or not I would “put him down”. She didn’t think Harlan was in any distress, “just weak”. "Was Harlan was still eating, drinking and going potty?” He was. Seemingly pleased with my response, she said, “when any of those factors change, Harlan should be reassessed”.

My next question was the most difficult. “What do I do when he dies?” She understood my question and assured me that I could have Animal Control pick him up from my house where he would be brought to a group animal crematorium or I could bring Harlan to the clinic where they would take care of him personally and I would receive his ashes a few weeks later.

I just couldn’t allow myself to consider the Animal Control option. Harlan had become too precious.

It was a beautiful, sunny autumn morning. Mr. Something had come home from the Fire Station and gave Harlan a pork chop. After eating, Harlan walked into the family room and lay down on the floor.

He was gone.

What a life. What a dog.

But, my life with Harlan was not quite over...

Part 10  Harlan's Finale