When you get a call in the middle of the night you automatically think the worst. Especially when its a teenage boy coming in at around midnight. I drove myself to the hospital knowing the worst but hoping for the best. I got into scrubs and put on the worst shoes because I knew we would be dealing with a tremendous amount of blood in the abdomen and possibly in other places. A car crash like this could mean anything and without seeing the whole picture it is hard to narrow down what could have happened.

I ran down that hallway, as it was my job to run everywhere and never be short of breath, and I opened the trauma room door to find about ten doctors trying to do a million things at once too fast. I looked further and saw a young man who seemed like he could use all the help he could get. I walked in closed the door behind me and stood my ground. “Everybody!” Everyone came to a quick stop but eyes were still moving as they were checking monitors and vitals. “Everyone, need to take a deep breath right now and believe that what we are doing it right. If we work fast we work sloppy, so take your time, and do what you know how best to do.”

My nurse gave me the full report of what was happening, and as an acting trauma surgeon, I was forced to know what to do, when to do it, and who to have on my team. A broken femur, that was set in the field (also known as where the accident occurred), a few head lacerations that luckily just needed stitches, impaled abdomen, most likely a piece of the steering column, and a tender abdomen in the upper left and right quadrants. This isn’t the worst things could get, but in my opinion, it also is not the best things could be. While in the room we began to get ready for transport to an operating room, but a few things had to happen first. I stood next to the bed as the nurse inibated quickly to give the patient an airway, as he was not breathing on his own. We chose manual ventilation instead of taking the time to hook him up to a breathing machine which we can rather do in the OR. We got rid of the temporary casts that the paramedics put on his breaks to stabilize the bones, and also reset a hip dislocation to help restore blood flow to the leg in order to save his leg and not risk losing the leg. We got all the Iv’s in and starting infusing blood and plasma into his body to try and replenish the red and white blood cells and the proteins needed to allow the cells to multiple and start the regeneration process. The tubes and wires going through his body attached to the machine on wheels, now are ready for transport to a sterile and relaxing environment in which people, amazing people, do their best work.

As a doctor coming from a trauma room and moving to the OR, it is at a run, and that is one of the most important things. At all times people and everything is buzzing around and you cannot help but match that energy. The adrenaline in your body that is built during this time can keep you going for hours on end until you are the ones sewing him up and you know that he is going to be okay. At a run myself, two nurses, and a resident, who is a surgeon in training, head to the OR to break everything down and figure out where to start to give this boy the life he deserves and a bright future that is ahead of him.

The anesthesiologist quickly got in him under, as I scrubbed for the four minutes needed to prevent an infection. Before I began I leaned against the scrub sink and closed my eyes. Before every surgery, I go through this and try to put some confidence in myself and believe in myself to know that I am the person that is holding the possible life and death of this boy in my hands. Being a surgeon comes with having a strong mental game. Self-confidence, but not cockiness, is important in this line of work because if you step up to the operating table and have any doubt that will stand in the way of everything you plan to do and accomplish, you will be crushed. To any other people wanting to become a doctor make sure your mental toughness beats all other things, because without that you will not succeed.

Walking into the OR the air was tense, and many people knew that any outcome is possible whether it is good or bad, and that is what scares me the most. I stepped to the right side of the table, next to my scrub nurse who knows my moves before I even make them, and she handed me a No. 10 blade, the standard to open any patient. I looked up at the resident standing across the table holding the suction to try and clear the field before finding the source and trying to suture it up. As I separated the muscle, blood came pouring out, we got in there fast with suction and lap pads to try and slow the bleeding as much as possible. To accumulate this amount of blood, he either had to have been bleeding for awhile or quickly meaning the repair might be harder than I thought. After suctioning and trying to absorb as much blood as possible for the last twenty minutes, he was receiving multiple units of blood by way of his IV and packed cells, which are red blood cells in order to improve the production of more red blood cells to make up for the amount of blood he lost. It was found that the impalement, which was removed carefully, had punctured a small hole into the abdominal aorta and once that hole was plugged there was minimal bleeding, and with a 3.0 silk suture, it was able to be closed without worry. Later in the procedure, the spleen was removed, as it is something you can live without, and one of the lobes of the liver was repaired as it was punctured as well. There was not much bleeding from those two organs but it would eventually lead to further damage so fixing these problems now was a no brainer. As things were winding down, I lead to checking everything over again to see if sutures would hold and no more bleeding would occur.

The neurosurgeon was working simultaneously besides me, he still had about an hour left of his craniotomy if all goes well. This surgical option was chosen by the neurosurgeon in order to relieve pressure from his brain because of some swelling and a hematoma from an injury during the accident. It is oftentimes a very routine procedure for a neurosurgeon as this procedure could be used for a lot of different scenarios such as tumors, AVM’s, aneurysms, and a foreign object, such as a bullet.

As I began to close up after checking my work for about a half hour, the monitors went off. Atrial fibrillation. The brain began swelling too much and the neurosurgeon had about 2 minutes to solve the problem before this boy would stroke out. I tried to stay calm and the clock was ticking. The surgeon was concentrated and focused and was not about to let this kid go after going through hours of surgery. It was intense to watch and the clock only had 20 seconds left before the worst could happen. Then as soon as the clock hit 10 seconds, the monitor stopped and beeped at a normal rhythm. We both let out a sigh of relief and a round of applause was given from the nurses and other doctors in the OR. We had beat all odds for this kid to survive, but the next 24 hours were to be crucial, with him being in a medically induced coma. If he gets through the night there is a very good chance he will come out of this with little to no deficits.

The nurses took him to a post-op room for him to be seen by his parents after we had talked to them. I walked out the door of the operating room, leaned against the wall and dropped to the floor. Before I walked out and faced those parents, taking time to compose myself was all I needed. Right now with all the adrenaline in my body vanishing time to myself was most important. As I sat there for about five minutes I got up, walked over to the nurse's station grabbed the other surgeon and resident and went out the door to the waiting room to find the parents sitting there. As I opened the door, I have never seen two people get up faster. We had no time to update them throughout the surgery, and at this point, they did not know what was going on with their son.

I stood at the door with the mother and the father came in from the elevator at what seemed like perfect timing. I explained all that happened during the surgery and how the next 24 hours were crucial to how he would come through. I advised her that there were cots set up in his room and they could spend the rest of the night and the following day with him because his people is what he needed. “We are all here rooting for him to make a full recovery and beat all odds and right now it is looking good that he will.” As I finished speaking, his mom still looked a little distraught, so I did something that normally I don’t do with patients family without getting too close to them. I hugged her. Not just a small one but a real hug to let her know that everyone was in her corner and if she needed anything to not hesitate to ask.

When you get a call in the middle of the night you automatically think the worst. Especially when its a teenage boy coming in at around midnight. I drove myself to the hospital knowing the worst but hoping for the best. I got into scrubs and put on the worst shoes because I knew we would be dealing with a tremendous amount of blood in the abdomen and possibly in other places. A car crash like this could mean anything and without seeing the whole picture it is hard to narrow down what could have happened.

I ran down that hallway, as it was my job to run everywhere and never be short of breath, and I opened the trauma room door to find about ten doctors trying to do a million things at once too fast. I looked further and saw a young man who seemed like he could use all the help he could get. I walked in closed the door behind me and stood my ground. “Everybody!” Everyone came to a quick stop but eyes were still moving as they were checking monitors and vitals. “Everyone, need to take a deep breath right now and believe that what we are doing it right. If we work fast we work sloppy, so take your time, and do what you know how best to do.”

My nurse gave me the full report of what was happening, and as an acting trauma surgeon, I was forced to know what to do, when to do it, and who to have on my team. A broken femur, that was set in the field (also known as where the accident occurred), a few head lacerations that luckily just needed stitches, impaled abdomen, most likely a piece of the steering column, and a tender abdomen in the upper left and right quadrants. This isn’t the worst things could get, but in my opinion, it also is not the best things could be. While in the room we began to get ready for transport to an operating room, but a few things had to happen first. I stood next to the bed as the nurse inibated quickly to give the patient an airway, as he was not breathing on his own. We chose manual ventilation instead of taking the time to hook him up to a breathing machine which we can rather do in the OR. We got rid of the temporary casts that the paramedics put on his breaks to stabilize the bones, and also reset a hip dislocation to help restore blood flow to the leg in order to save his leg and not risk losing the leg. We got all the Iv’s in and starting infusing blood and plasma into his body to try and replenish the red and white blood cells and the proteins needed to allow the cells to multiple and start the regeneration process. The tubes and wires going through his body attached to the machine on wheels, now are ready for transport to a sterile and relaxing environment in which people, amazing people, do their best work.

As a doctor coming from a trauma room and moving to the OR, it is at a run, and that is one of the most important things. At all times people and everything is buzzing around and you cannot help but match that energy. The adrenaline in your body that is built during this time can keep you going for hours on end until you are the ones sewing him up and you know that he is going to be okay. At a run myself, two nurses, and a resident, who is a surgeon in training, head to the OR to break everything down and figure out where to start to give this boy the life he deserves and a bright future that is ahead of him.

The anesthesiologist quickly got in him under, as I scrubbed for the four minutes needed to prevent an infection. Before I began I leaned against the scrub sink and closed my eyes. Before every surgery, I go through this and try to put some confidence in myself and believe in myself to know that I am the person that is holding the possible life and death of this boy in my hands. Being a surgeon comes with having a strong mental game. Self-confidence, but not cockiness, is important in this line of work because if you step up to the operating table and have any doubt that will stand in the way of everything you plan to do and accomplish, you will be crushed. To any other people wanting to become a doctor make sure your mental toughness beats all other things, because without that you will not succeed.

Walking into the OR the air was tense, and many people knew that any outcome is possible whether it is good or bad, and that is what scares me the most. I stepped to the right side of the table, next to my scrub nurse who knows my moves before I even make them, and she handed me a No. 10 blade, the standard to open any patient. I looked up at the resident standing across the table holding the suction to try and clear the field before finding the source and trying to suture it up. As I separated the muscle, blood came pouring out, we got in there fast with suction and lap pads to try and slow the bleeding as much as possible. To accumulate this amount of blood, he either had to have been bleeding for awhile or quickly meaning the repair might be harder than I thought. After suctioning and trying to absorb as much blood as possible for the last twenty minutes, he was receiving multiple units of blood by way of his IV and packed cells, which are red blood cells in order to improve the production of more red blood cells to make up for the amount of blood he lost. It was found that the impalement, which was removed carefully, had punctured a small hole into the abdominal aorta and once that hole was plugged there was minimal bleeding, and with a 3.0 silk suture, it was able to be closed without worry. Later in the procedure, the spleen was removed, as it is something you can live without, and one of the lobes of the liver was repaired as it was punctured as well. There was not much bleeding from those two organs but it would eventually lead to further damage so fixing these problems now was a no brainer. As things were winding down, I lead to checking everything over again to see if sutures would hold and no more bleeding would occur.

The neurosurgeon was working simultaneously besides me, he still had about an hour left of his craniotomy if all goes well. This surgical option was chosen by the neurosurgeon in order to relieve pressure from his brain because of some swelling and a hematoma from an injury during the accident. It is oftentimes a very routine procedure for a neurosurgeon as this procedure could be used for a lot of different scenarios such as tumors, AVM’s, aneurysms, and a foreign object, such as a bullet.

As I began to close up after checking my work for about a half hour, the monitors went off. Atrial fibrillation. The brain began swelling too much and the neurosurgeon had about 2 minutes to solve the problem before this boy would stroke out. I tried to stay calm and the clock was ticking. The surgeon was concentrated and focused and was not about to let this kid go after going through hours of surgery. It was intense to watch and the clock only had 20 seconds left before the worst could happen. Then as soon as the clock hit 10 seconds, the monitor stopped and beeped at a normal rhythm. We both let out a sigh of relief and a round of applause was given from the nurses and other doctors in the OR. We had beat all odds for this kid to survive, but the next 24 hours were to be crucial, with him being in a medically induced coma. If he gets through the night there is a very good chance he will come out of this with little to no deficits.

The nurses took him to a post-op room for him to be seen by his parents after we had talked to them. I walked out the door of the operating room, leaned against the wall and dropped to the floor. Before I walked out and faced those parents, taking time to compose myself was all I needed. Right now with all the adrenaline in my body vanishing time to myself was most important. As I sat there for about five minutes I got up, walked over to the nurse's station grabbed the other surgeon and resident and went out the door to the waiting room to find the parents sitting there. As I opened the door, I have never seen two people get up faster. We had no time to update them throughout the surgery, and at this point, they did not know what was going on with their son.

I stood at the door with the mother and the father came in from the elevator at what seemed like perfect timing. I explained all that happened during the surgery and how the next 24 hours were crucial to how he would come through. I advised her that there were cots set up in his room and they could spend the rest of the night and the following day with him because his people is what he needed. “We are all here rooting for him to make a full recovery and beat all odds and right now it is looking good that he will.” As I finished speaking, his mom still looked a little distraught, so I did something that normally I don’t do with patients family without getting too close to them. I hugged her. Not just a small one but a real hug to let her know that everyone was in her corner and if she needed anything to not hesitate to ask.