By Sid Schwab
In case we get snow in the flatlands this year, I want to put on my trauma surgeon hat and tell you about one of the saddest things I’ve ever had to do. Maybe it’ll prevent it from happening again. It’s a true story: various details have been changed.
Called to the emergency room to see a boy of about 10, I didn’t know his name till it was over. He’d been pulled behind the family car, on a snowy day, on a sled, probably laughing at first, in that combination of delight and fear that gets kids screaming. And then they’d gone around a corner, whipping the sled into an arc for an extra thrill, causing it to careen off the road, fast. And then, into a tree. The boy took the full force of it on his right side, where the liver lives, breaking it into pieces, bleeding unseen, as the drivers first took him home and laid him on their couch. When he became unconscious, they called 911, and in the time it took for the medics to get there and back he was brought to the emergency room, in full cardiac arrest, CPR performed all the way. Arrest for that long doesn’t often end well.
Though there was still electrical activity in his heart, his pupils were dilated like death, and we couldn’t feel a pulse or measure any blood pressure. But he was 10, and we got him to the OR as fast as we could.
Making a rapid incision, I saw that blood had filled his abdomen. His liver looked exploded. Immediately after entry, I put a clamp across his aorta to stop the flow of blood into his belly and redirect it to his brain and heart. Cleaning up, suctioning, sponging, I realized that repairing the liver, if it was possible at all, was going to be a major challenge. But my first aim was just to control bleeding, enough to give the assembled group of nurses and anesthesia folk time to catch up, squeeze in pint after pint of blood, try to get the child halfway stable. Packs and clamps, placed wherever they might help, reduced the flow to manageable. For a while we were able to maintain blood pressure, and I made ready to see what I could do about the wreckage. But then, despite everything we’d tried, his heartbeat began to slow, portentously. Taking turns with the assistant, I compressed the boy’s chest, hoping for a rally, for any sign of life, a reason for hope. And finally, long after it was well beyond obvious, we stopped. In the OR, the surgeon is the one to make the call, and I hate it.
When you close an abdomen after a failed rescue, there is stillness. No beeps from monitors are heard, no sighs from the ventilator, none of the casual chatter that accompanies a case going well. Only silence, heavy as a sob. You close with a giant needle, wanting to make it end as quickly as possible. On a 10-year-old, with a baby’s beautiful skin, healthy tissues giving more resistance to the needle than in someone old and sick, perfect organs disappearing from view, you are sewing through tears. You feel the loss as if it were your own. You avoid meeting the eyes of anyone else in the room.
I went alone to the family area. I’ve done that walk a few times, and any number is too many. The mom was there, some others. Seeing the look on my face she stepped toward me, hand in a fist, pressed against her mouth. “I’m sorry,” I said. “I couldn’t save him.” In the echo of my words she ran to me, began beating on my chest with both fists, crying in gasps. “What do you mean you couldn’t save him? Why? Why? How could you not?” “I’m so sorry,” I said again, finding none but the predictable, meaningless words. “We tried everything, but there was just too much damage.” Letting her beat away without raising my hands. “How could you not save him? Oh my God, oh, Davey, oh, Davey.”
So that was his name. Davey.
Please. This winter, any winter. Don’t do it, don’t tow your kid behind your car. Don’t make another mom hear those crushing words, and don’t make another surgeon take that walk.
Sid Schwab lives in Everett. Send comments to firstname.lastname@example.org