T. Dixon - Critical Crash

 

So, I’m a physician. A surgeon, actually. That took a lot of sacrifice and a lot of time to get all of that training done. At first, I thought I wanted to be an anesthesiologist. So, I did some training in that before doing my surgery training. And then, ultimately, I did trauma, critical care and burn surgery fellowship down here, actually. But that’s 16 years of training. At the worst of it, I was at Hopkins in Baltimore. It was before the eighty-hour workweek rule, and so we were working about 134 hours a week. There’s only 168 hours in a week. I mean, in the entire week, right? [audience laughter] So, that’s 34 hours to eat, sleep and hopefully sleep with your girlfriend, you know? Not a lot of time for the important stuff, people.

 

So, at one point I went like 93 days without a day off. I’m talking no Saturdays, no Sundays, just 93 consecutive days. When we were on call, it was usually every other day, every other night and it was in the hospital, it wasn’t home call. So, we’d go in at 04:00 AM, and you might not get home until 04:00 or 06:00 PM, the next day. So, 36, 40 hours on, a few hours off, and you’re back at 04:00 AM. That’s why there’s a saying in surgery is, “Eat when you can, sleep when you can, and don’t fuck with the pancreas.” But that’s another story. [audience laughter] 

 

So, anyway, there was one point when I was in residency, I was going through a really tough time. Just personally. There’s not a lot of time, like I said, for your personal life. It was just a dark time for me. I was in a dark place. I didn’t know if I wanted to continue with my surgery training. I was depressed. I was really hurting. And at the time, I was the chief of the trauma surgery service. We got this call, we got this patient that was coming in, this girl. And the story from the paramedics is, it was her 16th birthday, and she wanted to take a drive. She wanted to get in her car by herself and go to McDonald’s and come back home.

 

Well, she didn’t put on her seat belt, and she took a curve a little too fast and she goes flying off this curve, which was on a hill. So, she goes flying off the hill, through the windshield, and then the car flipped over and landed on top of her. So, this was a devastating crash. She’s unconscious, obviously, and has to be intubated, which means a breathing tube put in at the scene. She comes in to us, and she has a head injury that is horrific, that could have killed her. She had bilateral lung contusions that could kill her still. She had a Grade 4 liver fracture that could kill her. She had a Grade 5 splenic fracture that could kill her, and a Grade 5 pelvis fracture that could kill her. 

 

 I mean, this girl was broken. I guess we both were at that point in time. But that night was insane. I get her to the intensive care unit and get her on a ventilator, and we’re starting this massive transfusion. Normally, we would take that spleen out. You don’t really need your spleen. But we were afraid to open the abdomen for fear that it’d let loose that liver. And ain’t nobody living without a liver. I mean, it’s in the name. liver, youk know? You got to have a liver. [audience laughter] So, we couldn’t do that. 

 

Doing this crazy transfusion, just trying to keep her alive minute by minute. At some point, I hear that the parents have arrived. The crash was in a small town. So, even though this chick, we don’t know who this 16-year-old is, she’s just Jane Doe to us. She’s a random patient. So, I finally get a tiny little minute that I can go and just update them. I end up alone with them for a minute. And as I was walking there, I was thinking, any one of these injuries could kill her. This is so awful right now. I have to go and prepare this family. I have to let them know how bleak this is. But I also don’t want to squash any hope they may have, because that doesn’t help anybody, you know, to squash that. 

 

So, it’s one of those weird things in trauma surgery, especially in the intensive care unit, where the doctors and the nurses are spending almost as much time taking care of the family as they are the patients, who are oftentimes not with it or completely unconscious. So, it’s a very delicate balance to do this job. And so, I end up alone with them for a minute in this consultation room, and I say to them, “I want you to understand, I don’t know if she’ll make it through the night. I’ve gone through all these five injuries and how each one of them is trying to take her life, like, as we speak.” And I said, “She’s 16. As best I can tell, she’s a healthy, fit 16-year-old. And if anybody could beat it, that would be it.” They’re still hysterical, they’re sobbing, that was the closest thing I could give them to any hope. And so, I’m like, “But I got to get back in there. She’s real critical.”

 

And so, I stand up to leave, and I’m walking to the door and all of a sudden, the sobbing stops, and it’s like everything calmed down. And the mama says, “She’s going to be okay.” And my hand’s on the door and I stop, and I turn back around and I said, “Ma’am? What? What?” And she said, “She’s going to be okay. Her name is Savannah,” and she points at me. “Your patient Doe is Savannah.” I look down, and I’m wearing the appropriate scrub top for that hospital, but for whatever reason, and I think it’s the first time it ever happened, I was wearing the inappropriate bottoms. My scrub bottoms were from my medical school and I had done my clinical rotations in Savannah, Georgia. So, Savannah was written across my ass. [audience laughter]

 

And that was just what they needed, that little tiny bit of encouragement. [audience laughter] And if my ass can bring hope to the people,- [audience laughter] [audience applause] -I’m here to help, you know? What can I say? So, anyway, I was grateful that they had some shred of hope. But I walked out of there and I was like, “That was funny. [audience laughter] But oh, my gosh, this girl’s still dying. So, I rushed back in there, and it was just-- I never left her bedside. She did make it through the night. But then, every day was like that. It was a constant battle to keep her alive. I would go in there and I’d be like, “Hey, Savannah, it’s Dr. T.” She’s unconscious, but I’m still talking to her. We had to do a lot of painful procedures on her during that time to help get her through this. She had chest tubes put in, chest tubes taken out. The chest tubes are very large, they’re like garden-hose-sized tubes that go in between your ribs to drain off fluid, air and blood from around the lungs, so the lungs can work better. She had to have those procedures multiple times. I put in multiple central lines, which are really large IVs that go in your neck. Had to give her a tracheotomy, which is a breathing tube through the neck as opposed to through the mouth.

 

I tried to warn her before I did anything to her, and just continued to take care of her. We made it through day by day. But still, you knew that complications were going to come from all this, like these were too horrible of injuries to get away with just, “Oh, you’re healed.” So, we were just like, “When is the next complication coming? When is the next fight for her life coming?” And even at that, we were like, “Even if we get her through this, we don’t know if one day she’s going to wake up at all. And if she does, with that brain injury, will she be catatonic? Will she be in a regressed state? Will she just have some deficits?” I mean, we had no idea.

 

But I took care of her on that intensive care unit for two or three months and then I consulted through the vascular surgery service for some blood clots for a few more months. But after about five months or so, it was time for me to move on. I rotated out to a different hospital in that same town and I lost track of her. That service had anywhere from 30 to 50 patients on it at any given time. I treated hundreds of patients over those same months that I was taking care of Savannah. So, I lost track of a lot of patients.

 

I went on to go back to this. It was the same as it was there, but 100 plus hours a week and just a high stress job all the time. I was still struggling and still didn’t know what I wanted to do in my personal life. I didn’t know what I wanted to do in my career. And with surgery, the stresses are as much mental as they are just the time. It’s not just the physical tiredness and the time, but I’m the type of person, I took my work home with me a lot, so I would worry about the patients and the cases even when I was off duty. And so, it was a very difficult time, and I just felt like I was really just limping along during that time. 

 

So, about a year after Savannah’s surgery, or about-- not surgery, but after her accident that she had, I was back in that same intensive care unit again. I’m working on all these patients. One day, I’m talking to this nurse-- If you hadn’t noticed, I talk a little loud, that’s just normal. And so, I’m talking to this nurse across the way, and this girl approaches me and she’s like, “Hey.” I’m like, “Ah, hey.” I don’t know who she is. She lowers her shirt a little bit in the front to show me a tracheotomy scar. Just about the time I realized who she is, she says, “It’s me, Savannah.” And I was like, “Oh, my gosh.” 

 

She looked great. She was healthy, and she was talking to me, and she only had one class to make up, so she could graduate with her fellow high schoolers and she was so excited. It was so much better than I ever thought she would be after all that she had been through and all those injuries she had. And then, all of a sudden, it occurred to me, I was like, “Wait a minute, how do you know who I am? You’ve never met me. You were unconscious every time I ever took care of you.” And she said, “Oh, well, I recognize your voice. You were the one who talked to me.” [audience aww]

 

So, all those times that I would say, “Savannah, this is going to hurt, but I’m going to do everything I can to try to make it as painless as possible, but it’s going to hurt a little bit,” she had heard me and she remembered it. And so, I knew that treating people like a human being, it does matter, it does make a difference. And for me, that’s when I finally realized that all that sacrifice and all that blood, sweat and tears, it was worth it. Thank you.