Perfect

”Trauma Stat, GSW abdomen, 12 y.o. female, 5 min.”

GSW: gun shot wound.

This page shat­tered a quiet Sun­day morn­ing. My guts turned to water. That was the last emo­tion I had for hours. Within moments my mind let fall the amaz­ing par­ti­tion that allows me (and most other sur­geons) to enter puri­fied chaos with the abil­ity intact to think and to take extreme actions. When I see this kind of mes­sage I know that I will match and sur­pass the bru­tal inva­sive­ness of the injur­ing bul­let. It takes so much more trauma to repair these injuries. I knew this then and I know it now, but in that moment, I don’t think in this way. There is no reflec­tion. There is doing.

I met Jess in the trauma bay, pale as rice, and almost as thin. If a sur­geon qui­etly turns to the per­son next to him and says, ”She is sick,” he is not talk­ing the same lan­guage as the sick­ness that might describe what keeps a per­son from work. It is under­state­ment weighted with the grav­i­ta­tional pull of death. Jess was sick, in shock, dying. Her blood pres­sure was low, her pulse rac­ing. The acci­den­tal bul­let hole was small. It looked unas­sum­ing; not like on TV. All the blood was on the inside.

A world of activ­ity was in play when I got to her bed­side. Dr. W, anes­the­sia, was actively sav­ing Jess’ life – giv­ing her iv fluid, warmed blood, plac­ing big lines in veins and get­ting her ready to move to the OR. Within min­utes a team had scram­bled and the room was ready, heated to pre­vent her tem­per­a­ture from falling too much which makes bleed­ing much worse. There was lit­tle talk­ing. Every­one was work­ing. I would like to say that I never hold ambiva­lence about doing oper­a­tions, but I some­times do. I could give exam­ples of when this hap­pens, but I don’t think I need to. If you are human, like me, you get it. When a 12 year old girl rolls in, all hearts beat together. All hands work at sep­a­rate jobs but the result is more than the sum of those jobs. A heal­ing envi­ron­ment is cre­ated. It is hon­or­able work.

Once I was in her abdomen, I knew I needed more exper­tise. I called in the vas­cu­lar sur­geon to repair her aorta and the ves­sel to her left leg. I held a sponge on the ves­sel until he got there. There were mul­ti­ple holes in the intestines. It was dire and it stayed dire. We even­tu­ally got her to the inten­sive care unit and then on to the uni­ver­sity, by plane. She stayed there weeks, almost dying sev­eral times. Even­tu­ally Jess made it home. I oper­ated on her over the next few years sev­eral times for her­nias, scars, pain. She never lost her smile.

When I walked out of the oper­at­ing room to the wait­ing room on that Sun­day morn­ing, I was met by a throng. It was like a hive, all gath­ered around the one injured mem­ber. There is no time like the end­less min­utes sur­vived by a par­ent in the wait­ing room of a dying child. Their faces change, the lines deepen. All the emo­tions (and many more) I held at bay, they were swim­ming in, drown­ing in. I don’t remem­ber the con­ver­sa­tion really. She is sick, this is as seri­ous as it gets, we are minute to minute, she is fight­ing, we are work­ing – I prob­a­bly said all these things. She is a won­der, a beauty, the morn­ing light, my heart is break­ing, this is wrong on every level – I said none of these things, but, as I was start­ing to reunite my heart and body with my mind, I was start­ing to feel them. I was affected. Her par­ents turned and got ready to go to Port­land, to the uni­ver­sity. They finally had some­thing to do. How to bal­ance the truth of the des­per­a­tion of the sit­u­a­tion with the need for hope? There were no words for it. My hand on her mom’s shak­ing hands, her father stand­ing by, drawn and withering.

Not only did Jess sur­vive, she thrived. It did take a while, but one of the gifts of youth is the almost unstop­pable ten­dency to heal. I have taken care of many chil­dren who don’t end up heal­ing, who are dev­as­tated and who die. But even in these cases, the child’s phys­i­ol­ogy yearns for life in a way that the adult just doesn’t. I don’t know how else to describe it.

It is rare to hear from peo­ple after surgery and the heal­ing is in process (and the bill has arrived). I don’t expect it, but when a thank you comes, it is great. It reminds me I should be thank­ing my mechanic, my farmer, my den­tist, bet­ter than I do. This fam­ily made me a part of their lives. I was get­ting mirac­u­lous invi­ta­tions to dance recitals, updates from soft­ball games. We went. I cried to see her dance. The wreck­age of her injuries had been trans­formed into a lithe, nor­mal teenager. I got invi­taitons to vol­ley­ball games. Jess and her mom would drop by the office to intro­duce her boyfriend, and we joked about my approv­ing or not. I got the invi­ta­tion to grad­u­a­tion from high school. She walked across that stage, a poised, assured, lovely and most of all, alive, young woman.

Today I got another page about Jess. ”Jess has had a baby and wants to know if you can see her today.” Meet Ben­ton Archer DeVore (ital­ics mine). !!

So there is the story: this per­fect 8 day old boy in my arms and already wrapped around my heart. When some­one dies we some­times say that the wheel has turned. In this case, I am deeply happy (seri­ously, happy) to say that the cir­cle is unbro­ken, my soul is clap­ping, I love my job, and I am so pro­foundly grate­ful to be Jess’ friend.

Photo credit: Kim Glaspie – nice work, grandma!