“Autonomy” was written April 21, 2004. 

I have been working Trauma for a while, and try not to take the ghosts home… 

Some people talk, some cry and scream, others just internalize…

 

Autonomy at 3:00 a.m.

 

          Autonomy… an eloquent word in itself.  The good Miriam Webster defines it as, “free from external control and constraint in action and judgment”, “personal independence”. 

          Autonomy.  A white-washed word that easily rolls around the mouth and falls off the tongue, simply means ‘alone’—in many contexts.

          That word was used tonight in reference to myself and the way my ‘Life’ has formatted my lifestyle.  In that, “grass-is-always-greener” connotation he said, “At least you can come home to peace and quiet.  Come and go as you want.  Work as you please…”

          Sure, parts of that are true and I thought about that as I stood in the kitchen at 1:00 this morning, having just gotten off shift, pounding out a chicken breast and setting it aside to marinate in cilantro and some lime juice I had just squeezed.

            I was drinking Glenfiddich then, and poured myself a couple of fingers of the well-aged escape over ice. I listened to the ice cracking as I raised the glass and inhaled the scent of the amber liquid deep into my lungs; the first sip is always the best.

            I tried to process the events of the last few hours and form some kind of semblance, some deep philosophical meaning, in my mind.  How can we, collectively, enjoy our job and be so good at what we do, yet ultimately have to learn to accept defeat in the end?

            I took out an eggplant I’d bought at a roadside stand I’d found recently and cut it lengthwise in slabs.  I dipped them in egg, and flour, and breadcrumbs and set them to bake with the chicken breast before I sat down.  If I had have sat when I’d first gotten in, I don’t know that I would have gotten up.

            It happened about two hours drive time away, but being the only civilian Level 1 Trauma center in a 400-mile radius…  The kids we caught were three and five years old, both girls, and the Mom was early 30’s and 34 weeks pregnant. 

            You have to say “pregnant” and not just “gestation”.  It’s like someone saying “passed away” versus being “killed”.  They’re still dead but the wording makes it different. 

           The story goes; Mom and four kids were walking along the side of the road and struck by a vehicle at approximately 50-60 miles-per-hour.  He scattered them into the air like seeds and left the scene.  Two kids got diverted to another hospital.  According to EMS reports, ours were intubated with severe head injuries. 

            Both kids arrived at the same time and EMS hadn’t been wrong, they were as bad off as we had expected.  Surgeons made their assessment and triage decisions and I cleared our main CT scanners to receive anyone we needed to.  They sent the three year-old upstairs to the scanner there, and the 5 year-old came with me into the ER CT scanner.

            I scanned her brain, face, and cervical spine and was setting the scan up for her body as she began vomiting up copious amounts of blood from her mouth and nose, past the ET and NG tubes.  As we rushed to get her suctioned, her heart rate began rising and her pressures fell rapidly, and we watched her belly start to distend almost in front of our eyes.  The surgical team pulled her off the scanner and rushed her upstairs to the O.R..

             Hearing the timer on the stove, I turned the setting to broil while I set the table.  I pushed aside my crystal lowball glass and opted for a cold glass of milk with a few ice cubes.  I pulled the eggplant and chicken from the oven and sprinkled them with Parmesan cheese before setting them on my plate.  Gotta give them a little time to cool.

              Mom was more stable but with shattered, pulseless bilateral lower extremities.  On physical assessment she also had a long contusion/abrasion running from just between her breasts to just above her pubic area on the left side. 

             We got her over to the scanner next.  Her ‘crit was dropping, she’s bleeding from somewhere.  I scanned her quickly and we found a large liver laceration, adrenal hemorrhage, renal laceration, and retro-peritoneal bleeding.

             A portable Ultrasound showed there was no fetal heart movement.

            She was at 5cm dilated and OB decided to wait and deliver the fetus first before going to Vascular/Orthopedic surgery. If she were to spontaneously deliver in the O.R., the amniotic fluid and meconium could contaminate the sterile fields.

            OB ruptured her membrane and about 15 minutes later the child was out.  They let her hold the baby and took some pictures and she left on her way up to the O.R.. I went back to the CT suite to clean up the room.

             They called down from surgery—the five year-old bled out as soon as they opened her up.

               I took a sliver of eggplant and dipped in some cocktail sauce with a little horseradish.  It’s good, and I know I need to eat but it just doesn’t seem to have any taste.  I wash it down with the milk.

               Autonomy.  My actions and judgments tonight were certainly fueled by my history and experience rather than someone’s direction or my ‘taking the time to think’.

                 My “personal independence”?   I’m home, alone, in a quiet apartment with my thoughts and my whiskey.  I’d give my eyetooth to be able to walk into my seven year-old daughter’s room right now.  To kneel next to her bed and kiss her before I lay my head next to hers, my knees still on the floor. Just to smell her and hear her breathe…

                 I remember what was said to me earlier tonight.  Do my personal choices, my autonomy, make it easier or better than going home to a significant other you can curl up next to, or a child’s innocence you can bask in for just a few minutes?  Does a tuna casserole with your family taste better or different than my baked eggplant and chicken breast at 3:00 in the morning?

               Autonomy may be that “greener pasture” up front, but take the time to look behind the curtain; The World can be awful big and quiet back here.

                My pager goes off as I stack the dishes in the sink; they’re not going anywhere; they can wait ‘til tomorrow. I recognize the number on the display and I dial the number for the Pediatric ICU, but I already know, somewhere in my heart and I close my eyes for a second.

                 The charge nurse says, “Sorry to wake you but I knew you’d want to know.  They called the three year-old a few minutes ago.”  She takes a deep breath and says, “Give your daughter a hug for me, will ya?”

                  I swallow a big lump in my throat and think, “God, I wish I could”.

–Doug Clark