The Endless Weapon

By guest writer - "The Bear Jew"

It is about 2 am in my level one trauma center in one of the major cities in the United States. By this point, I have been a nurse for about seven years in the Intensive Care Unit (ICU) and was completing my second year of my Certified Nurse Anesthesia (CRNA) training. I was pretty comfortable with death, and able to “keep my s*** together when s*** hit the fan.” I’ve broken ribs countless times while performing CPR and just to keep things a bit more interesting, myself and other staff members (including other nurses, respiratory members, physicians) had friendly competitions to see who can perform the most quality compression by watching an arterial line waveform and achieving best systolic blood pressure.  

 Figure 1 Trauma bay after event. Note the bloody footsteps.

Figure 1 Trauma bay after event. Note the bloody footsteps.

I was just getting ready to tuck myself in on the couch and close my eyes for a few hours before preparing the Operating Rooms (OR) for tomorrow’s cases. Suddenly, the beeper I laid on my chest to wake me up in case of an emergency started ringing and vibrating. I quickly reached for it and looked at the message: “Trauma level one, multiple stab wounds to chest and neck, CPR in progress, ETA 3 min.” I quickly got up, put my shoes on and ran to grab the emergency intubation equipment while calling to wake my instructor. I met him outside of the OR suite and we quickly rushed to the trauma bay. I could feel the adrenaline pumping through me, not fear;  just a heightened level of awareness and curiosity of what’s to come and how this is going to play out.

 Figure 2 Healthcare team awaiting trauma arrival

Figure 2 Healthcare team awaiting trauma arrival

If you haven’t seen trauma in progress in a medical setting, it may seem like a major cluster f***, and to some extent it is (this mainly depends on the team working, but that’s a whole different story). Extensive resources are devoted to save one individual with multiple teams of healthcare professionals working in a coordinated fashion at the same time doing various tasks. As the stretcher is being rushed in, multiple people surround it like vultures picking at their prey. IV access is being established (if not existing yet, or if additional is needed) while intubation of trachea to secure the airway and subsequent ventilation is achieved (if not done prior to arrival). Drugs and blood are pushed and pumped into the individual in attempt to stabilize them, and a FAST scan is achieved. The healthcare team often talk aloud, sometimes yelling and repeating orders making sure the correct things are occurring and correct medications and labs are completed. It’s a chaotic scene, with blood and sponges, different tools of the trade, syringes, and bodily fluid may be all over the floor and walls, and even staff (see figure 1). Personal protection, including eye protection and gloves are paramount.

 Figure 3 Some of the roles of healthcare team

Figure 3 Some of the roles of healthcare team

When we received our level one, blood was everywhere. It was hard to pinpoint one source of bleed, but the EMT holding pressure to neck gave me an idea. As an anesthesia provider, my primary concern is airway protection and ensuring that ventilation can occur. The EMT was able to establish airway control on the way to the hospital. According to the EMTs, they were called to the scene following a fight between two males. During the fight, one of the two pulled a knife and stabbed the other multiple times. The deep cuts to the individual’s forearm suggested his attempts to defend himself from some of the attacks, but it was futile and by the time he arrived to the ER, he was what we call “DOA” (Dead On Arrival).

You would think this would make the news the next day, online, in newspapers, or even on the tv, but not only it did not, it was not even mentioned. And unless you’re the victim’s relative or were involved in the case, you may not even know someone died that night. In fact, unfortunately, this is a daily occurrence in major cities around the US- violence ranging from gun shots to stabbings routinely occurring.

Now that I am a full-fledge CRNA, I’ve moved to a small community hospital, with a level two trauma center. I’m not looking for all the excitement I was looking for in the past, just trying to work, do my part and go back home to my family and enjoy my days off. Despite that, I still have my share of trauma, from Motor Vehicle Accidents (MVA) to Gunshot Wound (GSW) and the occasional stabbing.

To this point, I’ve had my share of all of them, but when that pager goes off, I still get that adrenaline rush. From what I experienced so far, while most of the GSW survived their attacks (at least initially, and mainly due to shot placement, including the one that was shot 11 times by a police officer), most of the knife attacks did not. While both are violent crimes, the viciousness of the stabbing attack is a lot more apparent and appears much more personal, i.e. multiple stab wounds with exposed tissues and blood. It’s not to say that GSW are not deadly, but the endless amount of ammo the knife offers married with the viciousness of the attack often appear more lethal.