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By Gerald A. Coleman, III, DO, FACEP
Driving in to my shift in mid-December 2009, it was snowing out. As a child, I loved the snow, but as grew older, I learned to dislike its presence when I had to drive to work in it. It reminded me of my daily commute when I went to medical school in New England. I could only think of all of the stuff I had to get done before the holidays which were quickly approaching. We are all guilty at times of getting caught up in the daily grind of our lives. My mind was on the various holiday distractions but soon it would be filled with an experience that would change my life. My shift that day started out being a typical case load of chest pain, sore throats, elderly abdominal pain and dementia patients with change in mental status. Halfway through my shift, the command radio went off alerting me to a possible stroke alert coming inbound to my emergency department which was at 110% with typical inpatient holds. Their ETA was less than 5 minutes. I discharged two of my patients in preparation for this critically ill patient who was inbound. Moments later, the medic busted through the door, yelling for a doc because his “stroke alert” patient was now vomiting and becoming more confused. I rushed to bed #8, our trauma resuscitation room, to evaluate a burly 62-year-old male with a long, partially gray beard. When I asked what was going on he simply stated: “Doc, I feel like crap and my head is going to explode.” His exam was non focal but I cleared the CT scanner with the tech via phone and we rushed him over immediately because I was concerned about a non-traumatic subarachnoid hemorrhage. The patient’s GCS at this time was 14.
The next of kin showed up with another 12 family members in tow. She was visibly upset and told me that her husband John was cutting down a Christmas tree with his grandkids when he screamed out and collapsed under the tree with the ax by his side. He was found by his youngest granddaughter who ran over to her and stated, “Pop Pop is hurt, Gammy.” John came to, stating he felt like an M-80 firecracker went off in his head. The CT tech phoned over to ED asking me to come over to the CT suite immediately. He stated: “Looks like John is not going to ride his motorcycle anytime soon.”
When I arrived, I stared at the monitor and dropped my head, my worst fear was confirmed; there was a large subdural and subarachnoid space extending into the R large ventricle with substantial mass effect at the level of the foramen magnum. We rushed John back over to the ED; en route he started to violently vomit all over my scrubs. I felt this was a bad omen and prepared to RSI the patient. His airway was predicted to be difficult so I made various adjustments in positioning John prior to securing his airway. When the respiratory tech came in to the room she immediately called the operator to page anesthesia. I looked up and stated, “Please give me a chance before you call in the cavalry, what gives?” I later learned that this respiratory tech was the niece of the patient and he had had airway trouble in the past with elective surgery. After I intubated John on the second attempt and made appropriate arrangements to transfer him to the receiving hospital, I sat down and talked to his family.
I walked into that room with a very uneasy feeling about the outcome of this case. One of the things that I learned early on in my career when dealing with families during a difficult case is to be truthful, direct, and professional. His wife asked me a direct question to which the entire room hung on my every word: “Dr. Coleman, is my husband going to die; you know his dad died the same way.” I had been through the gut-wrenching experience of losing a child at birth during my residency, so her fear was palpable and personal to me. This experience brought back unpleasant images of my deceased daughter. I simply stated while trying to ignore a salty tear streaming down my face, “We are going to do everything in our power to help John, I am in full court mode right now, take one step at time, he is a fighter, we can only hope for the best and prepare for the worse, time will only tell.”
Medevac had aborted the round trip 35-minute flight to the receiving hospital due to snow and low visibility, so my ground ALS crew was standing by to take John. I had to send an RN with John and the ALS crew because I started the following intravenous drips: cardene, mannitol and proprofol. John made it down to the receiving hospital’s interventional radiology suite in record time: door to IR suite within 86 minutes. This was amazing considering it was a 52-mile ground transport in suboptimal driving conditions.
After the dust settled, John had a protracted course in the ICU, staying there and in rehab for the next 4 months. He was finally discharged. Life went on in the ED as usual and a year passed. That year was a rough one for me because I survived my first year as a medical director after only being board certified for 6 months. A year later, to the exact day that John had his near fatal subarachnoid hemorrhage, I was working clinically when a middle-aged male without a beard come up to the physician charting area of the ED. I politely asked, “How can I help you today?” This gentleman’s eyes had strange familiarity to them. I said to myself, “Where have I seen this guy before?” He replied: “Hi Dr. Coleman, my name is John, and I wanted to say thank you in person for saving my life and giving me a second birthday.” I stood up for the desk in utter shock, “My god, John, you look amazing.” He had lost a ton of weight and lost the beard. He walked me to the conference room and there were more than twenty of his family members waiting to see me. Anyone who knows me well knows that I have an iron-clad exterior but at times can be emotionally sensitive when the time is right. I became overwhelmed with emotion as I listened to his family tell me John’s success over the last year in his recovery. We exchanged hugs, tears of joy, laughs, and simple stories of the heart. There are defining moments in your career; this was one of mine.
I firmly believe that everyone has a role and a purpose on this earth; mine was right here being an emergency physician. After a brief celebration with John’s family, he came over to me and said, “Dr. Coleman”; I immediately corrected him and said, “Please call me Jerry. “ He said, “Sure, Jerry, come outside, I have a surprise for you.” John was a lifelong motorcyclist and had an obsession for Harley motorcycles. During his ICU stay, I learned from numerous conversations with his wife that John’s goal was get back on his bike and ride again. When I stepped outside of the ED ambulance entrance, I saw a huge Harley Davidson bike sitting there. John asked ”Hey Jerry, you gave my life back, can I take you for a spin.” I stated, “I would love that, but John, my patients are waiting, I hope you understand. Can I take a raincheck on this one?” He understood. We embraced with a handshake that turned into a “man hug.” He again said thank you. I simply stated, “John, I did what I was trained to do, trying to save lives and alleviate suffering.” I walked back through the doors of the ambulance entrance, and picked the next chart with a renewed sense that I am doing what I was meant to do.
What I learned from this case is that life is far too short. Sometimes through personal life experiences or extraordinary cases such as this one, we are reminded that we need to take a step back and realize what is truly important in this world. Take time to enjoy life’s simple pleasures; tell people you love them unconditionally because you never know when your time is up.