Leap of Faith

“Oh my God!” I exclaimed to my wife as we neared the restaurant. A nice day out with the family, driving to lunch, abruptly changed by our gruesome discovery. Our route had been rather fortuitous: I missed one turn, made another wrong turn, got stuck in traffic, then finally we neared the restaurant. I looked over casually…and there he lay, completely by happenstance: Half on, half off of the sidewalk, a body contorted in a grotesque manner, coughing up blood, gasping for breath. I was completely caught off guard.

My wife Megan was shocked by the tone in my voice…"LOOK next to the car,” She saw him-speechless. I jumped out of the car and ran to his side. People on the street seemed oblivious to his existence. A lady on her cell phone, steps over the gnarled man, covered in blood, not missing a beat, no notion of compassion, talking, “Yea Sue, I’ll work out tonight…”

Who was he, where did he come from? Was he struck by a car…no one…myself, my wife and a stranger dying on the street. I yelled for someone to call an ambulance-no answer…my wife dialed 911. I called again...”HELP!!” I am used to dealing with crisis situations, yet suddenly I felt like an alien in a strange world. I had taken for granted the amount of help, the controlled environment we have in the Emergency Department. Patients like this come to us “packaged,” with a story. This poor soul was shattered, without a story, and was dying in front of us.

I stabilized his neck, I could feel a pulse. Finally a man on the street runs to us…”what should I do he asked?” “Let’s get him on the sidewalk!” We eased him onto level surface. He was coughing up blood, it covered my hands. He was looking right at me, through me, gasping for air. I realized part of his leg lay a few feet from his body. I held his jaw outward to ensure he maintained a secure airway. My wife screamed, “The medics are on the way!”

Someone yelled “His name is Joe…” “Who in the hell said that?” I thought. I heard the sirens in the distance. “Joe it’s going to be ok,” I kept saying to the man, knowing damn well it was not-I had to try to comfort him. I had the man hold Joe’s head as we tore off his clothes…his chest was filled with broken ribs, his legs shattered…a lady states clearly, but matter of factly-“HE FELL” I looked up, a lady smoking a cigarette on the 4th floor, curlers in her hair, points up to a balcony on the 5th floor-empty. A crowd had gathered to gawk like a strange freak-show carnival. The lack of emotion or empathy from anyone was indescribable, almost inhumane. His injuries suddenly made sense.

Joe still had a pulse. I knew the fall had severely damaged his lungs, his breathing was slowing, his pulse getting fainter, weaker. I kept telling him to hold on. He stopped breathing, his eyes were now lifeless. This was the longest minute of my life. I had nothing to help this man breathe. I was not comfortable administering mouth-to mouth given the amount of blood covering us. His pulse then stopped…the Engine Company arrived.

Described as a “Traumatic Arrest”, or loss of pulses and breathing due to a significant traumatic injury, I knew this man had less than a 5% chance of survival…do we TRY to save him? These thoughts raced through my head as the fire engine rolled to a stop. He JUST loss his pulses not 30 seconds ago I thought to myself. “I’m an Emergency Medicine Resident at Stanford, he fell from the 5th floor, we just lost his pulse.” In Emergency Medicine, no matter how complicated the patient, it always helps me to take a step back, and remember the “ABC’s”: Airway, Breathing, and Circulation…right now we had none of them.

The firefighters administered oxygen and started forcing air into his lungs with a mask. Another started CPR and attempted to start an IV. The Paramedics arrived. I now was also in unfamiliar territory…I did not want to “step on anyone’s toes”, this environment is the Paramedics territory, I needed to take a “back seat,” and let them run the show. Luckily I knew one of the Paramedics from the ER. He prepared to intubate Joe, or place a tube through his vocal cords, and into his trachea, to secure his airway. “Sean, I cannot see a thing,” he stated as he struggled to place the tube, “do you want to give it a shot?” I suctioned his mouth, and took a look: there was still a lot of blood, but we were able to pass the tube into his lungs.

This experience was truly eye-opening, and raised many salient lessons and questions for me: Why was I so under prepared to aid in an emergency like this in the field? Had we done the right thing for this man? Did I do the right thing as a Physician? Why did Joe die alone?

I was vastly underprepared as a physician in the field to deal with an emergency like this. My cars are now stocked with at least gloves, and first aid kits. Even though his injuries proved to be fatal, I feel we gave him every chance to live. After talking with several of my attendings, I think I handled the situation correctly: Joe’s care was under the direction of the Palo Alto Fire Department. They ran the call perfectly and renewed my respect for what they do day after day for all of us. (Physicians and lay people are covered under “Good Samaritan” Laws in instances like this.) Lastly, I often think of Joe. I like to think my wife and I stumbled upon him to be able to comfort him in his last moments...he really was alone on the street. I do not think we will ever know the events surrounding his death. As the ambulance left for Stanford, a lady commented to me, “That was really great what you did for that man…” “That’s what we do for a living,” I replied. That felt pretty good.

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