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Saving Lives

I knew it was going to be a long night. It had to be. The blood still poured from his ear. I had been working nights in the Surgical Intensive Care Unit (SICU), and our new trauma patient had just come to the floor. As I sat with Patrick watching the blood pour in, and pour out, I thought about his choice, his life. Patrick had two choices, to hold on or to let go. He chose to let go, a decision which ended his life. I knew keeping him alive, in a strange sense would ultimately save others.

Patrick was just 18 years old and had jumped onto a moving train 2 hours earlier which he was trying to catch as it left the station. Stuck on the outside of the train, it gradually gained momentum, he had nowhere to go. In an instant, he was faced with the choice of a lifetime: to hold on, or to jump. The train picked up speed, the wind rushed through his hair, the noise became deafening. He chose to let go. Witnesses said that as the train left the station he landed on the platform on the back of his head.

I received the page that there was a "Trauma 99" arriving at Stanford University Medical Center by ambulance. A Trauma 99 is a designation for the most critical trauma patients. When I arrived at the trauma bay, Emergency Physicians were busy securing Patrick's airway- he had obvious facial and head trauma, and was bleeding profusely from his injuries. Amazingly, they were able to secure his airway by placing a tube in his mouth and into his lungs which enabled us to breathe for him.

In order to determine the extent of Patrick's injuries, he was rushed to a CT scanner. The damage from the fall was massive: he had completely broken through the base of his skull, severing the major artery which supplies blood to the brain. His brain was literally filled with blood. Blood continued to pour from his ear. The Neurosurgeons said there was nothing they could do for him. The injuries were too massive. His brain had taken a fatal blow.

Patrick, although unconscious, still had a very strong heart, and was in perfect physical condition. His mother later told me, "he had never been sick in his life." Everyone was deeply moved by what had transpired. This perfectly healthy young man-gone. At times like these there is always a feeling of hopelessness. There was nothing we could have done better or faster to save his life. Yet oddly enough our charge became to keep him alive…for one last conversation or remembrance, and so that he might save others. Patrick as it turns out was an organ donor.

The rest of the night we worked frantically to keep Patrick’s heart pumping, and to keep enough oxygen circulating to protect his organs. Having a son, I cannot imagine the pain, and horror of receiving the phone call Patrick’s parents received that evening. Your whole world would change in an instant. In order to say goodbye to their son, they had to drive five grueling hours. They pleaded that we keep him alive for them, and for others.

His blood pressure plummeted, blood continued to pump from his body faster than we could replace it. Vital clotting factors were missing, making it impossible for us to slow the bleeding. I had to use medications to keep his blood pressure elevated. We used one, then two, then three. The bleeding would not stop, his blood pressure steadily falling lower. After all had seemed lost, after 15 units of blood, 8 units of platelets, 6 units of plasma, and 7 hours of tireless work by the nurses and physicians, he stabilized. The organ donor network team arrived. We checked with the Neurosurgeons for reflexes which would show Patrick had brain activity…he did not. The ventilator made the only noise in the room. Patrick was declared brain dead at 8:00AM. Over the next 8 hours, his room was filled with a steady stream of specialists: Cardiologists, Pulmonologists, Nephrologists, Gastroenterologists, and Hepatologists all determining which organs would be suitable for donation.

In all, Patrick gave the gift of life to 4 people awaiting transplants-his lungs, liver, heart, and kidneys now exist, and work for others. Patrick’s parents arrived at the end of my shift. I gave my all and did my best to comfort them. I am a firm believer that on some level Patrick knew they were there with him. He passed soon after they arrived. His father sobbed, “my boy…my boy…” His mother asked, “Will Patrick get to help others?” I replied, “Yes.” She whispered through the tears, “Then he will live on.”
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About the Author

The Stanford Emergency Room is the center of emergency care at Stanford University.