A Pile of Wiggly Worms

I was on call again last night. From the beginning I knew it would not be a quiet night. A girl was transferred from Idaho who had been hit by a truck and sent flying more than 30 feet in the air. She had her spleen repaired at an outside hospital, but still had a nasty pelvic fracture that needed to be repaired. We were told that she was stable, however, when she arrived to the SICU, she was not oxygentating well and was very confused. We had to rush to put a breathing tube down here windpipe before things went south in a hurry.

We then had a lady come to the unit who had a ruptured abdominal aortic aneurysm repaired. When she got to her room it was obvious that she was not in good shape. Her blood pressures were crap, her abdomen was distended and growing more distended by the minute, and she was oozing blood from everywhere. We decided to re-open her belly to relieve the building pressure and to look for a potential source of significant bleeding that might be contributing to her unstable condition. After we got her abdomen open, her intestines jumped out like a big pile of wiggly worms. We fished around her belly for a source of bleeding and then improvised a bandage over her abdomen that would give her swollen intestinal contents room to hang out until the swelling went down. The nurses pushed liters and liters of blood products into her, and we gave her every last bit of factor 7 (a protein that aids in clotting) that was left in the entire hospital. When morning came, I peeked into her room, half expecting to see a corpse. Instead, I saw a stable lady whose color had returned to her face and who was resting comfortably.

I grabbed a couple hours sleep, but when I woke up I felt terrible and had to drag myself trough the motions for the next 6 hours until I was able to go home.