I slowed my pace as I walked from the Emergency Department CT scanner back to my computer in Care Unit 1. My shoes briefly disturbed the down that had settled on the floor. Gravity pulled it back to the ground.
As I passed the recess bay, my eyes turned to where more feathers rested amidst the gloves discarded in haste and drops of blood left behind on the sanitized stage. He was in the hands of the trauma surgeons now with act two listed as a pelvic artery embolization, followed by an appearance in the operating theater. For a moment, the emergency department had returned to calm as the actors dispersed at the end of a rehearsed performance.
He came to us for help after he was struck by a car. The charge nurse told the room as we prepared for his arrival by ambulance, “pedestrian versus motor vehicle”. My preceptor would later draw an image on a sticky note for me; pictured was a car and stick figure as they made contact. One of our learning points for the day would be the classic pattern of injuries seen in these types of situations.
Who was he, our main character? John Doe, a man who happened to be wearing a blue Patagonia jacket when he became the victim of an unfortunate accident. The EMS team wheeled him in and the room sprang to action; a dance unfolded before my eyes. We methodically assessed his airway, breathing and circulation. “Do we have a blood pressure yet?” 80/40. “Let’s get some fluids running.” He shouted in pain when we pressed on his pelvis. We wrapped him in a pelvic binder. Abdominal ultrasound didn’t show any free fluid, but that didn’t mean it wasn’t there. We rushed to the scanner in search of more information. There was a blush down in his pelvis on CT, a sure sign of ongoing bleeding and an explanation for his soft pressures.
It was almost a comical scene as I recalled the feathers marking his path through the hospital, the lead trauma surgeon failing to remove them from his pant leg while we waited for the scans, the suppressed laughter from the staff watching these repeated attempts, the EMT apologizing for creating this mess.
But, what was this mess? Would John have made a different decision on his choice of outerwear had he known that he would later be center stage?
In the wake of John’s appearance in the ED, we lamented the inconvenience of the feathers and commented on how we would continue to find them in various corners of the department for weeks to come. My preceptor and I discussed the sticky note. I wondered how he was doing in the next act. In the midst of this tragedy, I wondered if John would be upset upon finding his down jacket ruined and scattered across the hospital halls? Would he find some humor from the way he entered from stage right? Or would it not matter that his coat was destroyed in the effort to save his life?
It wasn’t my Patagonia, but it’s caused me to pause all the same.
Since that morning in the ED, I’ve had the chance to visit and learn more about who John is. When I told him about the jacket, a knowing smile erupted on his face and his eyes pointed to the cupboard in his hospital room – “It’s in there”.