Blindness

"GSW to head. Please come to OR 4." [GSW = gunshot wound]

There aren't very many times that we run in the hospital. Luckily so, as our Dansko clogs in the best of conditions aren't capable of staying on past a moderate jog. I was about to check on our recent post-op patients before heading down to grab a bite to eat when this page came in. The last GSW patient I had was essentially brain dead by the time I arrived, but they were operating on this one so maybe this patient had a chance.

I jogged to the elevator and pressed the button for 2, thinking that this would be faster than 4 flights of stairs. A bunch of pediatric nurses got on at 5 and took the elevator down to 3. Internally I shouted. But how could they know I was rushing over to someone that was likely dead or dying. We were in the same elevator going down, and they were potentially slowing down an urgent medical evaluation and life saving intervention. I wonder if they would have still been laughing about their workplace intrigue if they had known this.

I was there in 2 minutes, but the patient was already intubated and sedated. Great, I'll just have to go with the cranial nerve exam. There were at least 20 people in the OR, hanging blood products, setting up IVs, charting everything as the maddening chaos of the operative theater unfolded. I maneuvered my way to the head of the bed so I could at least examine her eyes, as in addition to being the proverbial windows to the soul, pupils are the best indicators for impending or completed herniation from mass lesions such as bleeding in the brain. Pupils are... oh jeez. The patient's left eye was extricated from the orbit and the right one had ruptured, sequelae from the blast damage of the bullet that was imbedded in the left temple. No CT scan, no exam. I could only wait for the trauma team to finish what they were doing so we could get a STAT CT to see what we were dealing with. The CT showed that, tragically, there wasn't much brain damage. She would survive this. The bone of the eye sockets were shattered beyond recognition, and likely beyond salvage as well. We lightened the sedation to get an exam... and I'm sure awakened her to a hellish nightmare.

Where am I? Why is it so dark? Why does my chest hurt so much. I can't breath. I can't... I can't move my arms. Why am I tied down? My eyes. Oh my God my eyes. I can't see. I can't see! Somebody tell me what's going on! Somebody, anybody. Where is he? Why did he... what did I do? Why, God, oh why? I can't see anything... I ... CAN'T... SEE...

She tries to scream, but is muffled as the ventilator pushes air back into her lungs, forcing life back into her.