Chapter 52: Good Doctors Know When to Call for Reinforcements

September 14, 1990, McKinley, Ohio

On Friday, while I was at lunch with the team, I was paged by the surgical charge nurse, and to save time, I went straight to the house phone and dialed the extension.

"Doctor Mike; you paged me?"

"Yes," Nurse Kimberly said. "Doctor Wernher asked for you. You're needed in the ED. They have a severe burn victim who needs to go to Columbus by helicopter, and you're the only qualified flight surgeon on duty."

"OK. I'll let Doctor Roth know, and Lauren and I will put on scrubs, then head to the ED."

She acknowledged me, and I went back to the table.

"Owen, they need a flight surgeon to take a patient to Columbus, and I'm the only one on duty."

"Why are you standing here?" he asked with a smile.

"I figured I should tell my boss I was going for a helicopter ride before I did it! Lauren, let's go."

"I'll take care of your trays," Shelly offered.

"Thanks."

Lauren got up and followed me to the surgical locker room so we could put on scrubs.

"I've never been in a helicopter," she said.

"Please tell me you don't have a fear of flying."

"No, but my dad says helicopters come off the assembly line with the single-minded goal of killing all their occupants."

"Ex-military?"

"Marines," Lauren replied.

Once we had put on our scrubs, we went down to the ED and found Mary with Dutch Wernher and Mai Liu.

"Hi, Mike," Mary said. "Male, no name; twenty-nine; rescued from a fully involved structure fire by paramedics; 50% full-thickness burns, mostly arms and torso; smoke inhalation; hypotensive and tachy; IV Ringers with dobutamine; intubated; minimal urine in the bag; escharotomy of the chest; BP 80/60; pulse 118; PO₂ 90% via ABG; CO 10%."

"Barely stable enough for transport," I said. "Who's my flight nurse?"

"Kellie."

"OK. We'll get our gear on. When will the chopper be here?"

"Five minutes."

"Then we'll meet you upstairs."

I led Lauren to the locker room, where the helmets and jackets were kept.

"Put on a dark blue trainee jacket and a helmet," I said. "A small helmet and medium jacket should be right for your build."

I put on a large red jacket with 'Flight Surgeon' emblazoned on the back.

"Leave the radio wires dangling over your left shoulder," I said. "Fasten the chinstrap and pull it tight, but not too tight."

She did as I instructed, and after I checked her helmet, we headed for the elevator to take us to the roof.

"What do I do?"

"Same as me! Watch the monitors and enjoy the ride."

"Seriously?"

"So long as the patient doesn't code, that's it. If he does, I'll tell you what to do. Kellie is very experienced.

"I am!" Kellie declared, joining us in her light blue 'Flight Nurse' jacket. "Is this your first flight, Lauren?"

"First flight in a helicopter, too!" Lauren declared.

"Her dad was a Marine," I said.

"So she was taught helicopters have but one mission, right?"

"Yes," Lauren said. "He had a couple of hard landings, but he was never hurt."

"Doctor Mike and I had an engine-out emergency landing," Kellie said.

"What happened?"

"A gasket seal separated and caused an oil leak, which caused the engine to seize. We landed on a ball field on our way back from Columbus."

"Wonderful," Lauren said apprehensively.

"It woke Mike out of his nap!" Kellie said.

"Nap?"

"I've slept on every flight back from Columbus," I said. "All of them were during long shifts."

I heard the rotors, and the helicopter came into view about twenty seconds later. It landed on the pad, and the co-pilot jumped out to open the door just as the team from the ED pushed the gurney out of the elevator. We loaded the patient, then got in. I helped Lauren connect the communication wires and showed her how to use the mic button and how to switch to the medical comms channel, but had her keep it on the crew comms channel for our departure.

The flight to Columbus was uneventful, and our patient, who had, at best, a 50/50 chance of survival, remained stable throughout the flight. We turned him over to the team from the burn unit, then climbed back into the helicopter for the flight back to Moore Memorial. I closed my eyes and napped, even though I wasn't particularly tired, because it was what I had always done. The return flight was equally uneventful, and we landed safely on the helipad.

"Write this in your procedure book," I said to Lauren as we took the elevator down to the ED. "Four more and your MD, and you can be signed off as a flight surgeon."

"How often do we have these?"

"Not nearly as often as when I was a First Year," I said. "Now it's only burns; before, it included anything that needed extensive orthopedic or heart repairs, which we couldn't do here. Now, we can do most of those. We'll still send severe burns to Columbus after we have Level I certification because specialized burn units are complex and expensive, and we can't justify one here."

"Do we receive patients by helicopter?" Lauren asked.

"About four a month," Kellie replied. "Mostly from adjoining counties."

"We'll actually have more once we're a Level I center; now they send people to Columbus, Dayton, or Cincinnati."

We reached the ED, and Lauren and I hung up our jackets and helmets. Once we'd done that, I filled out a transport report, which I handed to Nate. He checked it and pronounced it 'complete', so Lauren and I went up to the surgical locker room to change out of our scrubs. When we were dressed, we went to the lounge, where Lauren filled out her procedure book, and I signed it.

"What did you think?" I asked.

"I was a bit freaked out at first, but then I just watched the monitors and didn't think much about it until we landed. On the way back, I watched out the window while you slept."

"One thing you should learn during this year is that you sleep whenever you can, because you never know the next time you're going to be able to sleep. That's super important on your twenty-four-hour shifts as an MS4, and even more so if you Match at a hospital that has thirty-six-hour shifts, which most still do."

"That sounds like what my dad said about Marines — when you have the chance to sleep, you do it because you never know what's going to happen next."

"Doubly true for me because I'm carrying the pager, but so far I've only been paged in the hospital."

"What are you on call for?"

"Mostly the ED, but also weekends and nights if there's an emergency surgery. Of course, now that I've said it, I'm going to get paged in the middle of church or something."

"It always seems to work out that way, doesn't it?"

"Yes, it does."

September 18, 1990, McKinley, Ohio

The second tour by students from Harding High was on Tuesday morning, as I was in the ED. This group included Ben Olson, Debbie Sanders, Stacy Holmes, Vickie Johansen, Mallory Liston, and Ken Jones.

As I had with the previous group, we started in Pathology, but this group had the fortune — or misfortune — to see part of an autopsy. It almost reminded me of the Dirty Harry movie, The Enforcer, or the opening sequence of Quincy, M.E., with three of my High School Juniors nearly losing their breakfasts. Fortunately, they kept them down, and we went to the ED lounge so they could sit.

"A fair warning," I said. "During First Year, you'll conduct a complete dissection of an adult human cadaver. And I mean complete, including genitals. If you can't handle it, you cannot become a physician, as it's a required course."

"Are they mostly old people?" Ken asked.

"It's a mix. My study group's cadaver was a young woman named Caitlin Todd. She was thirty-two, married, a homemaker, and a mother of two. She died of complications due to ovarian cancer."

"Whoa!" Mallory exclaimed. "And you, like, dissected her?"

"Completely."

"How do you deal with that?" Debbie, one of the students who had become nauseated, asked.

"As I said back then, 'Doctor Mode' is the only way through this. That means turning off your emotional reactions. As my professor, Doctor Sparks, said, it's a skill you need to learn, as it's the only way to get through that part of your training. It's doubly true for anyone who wants to be a surgeon, quadruply true for anyone who wants to work in an Emergency Department.

"If you can't handle a toddler dying in front of you, or the results of a car versus train accident, or severe burns, or examining rape victims, emergency medicine is not for you. You can get through medical school with only a single ED rotation if you want to practice family medicine, or something like dermatology, psychiatry, or oncology. That last one, though, is rougher than a bloody trauma or a patient with full-thickness burns — what you would call third-degree burns.

"The true heroes in medicine are oncologists, especially pediatric oncologists, because the vast majority of their patients die. Things are improving, and leukemia is no longer an effective death sentence, but so many other forms of cancer are, in effect, untreatable, except to slow them down. Pediatric cancers are one of the most evil things I can think of."