Trauma Night

Have you ever noticed that you and your co-workers sometimes speak in a special type of code; or in terms that most people wouldn’t recognize? Take us, here at the City Weekly, where you might hear things like this on a given day:

    “Is that in-house bus crawl ad an eighth or a quarter?”

    “Did Blice send a jpeg of ‘Pirates’ that we can use for the second theater piece?”

    “Dude, this f**king computer!”

    “Got the spins again? Tried to open InDesign on that piece of crap, didn’t you?”

    “Why does she always lead her stories with a quote? Plus, she buried the lead again.”

    “There’s no way we’re going to fit 2,200 words in that hole.”

As you can imagine, those who work at a trauma center in an Emergency Department have their own language, too. Here’s a sample of what we overheard during a visit to the University of Nebraska Medical Center last Friday night and into early Saturday morning:

“Someone page ortho.”

“Tell me your mom’s name?” (a gurgle) “What’s your mom’s phone number?” (a moan)

“Just tell them the transfer is here.”

“Hey, ortho wants to talk with you.”

“Where’s his film?”

“Mom’s in route.”

“Where’s the ATV patient?”

“This is a minor – who are you?” (directed at our photographer in the trauma center)

“Make this happen, man. Make this happen.”

Interestingly, in our four hours there I didn’t hear anyone say “stat,” the abbreviation of the Latin statim, which means “immediately.” They say “stat” all the time on “E.R.” Then again, this wasn’t a TV show.

Trauma at UNMC

Like all hospital Emergency Departments, UNMC now has a police officer on duty 24-7, along with the hospital’s security. You also must enter through a metal detector.

Last Friday was a trauma night for UNMC. The hospital shares trauma duties with the Creighton University Medical Center. On Mondays, Wednesdays, Thursdays and Saturdays the area’s shooting victims, people who get foreign objects (whiffle balls, dildos, flashlights, light bulbs, etc.) stuck in their rectums, car accident victims, people with serious psychological issues, people with traumatic injuries, etc., are sent to Creighton. On Sundays, Tuesdays and Fridays, those cases go to UNMC, which opened a new E.D. in 2005.

During large casualty situations, such as last year’s shootings at the Westroads’ Von Maur store, the two hospitals share trauma duties.

At UNMC’s trauma center there can be up to 25 doctors, nurses and technicians working the room, with additional staff on call. On an average year, UNMC handles about 550 cases, including all stroke victims, which are brought to UNMC regardless of which hospital has trauma duty.

Among the trauma patients the night we were there included a man with a broken leg, a result of an ATV accident; a man who robbed a downtown Omaha liquor store and, while running away on foot, fell off a 30-foot wall near the W. Dale Clark Library, massively crushing his shoulder; and a male car accident victim with a head injury.

The heartbreaker of the night involved two patients flown in from Crescent, Iowa, to UNMC via a LifeNet helicopter at 140 mph. The first to arrive was a 4-year-old girl. Her and her mom had been in a car accident in which their vehicle was T-boned by another car. The little girl, with a broken neck, deep facial lacerations and 15 medical staff hovering over her, was conscious, and periodically called out for her “mommy.” One of the Emergency Department physicians appeared in seconds with a teddy bear.

The girl’s mom came in on LifeNet a few minutes later. She also had a severe neck injury, as well as a brutally broken ankle. Both are expected to survive.

A different breed

By now, it should be clear that the people who work in emergency medicine are made from a different mold. The doctors at the trauma center aren’t like your regular docs. They don’t have time to mess around or mince words. Instead of asking, “Billy, I heard you have a tummy ache. Where does it hurt?” a trauma doctor might instead ask:

“Billy, why in hell didn’t you tell me you have a dildo so far up your ass that it’s knocking at the door of your spleen? I know you’re embarrassed but you could have told me that before I ordered an x-ray and wasted valuable time messing around with you.”

That – the event, not the dialogue – actually happened to a patient of Dr. Darin Jackson, a 14-year veteran of emergency medicine. He said the young man in his 20s came in with his mom and was reluctant to say why he was having such severe abdominal pain. Of course, a large dildo was the culprit.

“It had worked its way all the way up to his spleen, all the way up the left upper quadrant of his abdomen,” Jackson recalled.

“I thought they were going to have to take him to surgery but what they ended up doing was, in this particular case, was they gave him some this fluid, which makes you have tons of bowel movements and he ended up passing it naturally.”

I had to ask: Was there a lot of screaming involved when said dildo exited said butt?

“I don’t know, man,” Jackson said. “My shift ended and I was out of there (laughing).”

Humor, joking, laughing, surprisingly is a noticeable part of the atmosphere at UNMC’s trauma unit.

“I think there’s a lot of dark humor; it’s a defense mechanism to keep from dwelling on the severity of some of the things we see,” Jackson said. “We are a fun group, and we do like to have fun at work, but when it’s time to get down to business we get down to business. It’s a family. In that particular setting everyone has to know their job and I’ve got to trust that you know what your job is. It’s a tight-knit group.”

But no mater how hard the staff in the Emergency Department tries, there are cases that they no doubt take home with them. Jackson said he once had a case where a young child was in a car accident and ended up under his care in the trauma unit.

“He looked like one of my kids and he kept asking for mommy,” Jackson said. “And I knew that his mom was dead. It was a car accident; mom was dead on scene.”

Jackson, who served as a trauma doctor for a year in the field in Iraq, said he had to “take a lap” after that one.

“As a defense mechanism you almost have to keep your emotional distance,” Jackson said. “I’ve explained it to my wife, we almost have to, even though we know they’re humans, we have to almost treat them like a machine to stay focused and objective.”

War trauma vs. civilian trauma

Jackson served in the war in Iraq between 2004 and 2005, and he said he saw a “career’s worth of traumatic amputations.”

In my civilian life, I’ve only seen in 14 years two traumatic amputations, and I can’t even count how many I had over in Iraq,” Jackson said.

One of the most frustrating things about trying to save lives in Iraq, Jackson said, was knowing that many of the patients lost in battle could have been saved had they been taken to an Emergency Department like UNMC has.

“When I was in Iraq, several of the guys who I ended up taking care of I knew, and one in particular … I can talk about it now, because it’s been few years, but early on when I got back I didn’t even want to think about it.

“A buddy of mine, our company commander, was shot and killed and we took care of him. And I knew that had I been back home we probably would have had a good chance of saving him. We could have cracked his chest and taken care of the business the way we would have taken care of it here in a trauma center.

“But where I was in Iraq I didn’t have the support or the tools to do that, and he ended up dying in the O.R. a couple of hours later after we had flown him to the hospital. That was a really tough to deal with. That was hard.”

Back at UNMC

Warm weather, paydays, long weekends and, yes, even when the Cornhusker football team loses – these are times when the emergency department sees an increase in business from alcohol-induced situations.

Emergency Department physician Dr. Chad Branecki, who joined the UNMC faculty in 2007 after he completed his E.M. training at UNMC, confirmed that it’s true that domestic violence cases spike after a Husker loss.

However, the common cases include alcoholics with the DT’s, chronic pain issues, headaches, chronic abdominal pain, etc. Some of the more tricky patients come in the form of PCP users.

“They’re kind of hyper, kind of wigging out, paranoid,” said Jackson, who works 14, 9-hour night shifts each month. “They can be easily agitated if they aren’t already agitated. What we try to do, which is kind of hard to do in that setting, is get them to a quiet room, a more peaceful setting with the least amount of agitating factors. And there’s medication we can give them to calm them down.

“More common are the psychotic patients, who once they are committed realize they can’t leave, and that’s when emotions can run high and they tend to get combative.

Has Jackson – a high school wrestler at Papillion-La Vista (class of ’85) – ever had to throw down with a patient?

“I have. It’s not recommended; you try to let the security do their job, but sometimes when they might not be there yet on the scene, you have to do what you have to do.”