Friday, April 3, 2020

"Bugle Notes" - The Accident

It was a beautiful Spring day. My wife and I were returning from UNC-Chapel Hill after visiting our oldest son. Driving on Highway 54, I suddenly saw a young woman on the left side of the road frantically waving her arms and screaming. Behind her, a pickup truck had crashed into a tree. I immediately stopped the car. That’s when I saw him. Lying, unmoving, on his back was a young man in his 20s. I quickly ran to him. He had significant head trauma. There was a large, gaping, right parietal skull fracture. His brain exposed. He was bleeding from his nose, mouth, and ears. Surprisingly, he was breathing and had a pulse. A few feet away, his girlfriend screamed hysterically as my wife tried to calm her.

 A woman appeared on the opposite side of him, quickly saying she was a nurse. At that moment, he stopped breathing and what was real suddenly became surreal. What do I do? Do I start CPR knowing I would expose myself to his blood and the potential risks that carried? Do I do nothing and let him die, his distraught girlfriend standing over me? Memories of the scores of HIV infected soldiers I cared for in the Army during the mid-1980s came flooding back to me. All died horrible deaths from AIDS. I had to make a decision. Everyone was waiting - the young woman, the unknown nurse, my wife, and now several newly arrived bystanders - all waiting to see what I would do.

 I gave him two breaths. The nurse started chest compressions. With each breath, my blood exposure increased, yet I continued. Why? That question came later. Later, after the EMS arrived and took over; after a kind woman took me to her home to clean off the blood; after I returned to the site - the man, the girlfriend, the ambulance no longer there; after the surreal became real again. Did this really happen? My thoughts returned to those soldiers….  

From my car, I called the ED at the hospital where I worked. I relayed what had happened to the ED physician, a good friend. He was waiting for the patient to arrive as EMS had called with their report. He told me they would do all they could. He quickly added he would get the necessary blood tests and call me as soon as they returned. As I waited for his call, my thoughts went back to my family. Any fear or anxiety for myself were replaced by fear of what this could mean to my family should I become infected.

Did I do the right thing? Does a patients’ needs come before our families, ourselves? My years of education, training, and practice said yes. What would my family say? My wife was there. I did not ask her. I just did it. I believe I did the right thing. I would not question anyone for choosing otherwise.

 The call came. He died. His HIV was negative as were subsequently all the other tests. The next day I bought a portable CPR mask to keep in my car.

Andy Lamb, MD

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