My Night on Call…Fight or Flight

It’s 3 a.m., and I am 6 months into my first registrar job in the UK at a major trauma centre in London. Being a general surgery registrar is difficult, especially at a busy trauma centre. It requires a whole set of new skills: decision-making, prioritisation, and leadership. After sorting out all the jobs remaining from the day team and admitting a few patients, I was about to get some rest when my bleep started screaming again. 

The A&E microphone was calling for help in the resuscitation area with a patient who might need a thoracotomy; how interesting and how lucky I am to work in a place with Cardiothoracic surgeons on call! We went there, driven by curiosity, to watch a thoracotomy. I walked into the cubicle and saw the A & E consultant, whose face I will never forget when he looked at me and said: “This patient is 23 years old, stabbed in the abdomen and is exsanguinating. He needs to go to theatres NOW”. 

I glanced at the monitor, showing systolic blood pressure of 60 and blood on his abdomen with a stab wound about 4 cm long. Red blood bags and lines running through his arms. My adrenaline levels skyrocketed. I called my consultant, woke her up, and told her this patient needs to go to theatres now! She said, “I am on my way.” I can easily say these were the most stressful moments in my career until now. It’s a new place for me, a new culture, a new hospital, and I must do something to save this patient. Looking around, I realised I was the most senior surgeon in the room. My brain and heart were racing; where is the bleeding coming from, what will I do, what do I need to do before scrubbing? I asked the scrub nurse for a knife, big scissors, and tons of packs. Luckily, I did my Definitive Surgical Trauma Skills (DSTS) course with RCSEng 3 weeks ago (a course for ST6 to ST8 level). Fine, I will follow the principles: laparotomy, packing, and wait for my consultant to arrive. I will stand to the patient’s right to pack in a systematic way. But I am left-handed, so I usually stand to the left for better control. It might be the spleen bleeding, so I need to pack systematically, starting from the left upper quadrant. So I decided to use my right hand. I looked at the anaesthetist for one last time, and he said, “you need to start.” 

I managed to enter the abdomen with a full-length midline laparotomy in less than 30 seconds. Diving in a blood pool while sucking out as much as possible, I packed every quadrant and put some pressure on it. I looked up to the anaesthetist, took a deep breath, and asked about the blood pressure. At that moment, my consultant walked in and asked what did you do? It had been about 30 minutes since I called her. The most difficult and stressful but satisfying 30 minutes in my short career. 

We spent about another hour controlling the bleeding from the bowel and closing a hole in the IVC. The feeling I had after leaving theatres was indescribable. The patient left the hospital on his feet 30 days later and paid a donation to our hospital to help surgical trainees attend the DSTS course. At the end of the day, I could proudly say I saved a life today!