That day encoded itself in my memory as an example of why trauma nursing doesn’t only refer to the patient’s trauma. It’s a shared experience to everyone involved, like a bomb explosion, affecting first responders who initiate resuscitation efforts – they witness the wreckage first-hand with accompanying smells, sights, and sounds. Next in line is the hospital personnel. Lastly, it’s the family and loved ones who absorb the final waves of the blast – trauma doesn’t ask to fit itself neatly into their calendar. It’s a disruption that obliterates safety and trust in the normalcy of life leaving behind a wound.

The situation was deemed a “traumatic code” meaning the probability of mortality was high

This particular emergency department work shift buzzed with high acuity and volume of patients, coupled with a staffing shortage. Doctors, nurses, and techs huddled around a radio call from the helicopter medics who were bringing in a man, approximately in his 20s, pulled from a car wreck, and they were ten minutes from the hospital’s rooftop. The situation was deemed a “traumatic code” meaning the probability of mortality was high. We knew it was bad and only had ten minutes to prepare the trauma bay. Our training and instincts kicked in. Blood was ordered STAT (immediately) as he’d likely need many infusions for survival. We were going to fight death for this young man the best we could.

The rest is a blur, quite frankly, except for specific moments. The trauma bay was full of more medical personnel than needed because this was a teaching hospital, so interns and students were eager to watch and learn. Urgency laced with hope overshadowed the surroundings as only a miracle would save him, and everyone wanted to see a miracle.

 I stood to the left of the patient, as the primary nurse, and vividly saw his insides

Thoracotomies are surgical procedures that give access to organs in the thoracic (upper chest) area. They are fairly rare occurrences in the setting of the emergency department (ED) because it’s something that should be done in a controlled, sterile environment of the OR (operating room). They are considered a last-ditch, heroic effort when utilized in the ED. Some tactics in a traumatic code include manually squeezing the heart because it won’t beat on its own, or removing pressure from blood and fluid around the heart due to injury. For these reasons, it was decided this man needed a thoracotomy.

The trauma surgeon made the cut from the left lateral position. I stood to the left of the patient, as the primary nurse, and vividly saw his insides. In a moment he’d been opened up in hopes of granting him back his life. All other attempts had failed including the multiple IV lines of fluids, blood infusions, life-saving drugs of epinephrine, and other vasoconstrictors to get his deadly low BP up to a sustainable number. The surgeon reached into his chest, pushed his lung aside, and squeezed the man’s heart at approximately 60 beats per minute. Blood flowed down from the bedside and pooled onto the floor by my feet. Meanwhile, replacement blood got pumped through an infusion machine at 1 unit per minute. About ten minutes of this excruciating procedure had passed, but it felt like a lifetime.

Then, the lead trauma doctor “called” it. We had to accept this man’s fate.

Everything went silent in my mind. I felt anger born from deep sadness. There were about thirty masked people in the room, their eyes mystified, scared, anxious, filling in the blanks of how each other felt. I suppose some pictured one of their own on the table. I had to exit the room, leaving a dead man behind, as I had done many times before.

The memory of watching the color fade from his body stuck.

This is part of trauma nursing where you turn off emotions to process them later (if you can even dig them up) and chug on to the next patient. I had signed up for this. The memory of watching the color fade from his body stuck. I noticed a blood drop on my shoe, a physical reminder of the experience which I held for the rest of my shift, and years after.

One minute beads of sweat are rolling off my forehead as I shout orders like, “I need an 18 gauge! More saline! How is the IV? Is the fluid running ok?”, and the next minute I’m taking a report from a medic for a patient with knee pain! Trauma nurses are expected to remain present, compassionate, and happy to serve without signs of frustration, grief, or anger. We aren’t supposed to have regular needs like bathroom breaks for hours on end, or lunch.

His own rift and deep loss moved me, like a vacuum of utter finality – where second chances vanish forever.

I gazed down at the “knee pain” report and noticed the blood drop stain dried on my shoe. I had no time to wipe it off, accepting it as just a normal part of my day at the office. My anger at the “system” surged. Trauma nurses were set up to fail with inadequate support and understanding. Yes, we were angry and grumpy moving from one bloody battle to the next without expressing our true emotions. Yet we learned to cope with the type of sarcasm that only a “seasoned” trauma nurse knows – proof you had been in the death trenches many times.

But even worse than death, is the aftermath. I saw for a brief moment, while performing the rounds in between one crisis and the next, the father of the young lifeless man slumped over his son in the trauma bay, crying. His own rift and deep loss moved me, like a vacuum of utter finality – where second chances vanish forever. No more “I love you”, and no more “do-overs”. It was the beginning of his grief marked by the completion of a chapter with his son.

That night I lay in bed with adrenaline flooding my body. Trauma nurses don’t clock out when their long shifts end. They often go home to replay the day’s scenarios with no off button. Some scenes linger for days, or months, as though hard-wired on the brain. “Just relax” becomes an annoying pat phrase that rolls off the tongue of someone ignorant to the weight of it all.

Trauma may even affect our physical appearance like the deformity due to an accident

That blood stain never fully washed off my shoe leading to many perspectives and perceptions. Many of us carry memories of trauma in our lives, often forgetting one for the next while the physical signs stay with us in the form of unprocessed emotions. Trauma may even affect our physical appearance like the deformity due to an accident, exposing evidence of a past hardship begging to be dug up and given its proper attention. Trauma nurses often drag strainful experiences to the next room, patient, job, and everything else. We work hard to put on a face and still act professionally, like having a casual conversation with someone in front of us, while under the surface wanting to scream, “Don’t you see the blood? Is what you are saying really as important as this blood?”

With a lot of grace, compassion, and willingness to sit in these spaces with others we find that we all have the “blood drop” of anguish to one degree or another. Although I didn’t see it on that horrible day, I realize we don’t have to die or be near death for one person’s hardship to elevate above someone else’s. Pain shapes how we see death and creates a new tolerance and threshold for stress. We grow, change, gain new perspectives and learn our limits. When your perspective becomes relative to knowing the love of God you know that all people matter to him equally.

Christ understands trauma, perfectly. I imagine as He hangs on the cross, a blood bead rolls through his brow, down his nose, landing on my shoe. He doesn’t erase the memory of the patient but shares it with me in this present time, allowing me to silently remember how He allowed His own death for our salvation. Stillness comes in the act of His one blood drop.