Going into my third year of medical school, my goals were simple: survive and figure out what I wanted to do with my life. My first clerkship was surgery, and what a chaotic start it was. I often felt like a burden on my team. I knew nothing and asked the exhausted, busy residents a lot of questions. I was a walking ball of anxiety those first four weeks: How many questions was too many? How many questions was not enough? I wanted them to think that I was interested – because I was. I was so, so interested. But the MS4’s warned me not to annoy the residents, and I was trying my best. So I sat back and observed for the most part, keeping a running list of topics in my mind to read about later.
When you start medical school they tell you that it’s like drinking water from a firehose, or eating a huge stack of pancakes every day or whatever analogy your medical school likes to say to represent the enormous amount of information we learn every day. I hadn’t felt that feeling since I was a MS1. But on my surgical rotation, that feeling came to me once again. Except this time, it wasn’t like drinking from a firehose at all. My trauma surgery experience was like drinking from Niagara Falls and getting that infamous brain-eating amoeba.
Those four weeks I spent on trauma taught me a lot about medicine, but more importantly, about myself. The fast-paced environment left little room for debate, and helped me become more confident in my knowledge. And once I discovered that being in the operating room (OR) at 2 a.m. was exhilarating, I realized that surgery was the specialty for me.
Between all the exciting level-one traumas and ex-laps, real people were going through the worst day of their lives. There are many patients that haunt me still – like the little boy shot in a drive-by shooting, the older woman in a car accident who didn’t make it and the 6-week-old baby who was abused to the point of a subdural hematoma. Even worse, the patients who weren’t with us long enough to even know their story. I cried for them, mourned them. It was the children that affected me the most and made me swear off pediatrics forever.
But the patient that I’ll tell you about was fine. At least, from a medical perspective.
It was a quiet night, about 10 p.m., and I was sitting in the pit doing practice questions. Music was playing quietly, a sweet indie love song that made me feel relaxed. But then the pagers came to life, breaking through the calm atmosphere with grating beeps. “Level two, MVped,” the resident said.
I jumped up and headed to the bay, my trauma shears in hand. MV vs. ped, meaning motor vehicle vs pedestrian. Someone got hit by a car. These usually weren’t that bad, but I’d learned to temper my expectations before the patient arrived.
EMS rolled him in and we transferred him to the bed. While the resident ran through the ABC’s, I cut his clothes off and felt extremity pulses, 2+ throughout. Now assured he wasn’t actively dying, we were ready to hear the story.
EMS told us he was homeless and wandering around on the street when he got hit by a car. His vitals had been stable and there was not much else to say about him. He was here because his leg was broken. We got x-rays, a CT scan and consulted ortho.
Once he was put into one of the rooms for safekeeping, someone grumbled something about him probably being drunk, and others agreed. My mouth opened to protest that he seemed pretty sober to me, but the thought died on my tongue. It wasn’t really my place to say anything. Or maybe it was, but as a newly minted MS3, I didn’t have the confidence.
Things slowed down after that. So I gathered all my supplies to clean his wounds and went to him, a gentle knock on the door to let him know I was there. I took my place beside him and introduced myself, which was barely acknowledged by him with only a grunt. He was a little short with me as I requested his permission to dress his wounds, but I didn’t blame him for it. I’d be grumpy too if I had been hit by a car.
Several minutes passed with neither of us talking. Only the sound of the monitor beeping and his groans filled the silence.
“How’s your pain?” I finally said, using wet gauze to free the pieces of gravel and rock from his flesh.
“I’m fine,” he grumbled. His eyes were closed tightly, his face curled up in a grimace.
“Really,” I said, my voice gentle. “If you’re in pain, we can give you more medicine. No need to be a hero.”
“I don’t need it,” he said, more firmly this time. I nodded and decided not to press the issue anymore, despite his heart rate being high and the way he jerked as I scrubbed away at his wounds.
A few more minutes passed and I finally finished my torture, applied the antibiotic cream and wrapped his intact leg carefully in a bandage. Orthopedic surgery still needed to tend to his broken leg, so I left that one alone.
Something in me hesitated to leave, but I had no reason to stay. I stood there for a second with unused rolls of gauze gathered in my arms, trying to figure out what I was forgetting. I shifted my weight and a few of them fell to the ground. As I gathered them up again, it hit me — the comments earlier bothered me, about how he was probably drunk. In the chaos of the trauma bay, no one had the time to ask him if he was truly “wandering around on the street” or if it was something else.
I took a seat back down next to him. He was lying with his eyes closed, wrapped up in a blanket. He looked so comfortable since I had stopped scrubbing his wounds. I couldn’t help but wonder how long it had been since he’d laid in an actual bed.
“So what happened?” I asked.
He looked at me, his eyebrows raised in surprise. He was silent for a moment, considering his words.
“I was crossing the street and some idiot on their phone hit me,” he grumbled.
“That’s terrible.”
“Yeah,” he said, “They drove off before I could really see anything. Didn’t get their license plate, nothing.”
A hit and run. Anger surged through my body, turning my blood to ice. I couldn’t believe there were people like that, who would just hit a person with their car and drive away. Everyday I spent on the trauma service, the more I believed that good people were hard to come by.
“That’s terrible,” I repeated, like an idiot. My stomach dropped in embarrassment. I’m not good at comforting words.
He didn’t seem to notice or care that I was giving myself an F in bedside manner. He just huffed in response.
“Maybe there are cameras,” I said, a meager offering of a solution.
“Doesn’t matter,” he said. “The police won’t do anything.”
I hummed and nodded my head. I didn’t know that for certain, but who was I to question this man, who has been through so much more than me? He said it like it was a fact, like it had happened a million times before. I was inclined to believe him.
“Well, I’m sorry this happened to you. We’re going to take good care of you,” I said with a smile and a pat on his shoulder. He smiled back at me and muttered a quiet thanks. I left him alone and went back to the pit, his words weighing heavily on my heart.
In the checkout that morning, the patient was cleared for discharge home, pending social work consultation. But can we even say discharge home, when he has no home to go to? No doctor would comfortably say sure, discharge them to the street, but it happens. Unfortunately, doctors, particularly in the emergency department, often lack the time to set up the perfect discharge plan for everyone. So we delegate this task and rely on social workers to work their magic. Despite the existence of excellent outreach organizations, there’s a significant community need to address the care of this vulnerable patient population.
As for this patient, I never saw him again, but I think about him often. He taught me to always talk to your patients, even if the story seems cut and dry. Through healthcare’s game of telephone, some facts may get lost somewhere along the way.
I wish we could’ve done more for him besides cleaning his wounds and splinting his leg, like getting him a home. But we’re doctors, not miracle workers, and we’re reminded of that reality every day.
I just hope that he’s okay.
Image Credit: “F.R.E.I.” (CC BY-NC-ND 2.0) by gato-gato-gato
Contributing Writer
Long School of Medicine- UT Health San Antonio
Kayla Privitt is a 3rd year medical student at the Long School of Medicine in San Antonio, Texas, class of 2025. In 2021, she graduated from Texas A&M University with a Bachelor of Science in genetics. She enjoys writing, camping, and hanging out with her cat and husband. After graduating medical school, she would like to pursue general surgery.