FEATURE
The patient’s eyes are now open, he is confused, I do not see signs of head trauma,
though possible intracranial bleeding is anticipated. Primary survey is unremarkable: good
breath sounds, strong pulses, pelvis stable, GCS 14 (less for confusion). I complete the
FAST exam while the radiology technician steps in to perform a chest and pelvis X-ray.
The FAST shows no free fluid and the X-rays are negative for obvious acute pathology.
We roll the patient off the backboard, cut off all remaining clothing and complete a
secondary survey. The EMS crew, as well as the whole Room 9 team, are astonished by
the remarkably intact physical exam. Excepting some dirt scuffs on his clothing, and a
self reported headache, there is no evidence of any trauma at all. There is not a single area
of palpable tenderness, no lacerations, no ecchymosis—not even an abrasion. Unable to
rule out internal injury, and that shock is diverting his nociceptive stimulus, he is rolled
from the trauma bay to the CT scanner.
In an accident mechanism which usually ends up with a patient immediately taken
to the OR in good situations, or, more often, dying in Room 9 —this young male being
stable enough for CT was remarkable in itself. Upon returning from CT, the patient was
wide awake, headache had resolved, and although he could not remember the accident,
he recalled everything leading up to the event. Repeat physical exams revealed the same
benign initial presentation. Full CT man-scan revealed no intracranial bleeding, no
fractures and no solid organ injuries. Three hours after arrival, he walked out of the ER,
back to his family.
In mulling over the accident in my head, I can see him falling asleep, waking up at 75
mph, veering off of the road. Upon realizing the situation, he overcorrects the wheel and
sends the car into a cataclysmic death roll while he was unrestrained. I imagine he loses
consciousness as his head contacts the roof of the car.
The rest is a blur and does not make any logical sense. It’s almost as if an angel paused
time in that instant, when the car begins to cascade through the air, opens up the wind-
shield, and picks him up out of the car, resumes time and when all is over, gently rests
him down in the grass on the side of the road. Maybe he never even hit his head and
unbeknownst to him, he was protected by something we cannot understand, for a pur-
pose that we can never know.
I cannot explain the miracle that happened that day. I do know I was fortunate to witness
something rare and incredible. I am also grateful I did not have to watch another healthy
person die suddenly over a single momentary lapse or wrong turn. And I am happy I did
not have to tell a young mother that her son is now dead.
I am thankful the bugs are gone. I pray the man with the swollen face follows up and
gets what he needs, and I hope he lives a wonderful life and is able to do something great
with his second chance.
When things are tough, I try to remember these people. In a profession like medicine,
we can all learn a lot from their bravery and grace.
Dr. Ferguson is a Emergency Medicine PGYIII.
OCTOBER 2017
17