Call shift.

I’m in-house overnight, things wind down by eleven or midnight or whenever. Brush my teeth, tuck myself in. I finally fall asleep at like one or two AM and sleep for a good thirty minutes then the pager starts buzzing and ringing in the most god-awful tone imaginable. Ah. Fuck.

Sigh once then spring out of bed, throw my shoes back on.

Pager says: ANESTHESIA STAT OR 5 LEVEL 1 TRAUMA OR 5.

Ok ok ok let’s do it. I don’t need caffeine to wake up when the stakes are high. I live for this shit. Trauma foxtrot, draw up the drugs, open the airway stuff, whatever let’s go. My hands can move without thinking about anything. Spiking bags, drawing up drugs, throwing in lines. I am a robot of excellence.

HEY—you got the airway, I’m gonna do lines.

They bring the patient in the room and he’s bleeding everywhere and I scan him for a second. He’s young. Young young. Tibia snapped like a wooden stick, white bone sticking out, bright red blood oozing around it. That was an afterthought.

Push the drugs let’s go. CRNA intubates him, I throw in an arterial line and a right internal jugular central line, let’s go, this is what I trained for. I start yelling MTP MTP MTP. Let’s get an ABG, INR, fibrinogen, lactate, ionized calcium. Let’s go.

Pressure is in the toilet. Hey man throw some Levo up there. Load up the rapid infuser, just start throwing in blood products. Packed cells, platelets, plasma, there’s a pool of blood on the floor and it’s getting bigger. We need more products NOW, get me cryo, K-CENTRA, he’s bleeding through his eyelids, we’re in DIC—FUCK.

Get cryo please or fibrinogen concentrate.

I’m yelling MTP MTP MTP. Keep it coming, come the fuck on. Round after round after round. The surgeon removes one of his lungs because it just won’t stop bleeding, there’s nothing else to do. Kitchen sink. Just bring every product in the hospital for Christ’s sake.

I take a step back. CRNAs are handling the handwork. His name is in the chart now. He’s young. I look him up on Instagram. Yep that’s him. Popular guy. Athlete. College kid. Girlfriend. They looked cute together. I’m looking at his Instagram, all these good memories with his family and friends and girlfriend.

What the fuck dude.

He was supposed to graduate in a couple months.

How could you do this you dumbass, people care about you, come on, hold on, we’re going to fix you, we’re going to save you. Hang on man, you stupid fucking kid just hang on.

Around me everyone’s moving fast. Surgeons yelling for instruments. Our anesthesia team is doing all they can.

I take the tape off his eyes. Lift his eyelids.

I look at his eyes and I feel sick. His pupils are completely blown. I lower his eyelids shut. Step back. The surgeons are furiously trying and reaching for instruments, trying to get a grip on the bleeding. CRNA loading the Belmont like a belt-fed machine gun.

I’m watching it all. And for a moment I try to catch my breath. Everyone’s working so hard to save this kid’s life.

But I know.

It’s over. He’s dead.

How long can I play this game.

How long do I watch people try before speaking up.

It’s over.

I mutter the surgeon’s name. I really don’t want to say anything.

He doesn’t hear me.

I raise my voice. Yell this time.

STOP.

His pupils are blown. We can’t keep his pressure. We have to talk about this. We have to call it.

FUCK, he screams.

“Should we call it?”

Ah I mean…

“Should we call it?!”

I close my eyes and sigh. It’s not my choice. He puts down his instruments and looks at me—“Should we call it?”

It fucking sucks. Every day and every hour I studied and every year of training and everything I prepared for and sometimes there’s just nothing anyone can do. When it matters the most. There’s nothing left man. It fucking sucks.

“Yeah. We should call it”.

Ok. Time of death is 4:34 AM.

I look back down at him. So young and so much left to do and so much to experience.

“Yeah. We should call it.”

We watch his heartbeat go down and down and down and the surgeon tells me to keep the epi and everything going so he can be alive for one last time for his family to see him.

Sure. We can do that.

We close up shop. Wheel him to the ICU room. Hook up the monitors and whatever.

The CRNA takes the transport vent and supplies and leaves and goes back. I should’ve left too but I felt this sick urge. I had to hang out and stick around to watch. I have to see the family look at him one last time.

I stood there lurking in the shadows in the corner of the room. I have to know this was a real kid. I have to know he was a kid who meant something to people and had dreams and hopes and everything. A crush. A favorite sports team. Best friends. He was real. I know he was.

I have to see.

They bring the family in.

His mom is shrieking in the most guttural horrific way. I will never forget her screams. His dad dropped to his knees sobbing at the bedside.

I’m leaning against the wall watching this all. He was a real kid. Someone who had people waiting for him to come home. Someone who had dreams and plans for a life he never lived. I think about my brothers. My friends. Myself at twenty-two. I am so sorry.

I’m sorry I couldn’t do more.

There is more horror in this life than I can comprehend sometimes.

I can’t think about it.

But I have to know it exists.