(calm guitar music)
- [Voiceover] It was nice day, blue skies, warm weather.
Spring, so you kinda had the jitterbugs to get out
and do something nice.
Being on a motorcycle is very different.
Kind of freeing.
You were out in the open air.
Joyride, that's what I was doing that day.
- Nick is a roommate of mine.
I had pulled into my house
and literally when I pulled in,
Nick must have been leaving.
The other vehicle didn't see him coming
over the crest of the hill.
They pulled out in front of him.
- [Voiceover] You don't really have time to think.
You lay the bike down, or you hit the car,
but you almost didn't have time to lay the bike down
so your only option was to hit the car.
- [Voiceover] Goochland 911, what is the address
of your emergency?
- [Voiceover] There was just an accident with a motorcycle
and a car at the corner of Cardwell and Broad Street.
An ambulance needs to come fast.
- I turned my volunteer radio on,
and I heard a lot of the commotion on the radio.
- [Voiceover] Attention companies
two and three fire and rescue,
motorvehicle accident, car versus motorcycle.
- It's usually, you automatically assume the worst.
(sirens)
- [Voiceover] Ambulance 20 is en route.
- There was a pretty significant distance from
where the accident was to where he had come to rest.
So, there was a lot of forces in effect.
I recognized his tattoo before I actually recognized him.
And he just looked at me and he just went, "Hey."
Just lookin' at him you could tell he was,
his color and everything, he was bad off,
and he knew it, too.
He was asked what his number one complaint was
and he said his hips hurt.
- His blood pressure was just tankin'.
- Heart rate was through the roof.
It was classic signs of shock.
- [Voiceover] Patient is awake, skin is pale, clammy,
some movement to his hands.
- [Voiceover] Go ahead and get Med Flight in the air.
- We don't carry blood on the ambulances,
and that's really what he needed the most.
That and surgery to stop the bleeding.
- [Voiceover] Nine minute ETA for Med Flight.
- We got him on the backboard, got him loaded,
we started an IV on him, and began giving him some fluids.
And just knew that we had to get him to the helicopter.
Nick's also a firefighter/paramedic,
and he was demanding vital signs.
Definitely wanted to know what was going on.
(dramatic music)
- We stabilized, they had an IV started,
the EMS crew on-scene did a fantastic job
gettin' everything going.
We kept the fluids running, we kept him awake,
gave him oxygen, and we ran to the hospital.
By the time we lifted off and gave our report,
we were landing again.
(intense dramatic music)
- He wasn't answering questions appropriately,
you could look at him and tell that he was very sick.
Very hypotensive, had lost a significant amount of blood.
- So the first thing we do in a hypotensive patient
is look for where the blood loss could be.
In his case, it could either be in the belly, the chest,
or in the pelvis.
- If I don't know the number, I just click it off.
For some reason I answered it.
And it was the nurse.
She said, "Are you aware your son's been flown in to MCV?"
I said, "No ma'am, but you gonna start talkin' now."
- We needed to get another IV in him right away.
That was my job when he came in as a medic
was to draw his labs and to get his second IV
in him if we could at that time.
- Within five minutes of Maxwell's phone call,
I got a call from one of his friends
that the accident had happened.
- Well, motorcycle and car, you know,
you envision everything.
It was tough.
- We dropped everything and took off.
- Based on our exam,
you could feel that his pelvic bones
were not quite in the position where they need to be.
We got the x-ray of his pelvis,
which showed literally a widening of the pelvic bones.
You expect them to make closed circles.
In his case, the pelvic bones were spread apart,
and there's a lot of potential for bleeding
and shearing of blood vessels in that area,
and what we needed to do was close that space
to try and tamponade or stop the bleeding.
(suspenseful music)
So we placed the binder
and we repeated the x-ray of the pelvis
which showed that we were able to indeed compress the space,
resuscitated him with our massive transfusion blood protocol
and what that means is that immediately a ton of blood
and blood products are brought to the trauma bay.
Once that was done,
we took him directly to the operating room
which was the safest place for him to be.
(dramatic music)
- Our heart skipped a beat because the chaplain
came and pulled us together.
It was serious.
(suspenseful music)
- We worried that regardless of which pathway we went down,
he may not do well because of all the bleeding.
So what we elected to do was keep the binder in place.
In the operating room, we performed something called
a damage control laparotomy.
Our goal was to stop the bleeding,
do the minimal amount we could
to control all of his injuries,
and then come back later to definitively take care of
other things which could wait.
While we were in the operating room,
we had the interventional radiologist set up
so that we could seamlessly take Nick
from the operating room
to the interventional radiology suite.
- The trauma team are the quarterbacks in this scenario.
By and large, if they decide they need us,
they call us and we come running.
More or less drop what we're doing
and we open up a room.
Our approach is typically
accessing an artery near the pelvis,
and that was not available in Nick's case
because the binder was there
and we couldn't even loosen it for a little bit
without his blood pressure tanking.
So we had to come from an arm artery
to move down through the chest, through the belly,
and down to the pelvis to work.
And here's an example where the contrast
is clearly leaking outside of the confines of the artery,
but scarier to me on the right,
is where an artery just cuts off abruptly.
That's a clearly abnormal damaged vessel.
Once the abnormalities are found,
the usual treatment in a scenario like this
is using a clotting agent that we can inject
through the catheters into the arteries,
and that'll clot things off and allow the healing to begin.
- The most important thing for Nick's care in those 24 hours
was to stop bleeding.
That first surgical intervention as well as
the interventional radiology intervention
making sure that he got all the blood
and blood products that he needed,
and making sure that we ensure perfusion
in the first 24 hours were key to his survival.
Those are things that need to be done
in an intensive care unit
with clear communication with the team
of nurses, interventional radiologists, surgeons,
critical care, intensivists, doctors,
everybody on the same page.
- [Female Speaker] So this is a 27 year old male who was
on a motorcycle, he was hit by a car--
- Nick is a young, healthy guy,
so, you'd resuscitate him with some blood product
or some fluids and he'd come up and he'd look good
and everybody'd go, "Ahh, okay good,
"we're moving in the right direction."
But then his bleeding continued,
and then an hour later we'd be coming back
in the same position, so.
(melancholy piano music)
- We put on a special dressing
called an ABThera device,
and what this does, it's a big sponge.
It's a window to the abdomen.
So it means that we can see any fluid.
If he continues to bleed,
the fluid comes out into a suction device
and we can see that it's blood,
so that we can address it immediately and go back.
- Initially, you know, the pelvic injury,
the bladder rupture,
he was bleeding from all of those great vessels.
So he had a tremendous blunt trauma force
with the impact.
- Nick was managed by our orthopedic trauma team,
and he had a bad pelvic fracture
and abdominal injuries.
The whole pelvis was shifted out and up.
We put an external fixator
and temporarily closed the pelvis,
which was detached from the spine.
- The orthopedic surgeons were focusing
on his pelvic fractures.
The nephrologists were focusing on his kidney function.
So our job is to take into consideration
all of their recommendations, and all of their efforts
and create one conjoined effort to treat a patient.
- He was certainly critical.
But I think when we, in my mind,
he got through the first night,
and it was a improvement.
- In the first week, we had him
as fixed as we thought he was gonna get,
we were gonna transfer him out.
- And then-- - [Maxwell] Everything
went to hell after that.
- The very next day, he turned jaundice
and it just became a cascade of bad complications,
one after another.
(tense music)
- They did say it was gonna be a roller coaster.
It's gonna improve one day,
he's gonna go down one day,
and we just didn't imagine
what was gonna happen.
- One by one, kidneys went down,
kidneys were affected,
and then the liver joined in.
So there was your jaundice.
- He was real sick at that point--
- [Dianna] Yeah, he was.
- [Meg] His bilirubin had climbed to such levels
that he was delirious.
- Normal bilirubin is about less than two.
His bilirubin was up to the 20's
and we could not figure out why.
We had the gastroenterologist involved,
we had the hepatologist involved,
we have interventional radiology,
we drained his gallbladder,
we optimized the blood supply that got to the liver,
we imaged the liver to see if it was a laceration
or if it was dying, and that's important because
that has an impact on the rest of his organs.
- Once you fix the big problem,
there's always sequelae,
and he was so sick at the beginning
that when you have that degree of critical ailments,
something's gonna happen,
it's just a question of where and when.
- Going into liver failure could have been
an issue with him deciding between life and death.
That was a life-threatening event.
- We are imaging, we are looking at so many different labs,
we're supporting him in every way we can,
and finally it was just like, let's put the lights on him.
- The next thing we knew,
they had bili lights in his room.
Just like an infant with jaundice.
Whether it did any good--
- [Maxwell] It helped you a lot.
- [Susan] But it just, our mindset.
They are doing everything they can do.
- That was actually the first time I had ever seen
a bili light used in an adult patient.
(tense music)
There was concern that he wasn't perfusing his bowel well,
he had profound abdominal pain at one point in time,
concerning for infection, concerning for bowel perforation,
and went emergently to the operating room
to explore the bowel.
- Devastating diagnosis of his bowels
basically going to slough,
and you don't know if it's going to survive.
And they told his parents, Nick was very sick at that time,
and he was sedated, he didn't have any clue
what was happening.
- It was one of those normal days,
he wasn't having a good day,
but we didn't see this one comin'.
(sad violin music)
I mean, it was a bedside vigil that night.
- Everybody was very upset and crying,
and reasonably so.
And I remember seeing his dad leaning over him and saying,
"Nick, son, for once won't you just
"do what your mama says?"
- Can't he get a break?
He needs a break.
- Dr. Aboutanos said he's not playing by the rule books.
This is not the usual course.
- We look at labs together, we look at x-rays together,
and we had hard conversations sometimes.
Multiple times we discussed the possibility of him
not surviving.
- His parents were always at the beside.
- Yeah.
- One of them was always there.
- [Dianna] They were amazing. - [Meg] And they were
writing things down, and calm, you know?
But just wanting answers and wanting to know
what we could do.
- All you could do was rely on your colleagues
and everybody's expertise,
and that constant vigilance of, this is a small change,
we need to address this before it becomes a big problem.
- I'm a people-watcher.
If people are calm, I know they know what's going on.
If they get on edge, I know we got a problem.
And I'm sure they were very concerned,
but they had that air of, "We will get this straight."
And that helped me more than anything.
- It was an on-going matter for everybody.
It was a collaboration across the board
just to make sure that we're not missing anything.
- [Meg] We went through a lot of GI bleeds--
- [Dianna] A lot of bleeding.
- [Meg] A lot of, will he be able to hold nutrition?
You know, are we gonna end up with an obstruction
given that he has a frozen belly at this point?
All of that stuff.
- He went for almost a week of absolutely no food.
No tube feedings, no TPN, no nothin'.
His body was, again, kind of deteriorating.
- Things on a daily basis would change
and, you know, just monitoring things really closely
and making adjustments.
But they were all things that we discussed on a daily basis
and worked really closely with pharmacy
and the rest of the team.
- And then got him back to where he was
a little back on track again,
and then when the infection set in,
he got really really sick again from that.
(melancholy music)
(medical devices beeping)
- Everything has an alarm, and every alarm means something
and you just know what your parameters are
and your ideal goals,
and you just work it.
(hopeful music)
- Once we got over everything inside,
so, you know, the liver, the gut and everything
and the kidneys are starting to come back to life,
you're breathing better.
He still had this metal bar in his pelvis,
and our dear Dr. Mounasamy tried for two weeks,
knowing that he was going to be leaving the ICU soon,
you know, we're going to internalize that hardware,
we're gonna get that thing hopefully fixed.
And every time he tried to take him to the OR--
- [Meg] Something.
- [Dianne] It was an unacceptable situation
to try to do that.
- The primary concern is him as a whole person.
The only way to save him as a whole person is to
just temporarily stabilize him
and wait for other problems to settle down.
- Dr. Mounasamy was, every week we would laugh
and say, "All right, next Monday he's gonna have surgery."
"Next Monday, he's gonna have surgery."
And never happened.
- [Dr. Mounasamy] We couldn't fix it with plates and screws.
It was a big delay in getting him rehabbed
and mobilizing him.
(hopeful music)
(bright hopeful music)
- I remember the day when he was sent to rehab,
and it was like a bittersweet moment
because we were so happy that he was doing so much bettter,
but inside it was like, "Ugh! Like, we care so much
"about you and we're gonna miss you!"
(gasping)
- I've lost twice.
- He's so motivated to get better.
He really works hard.
And therefore, it shows.
- Ready to get back to work.
(chuckling)
Tired of being a patient.
- He was dealing with the physical limitations
even though he was healing inside.
So there was no choice for him,
he was like, "I'm movin' on."
- The last time I encountered Nick in the unit
the tracheostomy tube had been removed.
He was smiling again, he was able to eat real food.
- So he actually went home with that ex-fix on his pelvis.
Went to rehab with it on, he went home with it on.
(hopeful music)
- [Maxwell] All right, Nick.
Get it behind ya.
- [Voiceover] Dr. Mounasamy, he was a smart man,
he played it right.
You know, after they took the external fixator off.
Everything is healed,
he did not have to do any additional surgery.
- Well let's just keep the settings as they are,
I really want you to push yourself--
What I really see that my role is
is kind of grading the challenges that we present to him.
You know, our long-term goal is for him to be up and walking
and not needing a cane.
Do you need to sit for a minute, or are you good?
- [Nick] I'm okay.
- The part that's been so thrilling and exciting
to work with him is he'll say,
"Yeah, you know, I was sore going home,
"but I woke up and everything was okay."
So that's, you know, for me, a big green light.
- I truly believe that there are some patients
who, no matter what happens to them,
they will survive, and Nick is a survivor.
- It was not the typical trauma patient,
we were always in our toes.
I learned tons from taking care of Nick.
- I've in fact worked in many trauma centers
around the world,
I don't think a person with such injuries could be
brought back to what level he is today in many centers.
- Knowing that he was in the best place he could be.
Of all places, he got flown into Richmond.
We were good.
- It makes me so happy to see it when
parents are so deeply involved in their child's care,
and he had the biggest team rooting for him.
- From the lady that came in and cleaned the rooms,
you know, all the way to the top brass,
we treated them like family and they treated us like family.
- That guy had the best attitude.
He was so fun to walk into.
First of all, he has a pearly-white smile,
as everybody is going to see--
- [Dianna] Yes, he does.
- [Meg] And he's got a great sense of humor,
but he was always positive.
- He'll be a big model to other patients
how they should have determination to come back.
- He's got guts.
- He's got workin' guts.
(laughing)
- I can fix anything.
I couldn't fix that.
I'd have traded places in a second.
That's the first thing I told him,
but I couldn't do it.
They did it for me.
Made my life good again.
I like that.
(triumphant music)