What a plastic surgeon learned from a man he couldn't save

You could hear a pin drop. The awkward silence at a dinner table after my pager went off. Eyes locked on me. For a split second, the laughter ceased, forks held in mid-air, chewed food, half-swallowed.

The nervous system of every doctor adapts to the sound of his or her pager during residency. Early in training, widening pupils and hair-raising palpitations fade to become a quiet groan and deep exhale before reaching for the phone to find out what major disaster or small question awaits.

I swallowed my food and excused myself from the table to answer the page.

“50-year-old male, trapped in a burning car with major trauma. He would likely require amputations and serious resuscitation.”

“I’ll be there in 10 minutes.”

I settled my bill and drifted out of the restaurant amidst the hum of conversation and clattering cutlery.

As plastic surgery residents on call, we manage burns. I was called in to assess the patient for the surgeries he would need to save his limbs and his life. Driving to the hospital, I thought through the various options and operations that might be necessary. Intubation, central line, escharotomy, skin grafts. My pager went off again, groan, exhale, right turn, park, reach for phone, answer page while walking into trauma bay.

The scene was worse than expected. The trauma surgery team was huddled in one corner, and in the other corner a stretcher lay still with a human form under a drape. Peering from underneath the drape was a black, charred foot. The smell of burned flesh hung in the air quietly. With each breath, everyone in the trauma bay was reminded of the pain this man suffered.

The injuries sustained were incompatible with life. He was destined to die that day, no matter what we did.

Although there was nothing I could do to save his life, I was determined to learn from his suffering. There in the trauma bay, with the chorus of the trauma team in the background and the soft glow of the OR lights was this man’s first memorial. He had not yet been identified, no family had been found, and yet I was there admiring this stranger.

I lifted up the sheet to reveal his charred arms, fixed, reaching out. His skin had melted revealing the bones and tendons trapped underneath. While algorithmically scanning his body to survey the damage my eyes paused. Left hand, ring finger. A faded patch of gold. A wedding ring. The medical flowcharts in my head stopped running, and I fixated on the melted ring. Deep breath in and out, the smell of burning.

For a moment, this man was no longer teaching me medicine but instead the valuable reminder to stop and be present. Indeed, inspirational quotes, “every day is a gift” posters, and daily mantras strive to remind us how precious life is. But without the sensations: Smells, images and human connection, they are nothing but pixels on pages.

The trauma surgeon recounted the details of how his team attempted to resuscitate the patient. “He never had a chance …” While he rattled off the list of procedures his eyes drifted around the room. He was programmed to deliver concise medical information and yet his eyes said something else. They were heavy, tired, and couldn’t wait to be home looking at those he loved.