I had wanted to take a long motorcycle trip for years, and I finally carved out two weeks to do so.  My pal Doug and I packed our gear onto our Harleys and headed out without an itinerary.  We would select the day’s route each morning.  Initially, we enjoyed spectacular scenery and good times.

After a few days, however, we encountered pouring rain while winding through remote mountains.  There was no shelter, so we donned our rain clothes and pressed on at a slow pace.  Visibility was poor, and the road was drenched.  We came around a sharp curve, and a man flagged us to a halt behind a line of stopped cars.  We were told there was an accident ahead.  Though 911 had been called, no rescue unit had yet arrived as we were very far from any town.

I snaked my bike forward to see if I could help, though I was concerned that my internal medicine skills might prove inadequate to deal with major trauma.  Further around the curve rested a single-vehicle flipped onto its roof, blocking both lanes.  The road nearby was littered with shattered glass, metal scraps, a doll, clothes, plastic soda bottles, and a magazine.  A bright blue plastic tarp was spread on the pavement in front of the vehicle, bulging up in the middle.  Two bearded men in flannel shirts and work pants stood nearby.  I said I was a doctor and asked who was hurt.  They stoically reported that they had covered a girl with the tarp, because they didn’t think there was anything they could do for her.  They had moved her parents a ways up the hill.

My friend is not a health worker, and he distanced himself before I peeled back the tarp.  A young girl lay on her side, perhaps six years old, unmoving.  The top of her brain was exposed.  Her face was undamaged; her expression was peaceful, and she bore some resemblance to my daughter.  I could find no pulse.  I decided that an extremely delayed attempt at CPR would be inappropriate under the circumstances and replaced the tarp.

I moved on to the two other victims.  A man wearing a T-shirt and jeans sat rocking by the side of the road, trembling a bit and staring disconsolately.  He had a small cut on his arm, already cleaned and bandaged.  He was alert, oriented, and without any other physical wounds or pain.  His obese companion had suffered a trivial scalp laceration from flying glass, and she denied symptoms or head trauma.  She seemed OK, though unemotional considering the circumstances, maybe numb in reaction.  I couldn’t think of much to do, other than to keep them warm to avoid the development of shock in the cold rain.  I resisted asking how fast they had been driving or who wore a seatbelt.  Fire-rescue personnel arrived and took over.

Images of the accident and of the little girl stayed in mind for days, accompanied by sadness and malaise.  Traveling by motorcycle, even with a fellow rider nearby, is a solitary affair – no conversation, alone with one’s thoughts for hours.  And my thoughts dwelled on the crash.  I was surprised at this prolonged reaction.  As physicians, we get desensitized to blood, wounds, tragedy, and death.  We’ve participated in surgery and autopsies, at least during training.  In big-city emergency rooms, I’ve observed grotesque sequelae of all manner of violence.  Previously I have been able to leave the bedside and professionally move on to the next patient or to my home life, even after witnessing an awful death.  You develop a callus of sorts around the heart to allow you to function.

But this time, I couldn’t follow my modus operandi and detach.  I suspect there were several reasons.  I kept picturing the anguish and despair on the father’s face.  His life has been absolutely and irrevocably divided into two pieces, before and after this horrible moment.  No matter what worries he may have had before the accident, they pale before the grief and loss he will carry from now on.  Also, the incident had been so unexpected.  In the hospital, you are accustomed to seeing nasty illnesses and outcomes, and you have a ready mindset.  You are on home turf, with tools of the trade at hand and teammates to pitch in.  Suddenly encountering a violent death in the mountains was far from business as usual for me.  The most distressing factor of all: This was the death of a young child, clearly a parent’s nightmare.  I had been unable to help her.

When I played ice hockey as a young man, a rocketing puck would occasionally find a small opening not protected by my pads or helmet, and it would do some harm, even draw blood.  The accident similarly inflicted a painful surprise when I thought I was well armored.  But do we want to be completely impervious?

David A. Goodkin is a nephrologist.

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