My Name is not a Number

The clattering of the pneumatic tube overhead alerted us of an incoming sample. When the carrier dropped into chute, I grabbed it, opened the padded box and grabbed the biohazard bag inside. I pulled out the requisition, stamped with red, two inch letters: TRAUMA.

And, as I grabbed scissors to open the impossible-to-rip-open bags, a nurse appeared at the narrow window used to drop off specimens.

“This is a STAT trauma sample.”

The CLS tech and I looked at each other. It’s a humid Saturday morning in the heartland, and people have barely roused themselves for the day.

I glanced at the clock. 7:45 a.m. I tossed one of the bags to my co-worker to accession

Here we go. Another day in the Critical Care Lab.

A look at the requisition gave the patient name. TWENTY-FOUR, PATIENT. A hospital number was assigned, the sex of the patient listed as female, no birth date or other pertinent information listed. No identification available for the person on arrival.

My co-worker and I mused over the number/name of the trauma patient. Our last unidentified patient was Thirty-six, Patient. We wondered why the number was lower on this new admit. We decided perhaps the number system returned to zero each month.

At any rate, there was work to be done. We’d had this conversation while the sample was being processed. My co-worker got on the phone and called to report critical values on the blood gas and hemoglobin results.

The other trauma sample from ETC had a name.

Yep, business as usual in the lab.

The phone rang. “Critical Care Lab, this is Kate, how may I help you?”

Blood Bank was on the line, asking if we’d received the blood they’d sent for Twenty-Four. Yep, we had gotten it, perhaps a minute and a half before. We were told to send it immediately to the OR. That was when we knew that Twenty-Four had been sent directly from the ER to surgery.

Just seconds after we’d transferred the blood products to OR, a surgical resident slammed though the “back” door into the lab. That’s the doorway that has direct access to the surgical wing. When they come through that door with samples, everything gets bumped. Samples from the operating rooms are always considered STAT.

But, the resident didn’t have a sample. Instead, with a voice full of intensity, asked, “Did Blood Bank send blood for a surgical patient?”

“Was this for Patient Twenty-four?”

“Yes.”

“We have already sent the units to OR…probably no more than a minute to a minute and a half ago.”

The Med Tech told him if he needed emergency Type O Universal Donor blood, we had six units available. He nodded his thanks and headed back to surgery.

The next few minutes in the lab were intense. The phone was ringing like mad. Routine samples were arriving from the top of the hour draws. Blood bank was pushing units of blood through the tube system like crazy. It took both of us to take care of the all that was happening, when “normal” is pretty much a defined routine for each of us. As we received the blood from the blood bank and shipped it on, the OR was sending back the carriers to us to return to Blood Bank so they could send more blood. I reached to grab for a returned tube, and another whooshed right in on top of the previous one, nearly smashing my fingers. I jumped back in time, surprised. Hospital SOP requires that we wait a minute between each carrier just because of the force of the vacuum will smash hands if it happens to get caught between two carriers. When “the rules” get suspended, there’s really something serious going on in OR.

Eight units of red blood cells, two units of plasma, and one unit of platelets were sent in roughly three minutes. Twenty-four was in serious trouble, it seemed.

When things eased up a bit, the Med Tech took a minute to look at the online headlines of the local newspaper. It stated a serious car accident had occurred about 20 miles west. Two were killed, four transported to BHTS.

We knew then what we would need to look for on the lab end of things. Now single words could be spoken when needed. A sample comes in. “Twenty-Four” will mean a STAT lab needs immediate processing. “Tube” means drop everything and go process whatever is coming through Blood Bank.

* * *

The kids had gotten out of school on Thursday. With ball games and camp and other summer activities, it seemed a great idea to take vacation very soon after the school year was done. And, boy, with the way Mother Nature had turned up the heat in the Midwest, an SUV full of family and luggage would not be comfortable in spite of air conditioning – too many bodies filling the space. The man and woman had discussed it, deciding the ideal thing to do was to get a head start in the wee hours of the morning. The kids could sleep in the SUV, they’d be able to get out of Chicago before the weekenders began arriving in the city, and the city dwellers left to escape the out of town invaders. They wanted to get rid of a huge chunk of the 16 hour trip out of the way before the sun was high in the sky.

The kids helped pack the SUV, or at least got most of the stuff outside to be arranged and rearranged by Mom and Dad. Then with giggles and plenty of excitement, they tried to settle in for a short amount of sleep, knowing when the time was right they’d be awakened so they could stagger out to the vehicle where they could snuggle back in for a few more hours sleep.

Six hours west of Chicago on I-80, the sun was beginning to brighten the eastern horizon. Dad glanced in the rearview mirror, smiling at the slumbering brood in the seats behind. He readjusted his sitting position, straightened his back and did a shrug and stretch of his shoulders as he held back a yawn. He glanced over at his wife, riding shotgun next to him. Her head was leaning against the passenger side window. She’d take the next driving shift after their next stop. He figured he’d let her sleep a while longer; she’d been the one who’d had to deal with the kids and their excitement. He’d been “lucky” enough to miss most of the packing, last minute laundry and general kid bickering. His wife deserved the snooze time. He choked back another yawn. Coffee would sure taste good anytime soon, he thought. Just another hour of driving and we’ll stop for breakfast. I’m getting sleepy.

The SUV drifted out of the right lane, over into the left lane. And, as the man fell asleep at the wheel, the vehicle drifted even further left into the median, rolling several times before coming to rest. His family would never be the same.

* * *

Back in the Critical Care Lab, blood samples are coming in from the OR on Twenty-Four every 15 minutes. Samples are coming in on another OR patient who is a late 30’s male. His samples are not as frequent as Twenty-four’s, nor are the results as massively critical.

Med Tech takes a moment for a bathroom break. As she heads toward the bathroom, she hears the folks in Surgical Path Lab say that there’s going to be more blood gases coming from Twenty-four’s OR. We waited, on edge, for the samples that didn’t arrive.

The pneumatic tube belched another carrier into the slot. This time the blood units were marked to stay in the lab instead of being transferred to the OR. Twenty-four must be out of surgery.

A few minutes later, a phone call confirmed this. Pediatric Intensive Care was calling to let us know that they’d ordered quite a few more things from Blood Bank and they’d be taking more units at a time than allowed. Twenty-four was out of surgery, but was going through blood products at an alarming rate. Whatever Blood Bank would send would be used.

* * *

The phone rings at a home nestled in a neighborhood where the backdrop is not Chicago skyscrapers, but Gaia’s skyscrapers – the Rocky Mountains. The woman has been up for about an hour. She’s had her first cup of coffee for the day. She’s got some last minute things to do before her family arrives.

“Is this Mrs. John Doe? This is the Iowa State Patrol calling. I’m sorry to have to tell you, ma’am, but there’s been an accident. Your son and family have been involved in a car accident.”

The woman pales, grabs the edge of the kitchen counter for support. Her husband, who has just come into the room, takes a look at her, grabs the phone and speaks to the voice on the other end. He thanked the distant voice and deliberately and quietly set the phone back in the cradle. He told his wife to pack some things for traveling. They were needed in Iowa, and as quickly as they could get there. While she packs, he’ll get the car gassed up and get some traveling money out of the ATM so they can be on their way. It will take about ten hours for them to get to BHTS where they’ll begin to sort out the things that need to be done.

* * *

The PICU nurse shoves a Blood Bank requisition through the window. I take it from her, glance at the name. The req is for two units of red blood cells.

“How’s Twenty-four doing? She’s out of surgery?” The Med Tech comes up to the counter to join the conversation..

The nurse nods. “She’s out of surgery, but that’s about it. We’re going to be pushing a whole lot of blood products, so be prepared. She’s taking them as fast as we’re giving them, and then some.”

We nod, and wait for the nurse to continue.

“It’s a shame. It doesn’t look good. Her pupils are fixed and dilated. And, the relatives won’t be here for about ten hours. We just have to keep her going for now…” her voice trails off, leaving the words ringing loud and clear in spite of them not being spoken aloud.

* * *

The story of the family is purely fiction. I have no idea where they were going, what they were doing, or why the accident occurred. But, what I talk about in the lab is a rough synopsis of another aspect of emergency medicine in action. This action just happens to occur farther behind the scenes.

In the early stages of this story, I spoke of our curiosity about the “low” number assigned to this Jane Doe admitted through the ER. Although I cannot offer a solid answer, it may be that the age factor of this patient has something to do with the number. Twenty-four is, I’m very sad to report, a eight year old little girl. There was no accessible identification at the scene of the accident and the condition of the other victims made it impossible to verify her name to hospital personnel. With no responsible legal adult on the scene able to verify many things, relatives were notified to get to the hospital as quickly as possible to do those things that need to be done.

Twenty-four’s 13 year old brother and another woman who may have been the stepmom, girlfriend or fiancee of Twenty-four's father died at the scene. There is no word at this time on the conditions of the father and the other passengers in the vehicle.

Note: Twenty-four died of her injuries later in the afternoon on the day this post was written. One of the flight attendants who was involved in the massive efforts to save this child said that as soon as the father was able, he came to the bedside of his daughter, said his good-byes and made the decision to let her slip from this plane. Twenty-four's father and the other two siblings were treated and released.