Every one of my worst days in medicine started as a typical day. Five years ago was no exception. The hospital I worked at was in the center of a busy city. There was almost no parking for the staff, especially those of us without the title of administrator. There was a mall close by and a train station. Honestly, parking and driving in this area were a mess.
I woke up at my standard time and took the city bus to work. It dropped me off directly in front of the hospital. Walking into the emergency room, I hoped that the day was going to go well. It never goes smooth as there is always something unpredictable that happens.
However, the things that happened that day were a level or two above unexpected.
I was assigned to help with three rooms in the emergency room. I was working hard with the doctor, a CNA, and we were seeing a lot of patients. In all, I had started six IVs, sent three patients for various CTs, and had given out a lot of medications. None of my patients for the day had yet been required to be admitted to the hospital. That’s always some extra paperwork.
Around 2 pm, just after I returned from lunch, everything changed. I was roaming the halls when a police car drove up to the front doors. Two officers jumped out, and one of them saw me right away and sprinted directly toward where I was standing. He was tall and lanky, but he was pale and bordered on hysterical.
He began screaming, “You’ve got to come with me.”
“Where?” I asked.
The officer continued, “You need to get an emergency bag. Supplies, Gauze, IV fluids, and anything else that you can.”
“What’s wrong?” I asked.
“There’s been a terrible accident.”
“Do I need to go with you?”
“Yes. There’s a pileup on the interstate, and the closest ambulance is twenty minutes away. I’m not sure we have that much time.”
The officer wasn’t able to say much more. The news spread quickly, and as I grabbed a ton of supplies, two other nurses were collected, and the three of us hurried to the patrol car. The doors didn’t completely shut before we peeled out down the street.
The second officer, the one driving, provided a little more information. He said, “There’s a drunk kid down by the train station. We think that he’s stuck and badly injured.”
The patrol car hurried down the street and turned right. Instead of going directly to the front doors of the train station, he turned left and headed away from the main building. There were other police already on scene, and they guided us over a utility road, across two train tracks, and directly to one of the main lines. Already, there were five or six trains parked on different tracks. None of these trains were occupied or in use, but they were there.
Approaching the sixth track, I noticed a fire truck had just arrived. A group of firefighters were being shown where to go. The patrol car parked, and we grabbed our stuff and followed. The group continued for about five or six cars along the track to where another group was positioned. A canopy had been set up. There were a few people, appearing panicked, unsure what to do.
I could see that they were pointing under the train car and explaining what had happened. My stomach dropped. When we were close enough, I heard what was being said.
“The kid is conscious. He must be twenty or twenty-one. He’s been drinking, and I think he was trying to get back to campus. He says he lives on campus. Instead of going around the station, he cut across. The only way to cross was to crawl under the train. It shifted or started moving, and now he’s stuck.”
A firefighter asked, “How can we help?”
“You are going to need to get him out. He’s stuck pretty bad.”
“Where’s the ambulance?” asked a female firefighter.
The officer in charge said, “Won’t be here for fifteen minutes. We got some medical help from the hospital. They are right behind you.”
All eyes turned to me and the other two nurses. We had had plenty of experience with emergency situations and the ability to just flow onto a scene and make quick decisions. None of us even stopped at the group. I yelled, “Where is he?”
Someone pointed to the area under the train where the young student was stuck. It wasn’t a simple position. He had made it partway through and had gone past the first metal wheel, but that was when it had rolled onto his left leg, caught it, and had pulled the leg up into a space above the wheel. Blood was dripping onto the track. The boy was barely conscious and barely alive.
Jeff, a trauma nurse, said, “I’m going to come at him from up the track, and you go below.” Turning to Zander, he said, “You’ll need to stay outside the area and hand in any supplies.”
“Done,” Zander replied.
I pulled out a backpack of supplies and army crawled under the train. The boy’s leg was mangled, but he had almost rolled onto himself. His head faces away from me. The only way he got in this position was if he also dislocated his hip.
The firefighters began working on the wheel itself. Their goal was to extricate him from the train. It was not going to be an easy thing.
“It’s pretty tight in here,” shouted Jeff. “I’m going to have a tough time getting him out.”
“The only way he is coming out is if we cut off his leg or the firefighters find a way to move the train.”
Jeff added, “He’s losing a lot of blood.”
I replied, “I don’t have a good angle for the IV. I’m going to try to a tourniquet on his leg.”
“I think I can get the IV, but it is so dark in here.”
Yelling out to the other nurse, I said, “Zander. Get under here with a flashlight. We need to start an IV.”
“Coming,” Zander yelled back.
The boy asked, “Am I going to die?”
“How much pain are you in?” I asked as I pulled over my backpack and unzipped it.
“So much.” The boy began crying.
I pulled out some IV supplies and passed them over to Jeff. We already had on gloves, but mine ripped as I crawled under the train. I pulled out more and put them on over my first pair of gloves.
To the boy, I said, “We are going to start working on you. We need to stop the bleeding. We’ll start an IV and give you some meds.”
“Hurry,” the boy whimpered. “The pain is too much.”
The tourniquet that I had in my bag was similar to a blood pressure cuff with a cord or wrap to pull tight. I scooted up to the leg, which was shredded. The jeans the boy wore were destroyed and soaked with blood. Bone was sticking out in a bunch of different directions. Blood was dripping everywhere. I unwrapped the tourniquet, and it took me a minute to find a place well above his knee to place it.
His lower leg bones below the knee were broken, and I was pretty sure his hip was dislocated. I wrapped the main portion around his thigh and pulled the strap tight. There was a noticeable change in blood flow, and it slowed significantly.
The boy screamed loudly and just about fell unconscious.
“This sucks,” Jeff yelled.
Zander had come from a different direction and was pointing a flashlight at the boy’s left arm. It was slightly trapped under the boy’s body, but the right arm couldn’t be moved correctly to get a good look at the elbow area.
“I almost got it,” Jeff replied.
Zander shouted, “You got it.”
“Hook up the bag to the bottom of the train. We will need to roll the boy more onto his back.”
“That’s going to be hard,” I said.
“We have to try.”
I reached over and grabbed the boy’s shoulder and rolled him a few inches. He screamed again, and the way his leg was caught, he couldn’t go much further.
From outside, a firefighter yelled, “We can’t find a way to extract the kid.”
Things were getting dire. We tried everything we could to get the boy comfortable and stable. We gave him fluids, pain medications and began wrapping his leg. That turned out to be pointless. Luckily a doctor had overheard what had happened. He came with the appropriate equipment.
I ended up sliding out from under the train. The doctor went in and cut the leg, causing an amputation just below the knee. He tried preserving as much tissue and bone as possible.
The ambulance arrived just as we were pulling the boy out. He didn’t look good and had lost consciousness at this point. He was placed on the gurney, and the doctor rode back to the hospital with the boy. After an in-depth exam, he went into surgery pretty quickly after that.
In the end, the leg required further amputation, and it ended up being above the knee. He had broken his hip, causing the dislocation. He required surgery for this as well.
It was one of the most gruesome circumstances I’ve ever been a part of. I never imagined working on a patient in the field as the ambulance crew does. It was a peek into an entirely different world.
