Christmas celebrated early in the emergency department

He probably did not realize it after the snowplow hit him but Christmas was coming early for the young man brought into my ER during the blizzard that buried Maine two weeks ago. He started receiving his gifts moments after he was hit, and kept getting them right through the night.

His first gifts came in rapid succession. He lived someplace where, in a nor’easter snowstorm so bad a dumb dog would not have gone out in it to chase a good steak, there were paramedics whose job it was to go out when he needed them. His next gift was that paramedics found him at all after he was hit, because the blow threw him into a ditch and the howling storm made him hard to find.

By the time they rescued him he was not only critically injured but well on his way to freezing to death.

They brought him through the ED doors with little warning to the ED crew because his mishap had occurred only a short distance from the hospital. His next gift was that they were ready for him anyway, because the ED crew knew the drill; mutter “Oh, Lord” under your breath at the extent of the injuries that a person can suffer and live, and then get to the work of the ABC’s of trauma. Within seconds he had a doctor, three nurses, a lab tech and an X-ray tech all swarming around him, working to pull him back from the edge.

No one had to be told not to move his neck, or to keep his head aligned with his body to avoid injuring his spinal cord. No one had to be told he needed warm blankets, high-concentration oxygen, and two intravenous lines with warm fluids. No one had to be told we stood between him and his dying three weeks before Christmas.

The team knew what to do because we had learned techniques of trauma resuscitation developed from experience with other critically injured patients in other EDs and on battlefields from Korea to Kuwait. Those patients had given the gift of their experiences, and some the gift of their lives, so this doctor and these nurses would know what to do and not to do in the resuscitation of this patient.

Then he got the gift of great drugs in rapid succession, drugs designed to render him unconscious, and then paralyze him, so he could have the gift of a breathing tube placed in his windpipe. Without that tube he could not get enough oxygen to his injured organs, not could he have his spine adequately protected during the work of caring for him. The drugs were so good he probably never knew he was being snowed, just felt sleepy and then nothing. They made it easy to see the inside of his windpipe without moving his neck, easy to slide the breathing tube into place, and easy for him not to feel any of the unpleasant but necessary things being done to him.

Some of his gifts that night were also gifts given to the team. Those of us who care for the critically injured and ill must have others behind us who will come immediately when we need them. Two surgeons drove in through the blinding snow to help us help the young man; they came without question after I simply told them I needed them “now.” Once they arrived at his bedside they never left until the patient left the ED for the trauma center down the road. Not only did they help me take care of him, they made it possible for me to take care of the other patients in the ED who also needed my attention.

He got the gift of great nursing care, the kind so good you almost don’t notice it because things go so well, the kind without which emergency physicians are almost lost. He got it from the moment he came through our door to the moment he left the ED and beyond. A nurse who took care of him in the ED that night then went with him in the ambulance to the trauma center, volunteering to work extra hours and leave the safety of the ED for the harrows of the snow-blown road and the long hours of the transfer.

Others volunteered other gifts. Two paramedics from a small area ambulance company volunteered at the height of the blizzard to transfer the patient to the trauma center, where specialists in trauma care waited.

The roads were swirling white, but the paramedics simply asked if we needed them and said “OK” when we said “yes.” They did not ask us if we were sure we needed them, if we were crazy, or if we were desperate, because they knew the answer to all three questions was “yes.”

He already had the gift of a family that cared; within an hour eight of them were in the ED, hanging onto our every word and nuance, faces tight with worry and questions that could not be answered: Will he be OK, does he know what happened, will he know we are here if we talk to him?

Finally, he had the gifts of youth and health, and must have had the gift of will to live, because otherwise he would never have made it to us.

Christmas isn’t about whether we get everything we want; otherwise life’s plow would never toss us into the ditch in the first place. It is about the miracles that come afterward. It is about the extraordinary things ordinary people will do on our behalf, about being safe in a storm because others will go out in it for those in need. It is about the miracle of what lights appear when the darkness descends, whether on a Christmas tree or an ambulance, in a winter sky or in our hearts. It is about someone reaching into the abyss to pull us to safety, and about the miracle of getting what we need more than the satisfaction of getting what we want. That is why every day can be Christmas, and is in the ED.

Erik Steele, D.O. is a physician in Bangor, an administrator at Eastern Maine Medical Center, and is on the staff of several hospital emergency rooms in the region.