There wasn’t a single previous moment in my life that I considered being a trauma surgeon until, as a medical student, I found myself in a six-week rotation in the state’s first level 1 trauma center.  

Wearing blue scrubs that smelled like hospital-grade detergent and a short white coat, I left the operating room when the most recent surgery had ended, walking in my clogs to help with and learn from the next patient in the Trauma Bay. I passed her as she was brought in by the ambulance and its team. 

I looked into her eyes. Ice blue eyes, pupils blown, the diameter of the black circle too large, encroaching on the iris. A black oil spill in a crystal sea. Her hair was the color of mine, the length of mine. It had the same waves in it, only her waves were cresting with gelatinous blood. This could be me, I remember thinking.

Because of the severity of her injuries, I was not sent in first to do an assessment, as the medical student usually was. Her car was hit not by a similarly sized car but by a train at high speed — a David versus Goliath collision, except, this time, Goliath won. She triaged to the front of the line, passing the broken bones and non-life-threatening gunshot wounds. She was the principal soprano in a cacophony of the ER’s tragic opera. 

Her gurney was pushed and pulled and scooted into a trauma room, and the four-layer team of medical student, resident, fellow and attending physician gathered round. I remember the straps that tied her body to its last bed. I remember the endotracheal tube taped to her face, her mouth slightly ajar. 

While she was in the CT scanner, somebody said that her husband had already been declared dead at another hospital. When she returned to the trauma room, I remember someone said her child or children had been taken to the children’s hospital next-door, dead on arrival. 

Don’t say it in front of her, I thought. She’s right here. She can hear you. I remember thinking how awful it was that her family was separated at different hospitals at the moment of death. 

Did I do anything useful as the nurses and respiratory therapists and trauma surgeons took over her care? I don’t recall doing anything at all except looking into those blown pupils and knowing what that meant. I watched a single tear forge a trail from lateral canthus to temple to ear. I remember wiping my own tears simultaneously with the final tear she would shed. 

When the radiologist gave us the damage report from the battleground of her innards, it was clear that she would not survive. Her injuries were too severe. The impact from the train was more than a human body could sustain. 

I don’t remember if her imaging showed a brain bleed or a bladder rupture, a liver laceration or a pneumothorax. What I do remember about her CT scan is seeing the fetus in her womb. I can still see it to this day. A life snuffed out before a first breath.

For days after, I wondered about her. Where had they been going as their car crossed the railroad track? What were their last words to each other? I wondered if the siblings had been told they had a new baby on the way. And at what point, when you’re hit by a train, do you realize you’re going to die?

I just stood there, lost in her frozen blue eyes. I held her hand; pink nails, wedding ring still on. Once the surgeons knew she wouldn’t survive, her bloodied body was cleaned for the next of kin to say good-bye.  The white sheet was pulled up to her neck, tucking her in for the last bedtime of her life. 

I went on a journey that day with this woman and her fetus, and it was the worst thing I had ever seen, hell and back. I remember my distress that, as I left my shift, the rest of the world was still eating and driving and making love and getting paid while she lay dying in Trauma Room 3. How could life go on, carefree, outside the hospital, when she and her fetus lay motionless, on the wrong side of the hospital wall? 

I woke up the next morning and returned to my Trauma Surgery rotation. I made the subconscious decision that I could handle it. I returned to work the next day to see what fresh hell the world would throw at Trauma Room 3, but I returned with a piece of my innocence lost. I came back to the hospital with another brick fortifying that wall of defense we slowly but deliberately construct to survive a career in medicine.  

It’s been over 20 years since I was assigned to this woman’s care as a naive medical student. Bit by bit, case by case, my other patients’ stories have weaved themselves deep into the recesses of my brain, or is it my heart, next to her story.

My challenge — and our challenge as physicians — is to keep that wall permeable, so that air can come in and out, so that the wall doesn’t turn us into humans who don’t feel anything at all in the face of human tragedy. Even though I did nothing at all to save this woman, I was there to hold her hand. 

 *Identifying details have been changed to protect the patient’s privacy. 

Julie Miley Schlegel is a practicing Pediatrician in Houston, Texas