An influential experience

By: Adam Joseph, high school alumnus High School Study Abroad, Health + Medicine

I was acting out an emergency medicine scenario. Four patients would die without immediate medical attention: a 30 year-old male with increasing intracranial pressure, a 26 year-old female, bleeding to death from her abdomen, a 34 year-old male with massive internal bleeding in his chest, and a 23 year-old male with severe burns over his entire body and likely brain trauma. Lightning had struck a campground and severely wounded four campers, leaving each with a potentially life threatening injury. To top it off the roar of the rain and thunder made it impossible to hear my own thoughts, let alone use my training to examine and assess each trauma.

There was only one spot open in the ambulance. One spot for four people! And then it hit me. There are four patients who could die…but someone had to decide who got the only spot in the ambulance. Crap. Options start flying through my mind like mad. Save the bleeder. No, the burns. No, the internal bleeding. Who’s going to die the fastest? Who has the best chance of living? And then I thought of something I probably shouldn’t have. Why should I save the bleeder instead of the increasing intracranial pressure? Was one of these patients really more important than the other? Who was I to decide which one should live?

A sensation overcame me: a sensation somewhere between terror, nausea, and exhilaration. It was like being a child and having a new experience: the sheer thrill of not knowing everything, of being naive, of being human. Thinking, breathing, feeling flooded my brain. What’s going to happen? I honestly didn’t know. My lack of foresight humbled me, but simultaneously gave me comfort. I’m human. I will decide my own fate (and apparently the fates of four other people too). That’s a lot to bear. Thinking about your own future and the impact that every small decision you make is by itself terrifying. But just imagine making one life-determining decision for four people. Many people would be scared, would blame some inanimate object or fate and back away from the situation. But I embraced my humanity. I couldn’t convince myself that things were spinning out of control because I was in control. That feeling of anticipation, when every single butterfly in your stomach is on speed, coursed through me, originating in my pounding heart and traveling down every venous highway in my body to make every muscle shake. Talk about an adrenaline rush.

But feeling wouldn’t change anything. I had to take action. The patients continued to worsen by the minute, and individually their chances of living slowly dwindled. I was going to have to make a decision, and fast.

I tried to recall the history of each patient we had gathered so I could judge who had the most “important” life. But that didn’t get me anywhere. Until I replaced my compassion with numbers and facts I wasn’t going to make a decision. Damn this rain! The mist was blinding and stifling. It saturated me, preventing the introspection for which I struggled. I was trapped and alone in a prism of indecisiveness and rationalization. I need a sign, help, something, anything! But then, fresh air filled my lungs, turning the suffocating mist into steely resolve. Just make a decision, easy as that. I can do this. I have to. Thoughts of crying families were replaced by statistics on increasing intracranial pressure and data on severe burn victims. How do I choose?

Although the Wilderness First Responder course is filled with practical skills and challenging techniques (splinting an ankle is not as easy as it seems), the most difficult part of the course was the Decisions Making section. In our lightning strike simulation, fellow students acted out injuries with gratuitous use of fake blood, face paint, and fake bruises. The goal was to pick one person to save from the four who had been injured. Making that decision was much harder than I thought it would be. In a situation like that, it’s difficult to think that a person’s entire life is in your hands. There isn’t any back-story on the patients, so picking who got the chance to live was solely based on the seriousness of the injury, not on who had the most kids or contributed most to society. Yet in a eulogy the deceased isn’t described as a heart attack, but as a father, brother, soldier, doctor, etc.

Being faced with such a question, which I had never confronted before, was at the same time scary, stressful and stimulating. The most influential experiences are often the most challenging. I saw that having the power to save lives and change the future is not to be embraced lightly.