Towards the end of my internship, I was becoming more confident in my skills as a doctor. By this time, you had sewn up countless lacerations, helped resuscitate patients, and assisted in surgery for several months. You had a long way to go, but the upper residents were actually letting you do some small surgeries and procedures on your own. I guess you never forget the first patient that you think you saved their life. I was working in the Accident Room and it was an especially busy Saturday night. We were finishing a room 4 and another critically injured patient was rolled in on a gurney to the adjoining treatment room. The Accident Room Charge Resident told me to go assess the patient and he would be there to help in a few minutes. This was a big deal, up until that moment I was not allowed to really do any independent thinking. I was normally taking orders from a senior resident. Thinking back now, I’m sure the Charge Resident was watching me much closer than I thought, but it seemed like it was just me, the patient, the nurse, and the ambulance crew.
The patient was a white male with tattoos everywhere. He was breathing with difficulty, but breathing. His head was bandaged and he had quite a bit of road rash on his chest and back. I asked the ambulance medic for some history while doing the trauma assessment. He said “We found him on the side of the road doing the chicken.” I asked “doing what?” The ambulance medic repeated himself, “We found him on the side of the road doing the chicken. You know flopping around like a chicken with his head cut off.” So that was the sum total of information I got for my first seriously injured patient. The medic also mentioned that he had lacerated his left ear, so that explained the gauzed wrapped around his head.
After a quick assessment, it was obvious the patient had multiple rib fractures and from the diminished breath sounds, a pneumothorax on one side. The chest x-ray confirmed that and I put in my first chest tube completely on my own. His vitals stabilized after the chest tube and nasal cannula oxygen. He was still pretty lethargic. He eventually got a head CT scan, which was normal. While off at imaging, I was tending to other patients. He finally returned and was much more awake. He was not sure what had happened, I was pretty sure he had been hit by a car. I finally now had time to unwrap the head dressing that the EMT had said was for a laceration of his ear.
After washing away a lot of dried blood and road gravel, it was apparent that he had lacerated his ear, and it was just barely still attached to his head by a small skin bridge. It kind of just dangled there, it looked pretty wicked. I explained to the patient that his ear was almost cut off, he just shrugged his shoulders and didn’t say much. I was not sure what to do, I didn’t think there was a team to do an ear reattachment at Charity. I asked the Charge Resident what to do. He said either cut it off or just sew it back on and see what happens. I talked with the patient and we decided to sew it back on. It took a while, but I did my best sewing the ear on. When I was finished, it hung a little lower than the opposite ear and it did look a little pale. I wrapped his head back up and told him I was not sure if the ear would make it. He just shrugged his shoulders again. He was a man of few words.
He was admitted because of the chest tube. I was interested in the ear and went to check on him over the next several days. The ear slowly turned black and sort of balled up on the side of his head. I gave him the ear status report each day. I asked if he wanted to go into the bathroom and look in the mirror. He did not. I explained the ear was not going to make it. He just shrugged his shoulders.
He was finally ready for discharge a few days later. The ear was now a little wad of dried out black skin and cartilage on the side of his head hanging there by a bunch of nylon sutures. On discharge day, I told him that I thought I should remove the ear. He had finally looked at it in the bathroom. For the first time ever, I saw him smile. He said, “doc, I kind of like it, I’m going to keep it there until it falls off.”
I never saw him again.
