Monday, July 3, 2023

“My first thought was terror…”

 Brady Bollinger, DO 


 

In two posts, Dr. Sehr Kahn and Dr. Brady Bollinger write about their experiences with trauma, friendship, and terror.


The lives of two resident physicians change in a split second when a car fleeing a police chase barrels toward the car they are in, and makes impact with the driver’s door at 80 mph…  

 


I was excited to go to Costco that weekday afternoon, as even mundane tasks can be enjoyable for resident physicians who aren’t at work. I picked up one of my close friends and co-residents, Sehr. Our plan was to fill our emergency medicine resident lounge with food. The stoplight turned green, and I pulled forward while peeking around the retaining wall holding up I-94 immediately to our left. That’s when I saw a car barreling directly at my driver’s side door. 

Knowing that this was unavoidable, I had just enough time to process “this is it” and yell Sehr’s name to warn her of the impending collision. That thought and the feeling of truly expecting to die have been pervasive for me since 


I woke up confused and unable to breathe. The car was now completely spun around and against a pole in the median. In those seconds before I could move any air through my lungs, my thoughts crystallized. 


My first thought was terror, assuming the left side of my body to be crushed, leaving me with a pneumothorax that would force me to pass back out momentarily My next thought, would I ever hear the voices of my fiancée, family, or friends again? This, of course, led to sadness which rapidly transformed to guilt as I looked at my co-resident, and one of my best friends, confused and suffering in the passenger seat next to me. 


Lastly, I felt relief as air entered my lungs after what felt like an eternity of suffocating. As any good emergency medicine resident knows, logically it was time for our ABC’s. Airway patent, breathing mildly labored, circulation intact for now as I am clearly getting sufficient blood flow to my brain to consider this absurd situation. Can I wiggle my toes? Yes. GCS 15. Exposure? Now probably is not the time or the place to take my clothes off to look for injuries, but do not worry, my colleagues will cut them off for me momentarily. 


Then a police officer pried open the passenger door and informed us we were hit because of a police chase. The driver fleeing police hit us at approximately 90 mph.  



Due to the high energy motor vehicle collision mechanism, I was paged out as a trauma alert, our highest level of trauma activation, necessitating an emergency medicine resident and attending physician, trauma surgery faculty, and attending anesthesiologist at bedside. 

Sehr called my associate program director, Dr. Timpe, over his Vocera badge, which alerted him to expect me in the trauma bay via ambulance. It was naturally quite a shock to him. Erich, one of my co-residents and closest friends, read the page: TRAUMA ALERT: 27-year-old male, MVC, t-boned 60-80mph, >2 feet of intrusion. Stable vitals. ETA 5 minutes.” As Erich looked at the page, Dr. Timpe realized out loud,That’s Brady. 


I arrived in the trauma bay moments later. My colleagues cut off my clothes, keeping me covered with blankets, as someone held my neck in place over my cervical collar.  

There were tears in Erich’s eyes as he performed my real primary and secondary survey. I knew the whole algorithm by heart. Although I was concussed, nauseous, and in pain, the familiarity was somewhat relieving to me 


I knew if my blood pressure dropped, or I stopped breathing, they could support me in seconds. I took solace knowing I was at Froedtert. No matter how embarrassing or shocking this situation was, I was reassured by my ED team and by the trauma surgery faculty. 


I still remember them saying,We have you; you’re going to be fine now. That was all I needed to hear.  


My team opted for a pan-scan which included a CT head, CT cervical spine, and CT chest/abdomen/pelvis with spine recons with contrast, which unfortunately revealed a grade 2 blunt aortic injury. This is basically an intramural hematoma, or a collection of blood in the wall of my aorta in my abdomen. It also bought me a few days in the surgical intensive care unit.  

All in all, I avoided any surgery or stents in my aorta which leaves me feeling incredibly grateful.  

Reflection: I routinely treat victims of violent trauma, both blunt and penetrating, in the emergency department. I routinely treat victims of car accidents and bystanders of police chases. 


I returned to the surgical ICU in February 2023, not as a patient, but as a doctor. A chill still goes down my spine months later when I drive through every stop light and every intersection. I feel anxious when I drive my family or friends around, as if I am already guilty if something were to happen to us. 


I cannot imagine those who have seen war or routine gun violence, because my experience is only a fraction as powerful, but the effects persist months later. 


I also understand that this greatly affected those around me. My fiancée only knew that I was in an accident, and I was at Froedtert. She came into the emergency department in tears not knowing if I were alive or dead. 


My mom received a text on her phone stating Crash detected SOS. Brady Bollinger called emergency services from this approximate location after iPhone detected a crash”. The next location sent was from Froedtert Hospital and my parents started driving from western Wisconsin with no other information. 


I can’t imagine being a parent and receiving that notification. The departments of emergency medicine, pediatric emergency medicine, trauma and acute care surgery, and vascular surgery all came together to care for and support Sehr, my family, my co-residents, and myself. We are so grateful to be a part of the MCW family  


I do not have a wildly profound new outlook on life. To be honest, I am still awestruck by some of the patients we can save and by some of the patients we cannot. 


However, that youthful feeling of invincibility that I grew up with, that I think many of us grow up with, vanished in a split second. Maybe having the experience that “only happens to other people” is a good thing for me. It has made me truly grateful for everything that I have and all my loved ones.  


It has also made me a better physician.  


It is well known that events such as cardiac arrests, penetrating injuries, traumatic brain injuries, and violent offenses are highly associated with PTSD. The injury doesn’t have to be major; it only must be perceived as such.  



This is evident when caring for people who are traumatized even after even minor motor vehicle collisions. One of the most important characteristics predictive of PTSD is perceived life threat. The “this is it” feeling is something that many of our patients may be feeling even after minor trauma due to decreased health literacy 


Studies show patient perception of healthcare worker compassion is associated with lower rates of PTSD1. Listen to your patients, reassure them and their loved ones, make sure they know you truly care for them, and empathize with their experience.  

 


Was this chase worth the risk of serious injury to me and my passenger for a suspect well known to police, and frequently in custody? It happened on a Tuesday at 4 p.m., at speeds more than 80 mph on West Allis city streets. It is still difficult for me to fathom that this chase met an appropriate risk threshold to pursue. However, my healing has not been focused on disdain, or hate, or even blame. Instead, it has been focused on appreciating every moment with the people in my life and being a humanistic physician. 


I am dedicated to using my experience to help my patients long-term well-being, even if I only get 20 minutes with them in the emergency department 



For further reading:


Moss, J., Roberts, M.B., Shea, L. et al. Healthcare provider compassion is associated with lower PTSD symptoms among patients with life-threatening medical emergencies: a prospective cohort study. Intensive Care Med 45, 815–822 (2019). Link to the article  



 Brady Bollinger, DO is a resident in the Department of Emergency Medicine at MCW.

No comments:

Post a Comment