Our first trauma case arrived by helicopter: a man who had fallen off a tall ladder at work. He had blown pupils and needed a craniotomy to remove a subdural hematoma.

Our second trauma case also arrived by helicopter and was a large, morbidly obese, close to 400 pound man who'd had a head-on collision with another driver. The other driver was killed on the scene. When asking the patient when his last drink or meal had been, a crucial question for anesthesia, he admitted to drinking alcohol at 10:00 that morning. He said he only drinks one beer per day, but it hit me later, when the commotion had subsided: what was he doing, drinking at 10 in the morning? His drinking was probably more of a serious problem than he was willing to admit, and perhaps it had been the pivotal cause of death of the other driver in this accident. This bothered me a great deal.

However, he was critically unstable and needed my undivided attention. Because of his enormous size and obesity he might be difficult to intubate, so I was nervous and scared as I got ready to intubate... though I kept this fact to myself as the crowd of other physicians hovered around his bed and me. Also, because of the possibility of neck injury, he required in-line stabilization. This meant that we had to keep his neck absolutely still and straight during the intubation, which would make my ability to find and visualize his cords in what was already challenging anatomy, even more difficult. But find it I did, and I was able to intubate. I was so happy, but this was only the first out of many challenges that the patient presented throughout the four hour case, so I wasn't able to enjoy my victory for long. He had almost non-existent blood pressure; ten minutes after intubation, his blood pressure was 30 over 20... and remained quite low until he got an elephantine dose of vasopressors and fluid resuscitation.

Last night for the first time I really felt scared for the patient's safety because of our fatigue. Both the senior resident and I were extremely exhausted by our 18th hour or so of working. I could barely keep my eyes open, my legs hurt, and I was nursing a cold. Thankfully, the wave of action subsided by 1:30 in the morning and we were able to sleep until it was time to wake up and leave the hospital at 7. Luckily, I don't feel sick anymore and I was able to get another few hours of sleep this morning at home... but I'm still too wiped out to do anything else.