忘れられない交通外傷患者の話 (English version is below.)
脳神経外科医になって忘れられない経験の一つ。
とある交通外傷の話。
私が当直中、いや明けになろうとしていた時のことである。
よく晴れた日には似つかわしい事故だった。
青信号で人が渡る街中のスクランブル交差点に車が突っ込んできた。
巻き添えになったのはまだ赤子を連れた若い女性。
夫の目の前で起きた事故だった。
女性の髪は赤黒く染まり、朱色のバックボードで覆われながら診察スペースに運ばれた。
ショックバイタル、JCS 3桁、いわゆる意識不明の重体だ。
末梢ルートを確保し、補液は全開、昇圧剤も併用したがなかなか血圧は改善しない。
採血はHb 6台
当然輸血もした。
しかし、それでも状況はよくならない。
CTはなんとか撮ることはできたが、全身の損傷がひどかった。大腿骨や骨盤も折れていた。
頭部CTは軽い脳挫傷様の出血が見られていたが、それ以上にびまん性に脳が腫れている印象であった。
ようやく集中治療室に運んだものの、患者の心拍は悪化していった。
心電図も、たまに心停止様のものがみられた。
何度も経験してわかる…もう死戦期に近いのだ。
病状説明のときの、夫の茫然自失とした顔は忘れられない。悲しむ余裕すらなくなると、人はこんな表情をするのだと…これまで痛いほど見てきたが、何度見ても慣れることはない。
擦り傷程度で幸い済んだ幼子は慣れない看護師の腕の中で泣いていた。
院内のミルクをあげようとしたところ、粉ミルクのアレルギーもあっだようで、すぐに対応できなかった。アレルギーのこと、夫は義母に聞いて初めて知ったという。
そして、女性の心拍がついに止まった。
できる蘇生措置は尽くしたが、救えなかった。
これからどれほどの、時には辛く、でもそれ以上に楽しく、笑顔にあふれた家族の時間があるはずだったかと思うと無念でならなかった。
後から、交差点に突っ込んだ車の運転手は外国人で、同乗者の供述で、信号手前で一点凝視と口元がモゴモゴし、ブレーキどころかむしろアクセルを踏んだようだった。
無力感に苛まれながら、当直明けの日差しは眩しすぎた。
帰宅後、妻のお腹をさすると、中からコツンと私の手を叩く感触があった。その時はまだ影もない存在に励まされていたと勝手に解釈することにした。
One unforgettable experience as a neurosurgeon.
It's a story about a traffic accident.
It happened when I was on night duty, or rather, just as my shift was about to end.
It was the kind of accident you wouldn't expect on such a clear day.
A car plowed into a crowded scramble crossing in the city center, where pedestrians were crossing on a green light.
Among those caught up in it was a young woman with an infant.
The accident happened right in front of her husband's eyes.
The woman's hair was stained dark red as she was brought into the examination area on a scarlet backboard.
Shock vitals, JCS in the three-digit range - what we call a critical condition with loss of consciousness.
We secured a peripheral line, opened the IV fluids full blast, and used vasopressors, but her blood pressure wouldn't improve.
Her blood work showed Hb in the 6 range.
We gave her a transfusion, of course.
But even then, the situation didn't get better.
We managed to get a CT scan, but her injuries were severe throughout her body. Her femur and pelvis were fractured too.
The head CT showed mild contusion-like bleeding, but more concerningly, there seemed to be diffuse brain swelling.
We finally got her to the ICU, but her heart rate kept deteriorating.
The ECG occasionally showed patterns resembling cardiac arrest.
I've seen it enough times to know... she was approaching the final stages.
I can't forget the husband's blank, stunned face during the explanation of her condition. When there's no room left even for sorrow, this is the expression people make... I've seen it painfully many times, but it never gets easier.
The infant, thankfully only slightly scratched, was crying in the arms of an unfamiliar nurse.
When we tried to give the baby formula, we found out about an allergy to powdered milk, so we couldn't respond immediately. The husband said he only learned about the allergy from his mother-in-law.
And then, the woman's heart finally stopped.
We did every resuscitation measure we could, but we couldn't save her.
I couldn't help but feel devastated thinking about all the time this family should have had ahead - sometimes difficult, but even more often joyful and filled with smiles.
Later, we learned that the driver who crashed into the intersection was a foreigner. According to the passenger's statement, just before the traffic light, the driver's gaze became fixed and their mouth started moving oddly. Instead of braking, they seemed to have stepped on the accelerator.
As I grappled with a sense of helplessness, the morning sunlight after my night shift felt far too bright.
When I got home and rubbed my wife's belly, I felt a little kick against my hand from inside. I chose to interpret it as encouragement from a presence that didn't even have a shape yet.