Hysterectomy; Trauma; The Uterus That Saved a Life

by Larry Puls @larrypulsauthor

Trauma; Hysterectomy

The uterus. Arguably, the most fascinating organ in the human body. No bigger than a tangerine ninety-eight percent of the time, no smaller than a watermelon the other two. Fertile soil, doubling as a temporary home, a safe haven, where the beginnings of life take hold. Where an embryo morphs and divides, transforming into billions of unique cells that make up the intricate pieces of the human body. All woven together and permanently bonded with a soul. The baby incubator that graciously and generously supplies all the nutrients and oxygen a small child will need to thrive. It provides the human race with the most beautiful, precious, amazing, heart-warming gifts we call children, made in the image of God.

The story starts at one AM. What happened first, remains a mystery. What happened after that, is a testimony to a well-oiled trauma team. I only saw the last two hours. On the cold night, a shot rang out, a piece of "poison" metal filled with so much rage that it defies logic or understanding or reason. An incomprehensible madness. Flying through the air, packed with only hate, it hit its intended target, entering from the woman's side. After striking skin and passing through it like butter, it hit bone, where it ricocheted off, coursed through the blood supply to her left leg, nicked the bowel, and mysteriously came to rest—at an undetermined location. There was no exit wound. She was for the moment alive—but on that cliff of life, staring down at her reflection of death.

The police and ambulance find her on the street. A body surrounded by a spreading ring of blood.  The EMS blares its sirens, flies to the hospital, all while attempting to save a Jane Doe. IV’s are slammed into the arms and chest. Phone calls made, panicked voices over the airwaves, directing everyone to be ready for the coming storm. The team readies itself at the trauma center. Tireless professionals standing poised. I remain at home asleep; it is now about 1:30 am.

Landing at the hospital doors, she is whisked into the ER, assessed, then transferred to the OR at lightning speed. More lines are placed. A tube is plunged down her throat. It forces her compromised lungs to open with oxygen. Bigger IV's. Her vital signs are weak at best. Now the real work begins: Control the blood flow. Patch the vessels. Restore blood flow to her leg. Fix the leaking bowel. Find the bullet. And do it quickly. The patient is totally unstable. Her belly is full of blood...  Her life is slipping away.

Anesthesia dumps liters and liters of fluid, plasma, and blood into her veins. Voices are raised. Surgeons scramble to stem the tide of red. She remains precariously closer to death than life, losing her innate ability to clot--vanishing in the tidal wave of blood. Liquid begins to seep from her belly. More plasma. More cryoprecipitate. More pressure. A hope and a prayer. Is there any way out other than off the cliff?

It’s now 2:30 am. I am safe in my bed. My phone rings. I'm on call. Stat, they say. Drive like there is no tomorrow. As I fly through the streets, I consider the twenty units of blood that have already been given. How stable can she be? I call the circulating nurse and hear of the saga that has occurred over the last two hours. I hear of a life hanging in the balance. Still a Jane Doe at this point. A face, but no name. In all of it, this vulnerable soul has by some miracle, gained a semblance of stability. So much done to save one life.

One precious life.

While driving, I'm thanking the Lord for the individuals with the sweat on their brows and surgical clamps in their hands. Her blood is now clotting because of them. My coming job can only be easier by what has already been accomplished. The saving events are a testimony to this team, to a functional trauma center, to the dedicated people who give up their nights to save the human race.

Entering the surgical suite, they ask me, no tell me, to provide the final piece of surgery. Her uterus, gray and ashen, has a hole through the side of it, blown to pieces, where blood is percolating up and out. She needs the uterus removed—to stem the tide, to prevent the impending sepsis, to extricate the bullet from this person who is yes, made in the image of God. She is not Jane Doe to Him.

The uterus, the organ that had given a surrogate home to her two children was the final resting place of a vengeful metal fragment--where the fury came to rest. It is buried inside.

As I scrub, I see the tell-tale signs of what trauma is all about. And though I live in the world of seeing blood, I have not seen this much outside of a human's artery or vein in years. Blood is on the floor, in the canisters, on people’s shoes, and is being replaced like a wide-open spigot. Reflecting on where this team had likely been over the last two hours, my only conclusion is that the room is filled with so many heroes. Men and women who do this sort of thing every day—and every night. They are suddenly my heroes. I don’t live in their world. Oh yes, I am a surgeon. But I live on elective surgery, not throw-down, fast, emergent, traumatic cases. 

Looking into the surgical field, I stand amazed at what all has been fixed. Now all eyes turn to me--and I am not worthy to be in that room. But her uterus was dying. And I could help. As I considered the task before me, a thought crossed my mind—odd perhaps. But I could not ignore it. There before me was this uterus, dying as it was, this safe environment, that was yet again in an unexpected way involved in the process of giving life. You might question that, but work with me. The uterus had in its own way given life by throwing itself in front of that bullet. Intended or not, it still did. Almost like it had a mind of its own, preventing any further catastrophic damage. And any more damage would have pushed her over said cliff. The uterus was the one organ in harm's way that was in fact, in its own way, expendable. And staring down at it, I realized it had actually sacrificed itself to save her life. It took the hit for the greater good. 

Completing my surgical task in the middle of the night, we closed her up. I saw the plugged metal projectile lodged into the middle of the uterine muscle. Somehow, this simple yet complicated organ living in this body, had played the martyr. “It was there for a moment such as this.” That is what I believed then. And it is what I believe now. But in saving that life, it required the ultimate price, by giving up its own. And so, it did.

At four am, we finished. The patient survived. 

When the Uterus Saved a Life, Larry Puls, (Click to Tweet)