Blood slowly dripped from two linear slits on the left side of the man’s chest. He focused on the doctor with a wide eyed stare and spoke in an anxious whisper:
“Doc, don’t let me die… don’t let me die, doc.”
“We won’t let you die”.
The doctor looked up from the patient’s tattooed face to the stony-faced nurses and paramedics, then continued his assessment.
“Tell me what happened to you.”
“I fell on a knife.” he whispered.
The patient would say nothing more.
The doctor approached the paramedics as they collected their equipment and finished their notes. The taller, red-haired paramedic said:
“As we were driving away from the scene a woman chased after the ambulance waving a large kitchen knife. Just a hunch, but I suspect that she might have something to with this…”
More information came to light from the nurse-in-charge:
“This man isn’t allowed within 200m of the emergency department. He’s been here quite a few times before with a number of badly beaten women and has repeatedly threatened and intimidated the staff.”
The patient didn’t look quite so menacing now – despite the crew cut, the gold teeth, the gang patch and leathers, the missing finger, the tattoos and the countless scars.
The police were standing outside as a nurse left the trauma room.
“Is he going to make it?”
“Looks like it.”
“That is a shame.”
The patient was plumbed with lines and remained stable, so he was taken for a CT scan. Apart from a small amount of blood and air around his left lung, his only serious injury was a difficult-to-spot knife wound to his diaphragm. The lower stab wound had missed his heart by less than a centimetre. He went to theatre to repair the diaphragmatic rupture and to look for other internal injuries. His recovery was uneventful, with the exception of the incident in the intensive care unit.
A woman, sunglasses partially concealing the bruise around her left eye, came to pay him a visit. Soon after she arrived, somehow, despite having been securely sutured in place, the patient’s chest drain mysteriously ‘fell’ out.
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.