Blood Loss

My first job as a Laboratory Scientist was at the blood bank of a Trauma 1 Center. The blood bank, in all its vampire-associated humor, was situated in Lower Level 2 of the main patient tower. Windowless, recessed in a hollow underground along with other forgotten spaces—mechanical rooms and housekeeping closets—it was a tomb, of sorts. It was a vault for the blood that came packaged on ice, roughly 300 ccs each, deep crimson, packed red cells separated from their plasma, preserved in CDPA or AS-5.

One fridge, 3-5 degrees Celsius, contained over two hundred units of O Positive blood. Two other fridges held the rest—A, B, AB, Rh Negatives. Hermetic freezers, -30 °C, kept the plasma products: FFP, the counterpart to blood, and cryoprecipitate at 10 ccs a bag, to be pooled and given only in the worst of circumstances.

At room temp, an agitator incubator swayed the platelets to keep them from clumping. In vivo, the circulation keeps platelets in motion. Whenever blood pools, platelets release proteins that activate the coagulation cascade, the body’s miraculous way of stopping blood loss and promote healing. Some wounds, though, are too vast, too deep. The body cannot cope.

The blood bank was strategically located below the trauma bays in the Emergency Department and two floors down from Surgery. One shot down the elevator and the nurses got the life-saving products within minutes.

Other departments were not so fortunate. Labor and Delivery was inconveniently two buildings over, too far from the mother who, in delivering her twins, went into DIC and the nurses could not figure out the maze that led them across buildings and into the dungeons. By the time they hung the blood it was almost too late. Raw from the near miss, the administration blamed the blood bank for being inaccessible, unclear in its directions to the staff. Didn’t we know she could have died?

And so, with every patient type and screen, every unit cross- matched, the possibility of death lingered near. True, most surgeries and deliveries went uneventfully, most transfusions required only one or two units. But we also got calls for active MTPs—four units of red cells, two plasma, one platelet, turn round time 18 minutes, repeated for as long as the nurses kept coming or the patient died. Usually, the patient died. A body could only lose its blood volume so many times.

This was in the years just before the cell-saver, when Dr.— was still taking high risk patients for liver transplants. He stopped after one of them used upwards of 70 units right before Christmas. The patient had been too elderly, too weak. Blood was in short supply, always is—

For every unit, there is a donor, willing to give thirty minutes of her time hooked to a 16-gauge needle, willing to drain her own life supply into a sterile bag. She is given a drink, a snack, many thanks afterwards. It takes her body two months, long after the expiration date on the bag of blood, to replenish that which she has lost. Or given rather, gifted to another body in greater need. Or the trash, as it sometimes happens too. It becomes a question of how to best allocate resources.

Who lives, who dies.

That liver transplant patient—he died.

It was one thing to hear about those patients in critical condition, quite another to see them, touch their graying skin. One Saturday, we had fifteen calls for traumas by early afternoon. With only two of us on shift, we rotated going up. The pager vibrated yet again.

T1 GSW ETA 5 min.

It was my turn. I donned the yellow impermeable gown and gloves, grabbed an alias tag, and headed up with the emergency release blood, liability papers cold and damp atop the units. Up on the bay, the trauma team waited.

Self-inflicted, they said. Missed. Unsuccessful attempt.

The paramedics wheeled in a man, naked on a stretcher. His jaw was gone.

Once inside the bay, the trauma team took over. The head doctor asked for readings, directed treatment. Epinephrine. Intubation. I rushed in to band him around the ankles, give him a name, ZZZIM Mountain or something like it. His feet were the color of ash. Blood? Two units now.

Prepare for surgery. Beeping sounds. Voices calling numbers, medications. People going in, coming out. Papers. Tubes. Instruments. I watched for the inguinal draw. A frantic rush. Then the head of the trauma team called it. Every effort ceased.

I grabbed the unused blood, left the afternoon sunlight that came in through the glass walls, and went down into the darkness and isolation of the blood bank. I sunk in my chair, gown and gloved. This wasn’t the first time I had seen somebody die. I had seen other traumas; I was in the room when my grandfather passed. I had counted the seconds between his slowing breaths, counted for the breath that never came. My grandfather used to say, “When I die, don’t bring me flowers. Give me flowers now, when I see their colors, smell their fragrance. When I die, don’t cry, don’t wear black, don’t bring me flowers.”

Dying is part of life. Death is not.

Eventually, I took off the gown, dropped it into the biohazard laundry bin. I put away the emergency release blood, filled the paperwork. I worked on other type and screens, cross-matches. At the end of my shift, I went home.

I petted my dog for a long time that night. Days in and days out, the years went by, and I would witness others dying, but still would think about that man. I never found adequate answers to my questions.

We worked to save the life he did not want.