Hospital
Hospitāle, 'place of reception for guests' (medieval Latin, 15th c.)
Trauma Room
Now that the ambulance paramedics have completed the handover, a nurse uses trauma shears to remove most of your clothing. (Yes, you're wearing clean underwear.) Leaving your cervical collar, pelvic binder, and electrodes in place, a hospital paramedic replaces the cables and connects you to a vital signs monitor. In the adjacent staff area, a resident and a pharmacist check your medical records for anything that might be relevant. When Nova Scotia's One Person One Record system is finally up and running, this should be easier.
You're surrounded by a large trauma team: a team leader, trauma resident, general surgeon, anaesthesiologist, orthopedic resident, neurosurgery resident, critical care paramedic, respiratory therapist, and two nurses. That's a total of ten. Although the trauma room is larger than a regular emergency room, it's still crowded.
Again, you're missing out on the surroundings. Your emergency stretcher occupies the centre of the room. It can be raised and lowered using a foot pedal, and tilted toward the head or the foot. Its side rails fold up and down. A pair of big wheels in the middle of the stretcher enables it to pivot around corners. This model also has a slot below the mattress for an x-ray digital radiography detector, so that an x-ray can be taken without moving the patient. Clever.
You're surrounded by mobile equipment. A large rack of monitors is suspended from a ceiling-mounted boom. Next to it is a bright surgical light, also suspended from the ceiling. Rolling stands hold a rapid blood infuser and a rack with four intravenous pumps. Everything on wheels is battery-powered, so there are no power cords for the team to trip over. Around the edge of the room are drawers of equipment, labeled for quick access. Other trolleys of equipment can be brought in if necessary.
You were wheeled in through the automatic metal doors on the hallway side of the room. On the opposite side, facing the central staff area, are glass doors with a curtain that can be pulled across for privacy. The trauma room can be environmentally sealed, with negative pressure from the ventilation system sucking out contaminants to prevent them spreading elsewhere. It's warm in here to prevent you developing hypothermia, which can worsen bleeding.
The Infirmary's Emergency Department has 48 rooms for patients. Five of them are these larger trauma rooms. Another seven treatment areas have been set up in a hallway to help deal with the space shortage. The Halifax Infirmary expansion will provide more emergency spaces, but not until 2031.
A clinical assessment and x-ray images confirm that your spine and pelvis weren't injured, so the trauma team removes your cervical collar and pelvic binder. They reassess your level of consciousness and lower your GCS score to 8. You're now intubated, with a breathing tube to protect your airway. To keep you comfortable, you receive pain medication and a sedative through an intravenous line.
After a few minutes, your vital signs stabilize, so you're wheeled along several hallways for a CT scan, with your cables attached to a portable monitor. Despite all the hospital signs, it's easy to get lost in here. Fortunately, you're not driving.
CT Scanner
The exam room for the CT scanner is kept cool. Attendants slide you across from the emergency stretcher to the imaging table in front of the scanner. The CT technologist covers you with a blanket to stay warm, then everyone leaves the room and goes into the control booth. Above you is a bright blue sky with wispy clouds that don't move.
From inside the control booth, the CT technologist and trauma team members can observe and communicate with you. Between these two spaces, a sheet of lead inside the wall and lead glass in the window protect them from ionizing radiation from x-rays. The CT technologist checks the exams that the trauma physician requested, chooses the appropriate protocols, then initiates the machine to start the imaging. At the press of a button, your imaging table slides slowly into the gantry, the big white donut.
During the next few minutes, the CT scanner takes multiple images in several different planes. It's surprisingly calm in here: just the whir of the scanner rotating around you.
Your CT scan is a product of innovation. The Computed Tomography (CT) scanner was invented in the UK in 1967. The first one in Canada was acquired by the Montreal Neurological Institute in 1973, followed by QEII Health Sciences in Halifax in 1975. In 2024, QEII Health Sciences was the first in Canada to acquire a new type of scanner for 3D imaging.
Inside the booth, the trauma team and the radiologist review your scans on a monitor. They can also generate 3D images and rotate them in different directions. It's too bad you can't see this. As the paramedics suspected, you have a depressed skull fracture and an intracerebral hematoma, with a bleed in two parts of your brain: at the fracture site and directly opposite it. When you hit the concrete, your brain bounced but your skull didn't. You need surgery.
The neurosurgeon calls to arrange an operating room and a surgical team, as well as a room in the Intensive Care Unit. You're wheeled along several more hallways to the Summer Street elevators, then up to the fifth floor, where the Intensive Care Unit and operating rooms are located. You'll park in ICU until an operating room is ready.
Meanwhile, a resident has been recording the many details of your condition and treatment since you arrived in Emergency. Your chart will accompany you as you move through the hospital. The trauma team leader will prepare his own report later, after things calm down.
Operating Room
When the time comes, you're wheeled from your room in ICU to an operating room. It has yet another bed for you to test drive. That must be six or seven so far. This one is a bariatric surgical table that can support 1200 lbs. It can use either AC or battery power, and has multiple adjustments, safety features, and accessories. Above you are two bright LED surgical lights. Around you are machines and cables, some of which you may have noticed earlier in Emergency.
Nova Scotia Health
Later, if you feel up to it, you might watch some videos about how an operating room works. A surgeon in Texas describes other machines and areas inside an OR. A surgical technologist in another hospital shows how surgical supplies and equipment are organized behind the scenes. Another surgeon in Alberta describes the many steps to maintain a sterile environment in an operating room, especially the central area around the surgical table. Surgery has been practiced for many centuries, but it wasn't until 1884 in Germany that the first sterile operating room was developed.
Your neurosurgeon briefs the rest of the team, which includes the anaesthesiology staff (anaesthesiologist, technologists, and anaesthesia assistants) and nursing staff (neurology nursing team and charge nurse). The anaesthesiologist gives you a general anaesthetic and you drift off. The neurosurgeon peels back part of your scalp to check the skull fracture. She drills a small hole to drain excess blood. Another small hole is drilled to insert an intracranial pressure monitor. Your brain is starting to swell, so she decides to perform a craniectomy, removing a portion of your skull. This will let your brain expand, lower the pressure inside, and reduce the risk of brain damage. The skull piece is saved for later. The exposed area is covered with a sterile dressing and a helmet, so now you look like a speed skater. The operation concludes and you're wheeled back to ICU.
Intensive Care Unit
Your ICU room is private, with a nursing station right outside. Behind you is a view of the hospital parking garage on Summer Street, so you're not missing anything. Your hospital bed in ICU is different again. It's loaded with features, including an adjustable mattress that minimizes pressure points on your skin when you're not moving around. Nurses stop by occasionally to turn you and ensure that you're clean and dry. Beside you, a tower of IV pumps delivers fluid and medications to you through an intravenous line.
Your next of kin is impressed by the large ICU care team that is keeping a close eye on you. It includes an ICU staff physician, residents, pharmacists, dieticians, a full-time nurse, and additional nurses. Everyone on the team stops by periodically to discuss how you've been doing, to keep your vital signs normal, and to check the pressure on your brain. When the pressure goes high, they treat it with pain medication and sedation. When that doesn't work, they give you a salty IV solution to help reduce the swelling.
Despite these treatments, the swelling gets worse over the next few days. Now that your brain is compressing your nerves, you can no longer move your limbs, cough, or breathe on your own. Your eyes no longer respond to light. Two ICU doctors assess you and agree that you no longer have brainstem reflexes and are not waking up, even when the sedation is turned off. They send you for another CT scan. It indicates that blood and oxygen are no longer flowing from your heart to your brain. When this test is complete, it's recorded as your time of death.
You're wheeled back to your room in the ICU. The ventilator continues breathing for your body, which in turn enables your heart to keep beating. You're still attached to the vital signs monitor and the IV pumps. The doctor notifies your next of kin that you've died and explains what brain death means.
Your medical records indicate that you wish to be an organ donor. You've now met the initial criteria: you won't survive this injury, you're on a ventilator, and your end of life is imminent. This isn't a good outcome for you, but it promises to work out well for others.