Ep 75-In the Trenches with Marybeth: Near Death By Boxcutter

He walks into triage at 3 AM with his girlfriend, dressed for a night out, calm as can be, and says he just needs stitches. Then we lift the paper towel and see the kind of injury that makes your stomach drop: a box cutter laceration to the neck with the carotid artery visibly pulsing inside the wound. If you’ve ever wondered how close to disaster a “simple cut” can be, this story answers it in unforgettable detail (with a clear trigger warning for graphic injury descriptions).

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Transcript

Welcome And Trigger Warning

SPEAKER_00 0:42

Hello Alley Cats and welcome to episode 75 in the trenches with Mary Beth Basic. Near Death by Box Cutter. Due to personal issues, we're unable to record our usual podcast, but never fear, we have a treat for you. Remember Nurse Mary Beth? Well, she has an incredible story to share with you today. And never fear, we'll be back next week with our usual format where I'll be covering another, can you believe it? Another dubious psychiatrist from the University of Minnesota and all about his nefarious activities. Trigger warnings for this episode include graphic details of injuries. So if you're squeamish, you may want to wait and catch up on our library of episodes. So for those who need it,

Who Mary Beth Is

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be warned. To recap who Mary Beth is, for those of you who aren't aware, Mary Beth comes from 17 years of nursing in various trauma settings. She prefers trauma in the rural area where resources are few and interesting cases are frequent. Shootings and stabbings and farm accidents. She's worked in prisons, reservations, and rural health care. Her first 10 years were in major trauma hospitals that thrust her into human meats train accidents, major meat processing plants, patients from around the world, and a few celebrities also. Prior to nursing, she was a social worker for the better part of 25 years. Her niche was addiction, meets mental health, meets marginalized populations. She's particularly fond of Native Americans and passionate to the needs of those who were judged daily. Prior to college, she grew up on an average farm that had puppies, kit, kitties, cows, piggies, plenty of duckies, and a never-ending supply of chicks. Well, Mary Beth, I hope you didn't have bears because that's what I'm dealing with here. We're talking the bears are coming out in force in northern Minnesota. I don't know if the wildfires have meant they have less place to stay, which is really sad, but yours truly here is ever wary of a bear siding. So stay tuned. I'll keep you posted. But meanwhile, Mary Beth is still working with a marginalized community surrounded by

A Quiet Night In Rural ER

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the most unique friends. She dabbles in holistic health. She makes bear fat soap, and in fact, was instrumental in getting that legalized in the state of Minnesota. And she never misses a chance to enjoy a dinner on the deck with family and friends. Oh, idyllic. Anywho, let's hear her story.

SPEAKER_02 3:26

Hello, everyone. Mary Beth here again. Today I have an extraordinary experience to share with you that made me a better nurse, made me very nervous, and shocked me to my core. About five years ago, I was working a rural ER in a community that is not only rural, but literally in the sticks. We have an amazing crew on with doctors that have seen it all. Remember that in the middle of the night, you will never have the resources or human power as a day shift. Let me set the scene. We are in a very small rural hospital in the middle of nowhere. The winter is cold but not frigid. The night has been steady with a short lull from the last surge of patients. My favorite doctor who has seen it all and never rattled is on duty until 8 AM. He is always busy charting and catching up on paperwork. The ER is staffed with a clerk to check in and register patients, a charge nurse who has about 10 years of ER experience on me, and the house supervisor. The house supervisor is walking between impatient and the ER. Impatient nurses can come over and help, but the situation needs to be pretty dire for the one ER nurse to leave the poor LPN in charge. There are a few security guards roaming around the hospital as the clinic won't open till 7 AM. The lab tech and radiology tech are always busy doing their thing and we never see them unless they are needed for their job. The charge nurse and myself are restocking rooms, cleaning equipment, and getting ready for the next wave that will undoubtedly hit. The doorbell rings from the registration clerk that a patient has arrived and needs triaging, no phone call to accompany the bell, just a bell and a message of the patient's name.

“Just Needs Stitches” Walk-In

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It's about 3 AM when a young couple in their twenties register with the clerk. They have a cut that needs stitches. Well that sounds easy enough. We have lots of stitches in the middle of the night. In the winter we have friends over and after a couple of drinks, a slip and fall can easily happen. Pretty easy. You would not believe how many people slip on the ice and slice their knee or arm open. So this young couple comes walking into my triage room, this room the size of a broom closet, with one chair, my desk and computer. The woman is dressed in very fancy clothes, says her boyfriend standing in the doorway, need stitches. I'm thinking this is a slam dunk and nothing I haven't seen before. Visualize this. This guy was holding his left neck while his right side is facing me. There was no blood streaming down his throat. He was calm and composed. Actually, I kind of wondered what was cut and bleeding since most cuts have blood all over the clothes and drops are plopping everywhere. He was all is dressed in very fancy casual clothes, and I remember him wearing a white t-shirt and jean jacket. I said to the guy, What happened to you? He is still holding his left neck and his right side is in my vision. His girlfriend is super calm. He says we were invited to this party by a friend of ours. I'm typing feverishly. It's down the road about twenty minutes, and everything is going fine when I see some girls talking to my girlfriend, and then they are pushing her out the front door. Okay, well, they're at a party and alcohol is probably involved. That is nothing new. We are in the winter and who doesn't throw a party on the weekend? I'm still not even nervous at this point. I think the calm attitude of the couple really threw me off my spider sense. Let me set the scene for you. This is in the middle of winter. The temp outside is in the mid-twenties. The weather is clear and perfect for a winter house party. The guy is super chill and almost too calm for my comfort. He starts in again. So these girls are pushing my girlfriend out the front door and I don't like that. The place is packed wall to wall like a frat party, and I got a couple of people to get through. I get to the front door and she is being punched by these girls. I jump in the middle and start breaking em up when some guy jumps me and now a bunch of us are fighting on the deck. It's pushing and shoving. Punches are flying, my girl is holding her own when I feel a sting on my neck. He points to his neck and with that his left hand is holding a water paper towel. Now he turns his body so that his left side is in my view. Even then I'm not nervous. I grab a couple of exam gloves and walk over to his left side and pull into view his left neck, gently lifting the paper towel.

The Carotid Pulse In The Wound

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Holy shit bombs! I can see his carotid pulsating. Literally, the cut is about almost a half inch deep and about one point five inches long. Is under his left ear lobe by about two inches and an inch over going forward. Can you see this in your mind's eye? The opening is glistening with a slight skim of fresh blood and nothing gushing out the wound. I almost can't believe my eyes. I have seen lots of fresh wounds, and it is really very rare to have a fresh wound not be oozing a constant stream of blood. The little pulsating wonder is completely intact. Nothing squirting, nothing weird to catch my attention. Well, other than the inside the wound is this gummy worm sized round tubule that is moving. Nope, it's pulsating. Oh my god. This is an artery and it has a heartbeat. My head is kind of swirling with this conversation I'm having with myself. Don't freak out. Don't say too much. Don't freak out. Don't say too much. Don't panic. Be calm. That thing is kinda cool looking. I have only seen one other instance of a pulsating artery, but that is for another episode. Impressive, I said. The young guy asked if it was pretty bad. No, nothing I haven't seen before. I have definitely never seen anything like this. Now I have seen some pretty wicked stuff, but that pulsating artery and what I would do if it burst was all I could think about. I put the paper towel back and walked him the ten feet through the double doors to a hospital bed. I asked the young girl if she had injuries like a stabbing or kicking or hit with an object. She said there was a lot of fist flying, but nothing like her boyfriend. I'm thinking to myself, Thank God you're okay. I can't take another one of this guy. The guy and his girlfriend are still very chill as I sit him on a gurney and she is in a chair. I'm walking out of the trauma room when the charge nurse says, Well, how is it? I'm making a face of the charge nurse like holy shit! Everything in this ER is electronic and live, meaning that as I'm typing the other person or people are able to read what I document, and as soon as I finish charting, she saw my triage node, started calling the nearest higher level of care hospital. This is very out of character, but I have a seasoned charge nurse who read enough to know that no matter how capable my doctor is, and we can handle some pretty amazing things, this is definitely out of reach for here. I'm kind of torn between telling this guy the truth and calling a nurse over to sit with them and play it cool. As a little side note, you might be wondering, why not just stitch this guy up and call it good? I have a little anatomy and physiology nugget. Arteries are very thick wall because they have all this pressure from pushing blood from the heart to pump blood throughout the body. This young man is pretty lean and his neck doesn't have a layer of fat on it for protection. The neck is also a very unprotected area because it doesn't have bones or muscle

Why This Cannot Be Sutured

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to protect it. Mother Nature is a wondrous thing. The skin of the neck covers the outermost jugular vein, and under that vein is the common carotid. The chances of a person being sliced on the neck and not bleeding out is a one in a million. There are so many veins, interior, external, and anterior juggler. Then there is this big carotid artery with this big thick walls. Now that we have done our AMP part of the story, this guy is a one in a million statistic in so many ways. If that box cutter even nicked the artery, it can start to build pressure that might spring a leak under all the push from the heartbeat. It might all look pretty good at this moment, but that rupture could happen at any second. Then there is a blood issue. This repair is not a small stitch event. The little ER I work in does not carry blood product. Small ERs in the rural area do not carry blood product because blood is so very precious and the shelf life is so very short. The best use of blood product is for a large hospital to carry the product. And when the hospital is flying to pick up a patient, they might bring blood product with them. It happens all the time in a large trauma. Back to the story. I casually speedwalk back to the ER doctor's office. And without knocking, open the door. I need you to come with me right now in my sternest voice. Our ER doctor had pretty much seen it all, and working in this very rural hour away from the nearest higher level of care hospital was a cakewalk for him. My doctor followed me back to the trauma room where my young couple are just casually waiting. My doctor dons a pair of gloves and casually lifts a paper towel. Very impressive, he says. What were you cut with? My young fellow effortlessly says, a box cutter. Without missing a beat, my provider says, I think I can stitch that up. No, I'm not one to pick a fight, but I could only see disaster if that box cutter made a nick in the artery and started springing a leak. Lucky for me, the house supervisor interrupted my moment. She informs us that the nearest hospital is informed and that this man will be coming their way. The nurse has also called for the helicopter and blood product. Just in case you're wondering why an ambulance is not called, I would

Helicopter Transfer And Teamwork

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wonder too. This carotid was a powder cake. The jostling, jostling of being in an ambulance, going an hour down the road and to a hospital could be very easy. The bumpy ride that could rupture the artery. The helicopter is actually a very smooth ride. By now, the police have arrived, and in a moment of complete chill, my favorite officer is there and offering to hold gentle pressure my patient's neck while casually interviewing him while I'm inserting IVs. The doctor has returned to his office to call the receiving hospital for a doctor-to-doctor discussion. It seems like forever the helicopter arrives with a cooler of blood. My patient has one large 4 IV in each arm. My boss, my officer is still holding gentle pressure on my patient's neck. The picture of this event is chaos, meets teamwork, meets law enforcement interview perfection. The patient is loaded on his gurney and together with three flight crew wheeled out to the helicopter pad just outside the ER garage. It seems to take hours, but actually is only a matter of minutes. With the critical patient flying away, the ER doctor turns his attention to the so patient girlfriend. She has some injuries from the fight, but nothing like threatening and is placed in an ambulance to be sent down to the same hospital. I can tell you that by the time the ambulance arrives at the higher level of care hospital, her boyfriend is in surgery. A surgery crew had been called in, an OR was waiting with the trauma crew standing by. Twenty stitches later, this man was right as rain. Our provider was still claiming he could have stitched this lad up right up until the very end of the shift. While I'm positive my provider can do anything, I didn't want to become a surgery nurse. The little morsel I didn't mention earlier is that this police officer is a frequent visitor to the ER in the middle of the night and will be mentioned in other events. His wisdom and spin on the world is amazing, in a legal sense and perfect for the rural demographic. This situation was a once in a lifetime event. I have witnessed horrid gunshots, stabbings, and even seen bones sticking out of the skin. Every situation is unique. Well, what did I learn from this event? Always keep your wits about you. This could have gone wrong at any moment, and that this young man lived while his girlfriend was ambulanced to the same hospital for her injuries is sheer luck. Youth is a crazy thing, and when we are invited to a house party where there are large groups, you never really know what could happen.

SPEAKER_01 21:20

Oh my goodness. An incredible story. So thank you very much for sharing that with us. It's always fascinating to have a glimpse inside the life of a common nurse. So next week we're gonna talk about a, as I said, another psychiatrist at University of Minnesota. Subscribe or follow Doctor in the Truth wherever you enjoy your podcast. Trust after all. You can access directly on our website at DoctoringTheTruth at Tastruth.com. Email us your own story ideas, medical mishaps, and comments at DoctoringTheTruth at Gmail. Please be sure to follow us on Instagram at Doctor in the Truth Podcast and Facebook at DoctoringTheTruth. We're also on TikTok at DoctoringTruth and at 808 U E D. Don't forget to download because we don't

Lessons Learned And Wrap-Up

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