We moved quickly. I remember saying to Jim, my colleague, “We can’t seem to get to the end of his injuries.” We took the spleen and left kidney out, stapled across the end of the pancreas, and tied off the splenic artery. At this point, a continued river of blood was pouring out of the pelvis and along the left side of the abdomen, continuously obscuring our view. We looked in the pelvis and found that the packs we had placed were soaked through. We removed these to find torrential, audible hemorrhage. Multiple arterial and venous branches deep in the pelvis were injured and bleeding rapidly. We noticed the rectum was full of blood but saw no injuries in the abdomen, meaning the rectum was injured deep in the pelvis just above the anus. We were able to identify and ligate many of the pelvic bleeders. We stapled across the sigmoid colon to divert the stool stream for an eventual colostomy. We compressed the distended rectum and noted about a quart of blood and clot shoot out between the patient’s legs.

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Despite Kurt, the anesthesiologist, pouring blood in the patient we were losing him. We placed tight packs throughout the abdomen. We had stapled off a couple of small bowel injuries, but had not had time to even address the esophageal injury. We temporarily closed his abdomen and took him to the ICU. He seemed slightly better. Other casualties were pouring in, so I instructed Tom, a Hematologist helping in the ICU, to give the patient as much fresh whole blood, factor VIIa, and blood products as he could to try and get him better. We ran back to the ER and then the OR with another patient.

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