3am on a Saturday. I was working in the emergency room of a level 1 trauma center and we had 3 people coming in after a gun battle. We only had 2 beds designated for severe trauma, so there was the typical discussion re: which 2 people to try to stabilize and which person to delegate to the make shift trauma bay. Do we focus on the most severely injured or the 2 most likely to survive? After what seemed to be a nearly comically drawn out and shakingly quiet/still wait, the first 2 victims arrived and the stillness flipped to chaos.
The first person wheeled in…just didn't seem to have a head. There was this bloody mass at the top of his neck but it didn't look human. I remember being so confused that we were using one of the bays for this person/body, who just could not still be alive. I was looking him over and I noticed his left thumb was was calmly and repeatedly cracking the knuckles on his left hand. It would squeeze one finger and rhythmically work down the other 4 and start over. He didn't have any anatomy left that we could easily intubate and yet he was cracking his knuckles. I still can't make sense of it. He didn't stay alive much longer, maybe a couple of hours, but that knuckle cracking seemed like such a human thing to do for someone that had no reason to still be alive.