An Arctic Moon

“You don't need to worry about my eye,” Doc said as he squinted up at me through the bright lights of the trauma bay. “The left one is glass anyway!” A conspiratorial smile spread across his face, compressed and molded by the ill-fitting cervical collar.

Moments earlier, Doc had been brought into the emergency room. Elderly, hard of hearing, and sporting a chart full of comorbidities, he had driven his ATV into the back of a road grader. The piece of heavy machinery rolled backwards, crushing him beneath its wheels. Here in northwestern Alaska there is no pavement, and ATVs are the only way to get around. Doc's family had been trying to get him off his Honda for a year. They feared that his declining health would lead to an accident such as this.

At first Doc bantered with us as we busily set about surveying his injuries and attempting to stabilize him. After a lifetime in the small community, he was known to all of the nurses and related to more than a few. But his blood pressure, initially borderline, continued to decline despite our attempts at fluid resuscitation. We called for blood and then for albumin. Finally our X-rays came back. The trauma series revealed a badly shattered pelvis. We labored for the rest of the afternoon, running through 12 liters of intravenous fluids and the only 4 units of type-nonspecific blood in the hospital, in a desperate attempt to make him stable enough to transfer. Then he developed disseminated intravascular coagulation. The trauma surgeon, consulting from 600 miles to the south over the phone, was clear in his assessment: “Don't wait to stabilize him. Get him on an airplane now. If he doesn't get to the operating room, he will die. You may still lose …