About an hour later Tom called up to the OR to say he was not making much headway with Khalid. Blood was still pouring out of his abdominal dressing. Jim and I were finishing with the next case, so I ran down to the ICU. Tom had given the patient a tremendous amount of blood products, but not much fresh whole blood. He still had laboratory values reflecting a profound coagulopathy, an inability to form blood clots. I told Tom to pour 6-10 units of fresh whole blood into him. I replied, “I realize that is probably the case, but until you get some products in him and get even close to the normal range for platelet counts and clotting times, we won’t be able to tell surgical bleeding from medical bleeding and he’ll die on the table!”

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Khalid was much better after the whole blood. We found an arterial bleeder deep in his pelvis, back in the gluteus muscle where the round had smashed through his bone. We were able to find and at least temporarily control all his injuries at this second operation, including his esophagus, which we stapled off above and below the injury. The bleeding was stopped. I was a bit giddy, when everything calmed down. Khalid woke up and was able to nod his head to questions from the translator, meaning his brain was okay. At that point in my career, I had not seen anyone quite as badly injured as Khalid, and we had rescued him. We had brought him back from the brink of death. Our resuscitation strategy, which I had had a hand in creating, worked.

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