The Yangtze Story

Today at the hospital, one of the nurses was flipping through my book and read the story about the motorcycle accident we came across on the way to the upper Yangtze River. The question came up: how do I prioritize what to do, and what was that moment really like?

I was literally taking a nap when a truck stopped. I woke up, looked outside, and immediately knew we had a problem. I think people make trauma—at least the first 5 steps—more complicated than they need to be. It’s the same way every time: head to toe.

The patient was talking, which meant airway, breathing, and circulation were intact in that moment. But the bleeding from his leg was so severe that circulation wouldn’t hold for long. This was one of those times where you don’t just run ABCs in order—you address the thing that’s about to end life. In trauma that means switching to CAB—Circulation, Airway, Breathing, then everything else—and starting with hemorrhage control. I put a tourniquet just above his left knee using a cam strap from the gear stacked on our truck and tightened until the bleeding stopped.

Then I moved to his head. He had much more than a scalp laceration—he had almost a scalping. We folded the tissue back into place and wrapped it for pressure. After that I turned to his left humerus fracture. It was bleeding, but in a manageable way. We reduced it, splinted it, and the bleeding stopped almost immediately. That illustrates the importance of field reduction: put the body back the way it was intended, and usually things improve.

Once the bleeding was controlled, I went back and repeated a primary survey. Always thinking—did I miss something with the airway? Was there a hematoma in his neck? A neck fracture? A pneumothorax developing? His pelvis worried me too, but somehow it was intact. My thought process was that I needed to be very thorough in my assessment because why would he have major trauma above and below it without a pelvic injury? Lucky for him, his pelvis was stable, there was no pain, and honestly, if he’d had a pelvic fracture, that probably would’ve done him in right there on the road.

We kept going. We wrapped him to manage hypothermia—a step in trauma that’s easy to forget, and lethal, especially in settings like this with significantly delayed transfer to a hospital. Remember: blood doesn’t clot well if you’re even a little cold. Then we loaded him into a passing van.

Much later we found out he survived after undergoing a controlled amputation of his left leg. At the time, though, I was pretty sure he was going to die on that road—or on the four-hour van ride to who knows where. Nobody else was coming, and the bystanders were just watching him bleed. Thankfully, there was an ER nurse on our team who did a fantastic job—it was very much a team effort.

Like almost all traumatic events, the key was staying calm and keeping it methodical. Run the basics, repeat them, and don’t skip the mental prep. Playing these things through in your head before you’re in the moment makes all the difference.

That one will stick with me forever.