"He jests at scars who never felt a wound" ~Shakespeare

I woke up this morning to screams. I thought I was having a bad dream. After a weekend of having our driver drive around like a maniac I thought that I dreamed we finally crashed, but when I woke up it took a couple of seconds to realize it had, in fact, come true. I looked up and directly above me was the roof that was supposed to be above the front dashboard, cold water was dripping on my legs from the air conditioning unit that was pushed up over the passenger side seat. As I slowly got my bearings and stood up to look around the car seats were scattered haphazardly. The immediate action by all was to make sure everyone was OK. We moved some of the chairs to free Anne from her seat and found Chris, unconscious, lying in the center aisle with blood on his face. I have to admit the terror surged through my body as I yelled "Chris" and he did not respond. Dinesh, being trained as an EMT and having seen accidents like this went into triage mode. He attended to Chris as my thoughts turned to "get the hell out of this car and find help."

The driver who had fallen asleep at the wheel had already climbed out of the front door and as I tried to squeeze behind the front seat he closed the door in my face. I yelled at him to open the door but I think he was in a daze too and did not turn around. (He was also very young, and a tad reckless and more than likely had no idea what to do in a situation like this). I was able to reach the door handle and squeeze behind the chair. Once out I felt like I could not catch my breath and started feeling light headed. A villager was directing traffic and told me to get in the median and out of the way. I sat in the grass for a few seconds trying to catch my breath and wrap my head around what had happened before I stood up to go behind the van. Vida was sitting on the ground and saw me stumbling around and yelled at me to come and sit. Vida and I both began yelling to call an ambulance and one villager who understood English stopped a jeep and told them to call the hospital. We began extricating people out the back door of the van and by this time Chris had come to and was answering questions appropriately, even joking sometimes like his usual self, as Jami held c-spine. We got all our stuff and all the people out of the van except Chris, Jami, and one of the guys from OSU traveling with us who was having vision problems, in retrospect due to vasovagal reasons but we held c-spine for him as a precaution.

The ambulance arrived and short of having c-collars were fairly efficient. They took the OSU guy out on a stretcher as we made make-shift c-collars with towels for Chris and him. Chris was hand carried by the two ambulance drivers to the back of the ambulance. Cristina, who was sitting opposite to me in the vehicle, had gotten hit in the chest with the front passenger seat and the TV above the front windshield had been pushed down and hit her head. She was having difficulty taking a deep breath so we decided to pile everyone, plus luggage, into the ambulance and drive the 120 kilometers home to Vellore. The van driver had a good head lac above his right eye but was completely coherent so we left him with the van and to wait for the next ambulance to take him to a closer hospital.

We spent the rest of the day in the hospital as Chris and Cristina got pan scanned and the OSU guy got x-rays taken of his legs. The rest of us were fairly banged up with scratches and bruises but all walking and talking. No one was hospitalized overnight and all scans, x-rays, echos, etc. checked out just fine.

This seems to be another lesson in India. I have been talking about the chaotic driving that occurs here and how I don't know where the car accident victims end up, I have come to the conclusion that they rarely make it to the hospital. The ambulance consists of two guys who own a van and a cloth stretcher similar to those used in WWII. Without a backboard, c-collar, any type of medical supplies it is a wonder that anyone makes it to the hospital. When things like this happen you begin to wonder what could I have done differently, what if we had left our initial departure site five minutes earlier or later, what if we had forced the driver to stop and get coffee after he refused, what if he had napped two minutes longer or slept during the day as we asked him to do. Bottom line is when you have a sense of doubt or danger or impending doom lingering n your gut listen to it. We were all uncomfortable with the drivers erratic driving and Chris had remarked on the way to Kerala that his driving was like rolling the dice and at some point you have to lose. We made it to Kerala safely and we should have found another mode of transportation home whether it had meant more money or being late for work Monday morning. But hindsight is 20/20.

We don't know who it was but we all decided someone was looking out for us. Being in India we thought maybe Ganesh, the god of luck, or perhaps Shiva, the destroyer. Shiva destroys in order to rebuild, maybe destroying our car to remind us we are mortal and not take for granted the people we have in our lives, the privileges we are given by being in the medical field or in the position in society that we function. Whomever or whatever it was we figured we would cover all of our bases tomorrow and visit the Hindu temple, the Christian church and the mosque down the road and be thankful for all having each other and thankful that we were all able to walk away.

I also say this because for some reason we all seemed to be in exactly the right position to not get seriously injured. Also being asleep probably helped. They say drunk drivers survive car accidents because their bodies go limp and they do not sustain as serious injuries, we figured sleeping was pretty similar. Jami, who had gotten car sick on the way to Kerala and was sitting in the front passenger seat was asleep in one of the chairs in the back, leaving the passenger seat empty (the site of primary impact). Because she was in the backseat Vida was then not lying across the row and was not hurt as badly when the seats were shifted all over the place. I was sitting in the front seat, behind the driver with a clear view of the road in front of me (due to my own motion sickness)and nothing between me and the front windshield. At the time of the accident I was thankfully lying down and the front of the car was pushed down above me and I barely rolled anywhere. Anne was sitting behind me and as we crashed she hit the back of my seat, stopping her from going anywhere and again because I was lying down the seat bent over me rather than pushing me forward.

We all made it safely to the hospital and got to experience the trauma bay from the inside (one rotation med students are not allowed to do). Once to the hospital we were treated very well. We were taken care of by the head nurse who had trained at the Mayo clinic in the US. Dinesh got his facial abrasion cleaned by a very friendly guy who later turned out to be the janitor, but that's India for you, using all your resources! India is also smarter than the US making you pay up front for everything (procedures, supplies, lab tests) before anything is done. Everything is obviously considerably cheaper than in the US but it still makes you think about all you are spending and what is absolutely necessary.

We stayed there most of the day then went back to the hotel to relax. After no breakfast or lunch and being incredibly dehydrated I ate like I had never eaten before and I was never going to eat again. I devoured my paneer naan, anything that is a fresh baked bread product with additional cheese is ALWAYS good. A few of us ate dinner together for somewhat of a debriefing meeting and treated ourselves to some much deserved ice cream sundaes.

As I said before everyone is doing alright. I have a few scrapes and bruises on my legs as do the others but we are all thankful that we walked away. This is just a clear message to never travel at night, make sure you tell your friends and family you love them as often as possible and live life with no regrets! There are too many things that are left to chance in this world, things that can happen in a split second, that could be irreversible. We see it happen to our patients and begin to think "this could never happen to me," only to wake up one morning to your worst nightmare. We have to remember we may be physicians but we will forever remain mortal.

much love to all! Pictures to come...