Trent's Story

UPDATE

It’s about 5pm on a Tuesday in late autumn.

The Landcruiser has a big canopy at the back, one of those ones that blocks all vision behind. The driver’s attention is on the ute in front of him, which has just flicked on a right-hand indicator. The two vehicles are travelling along a narrow back road outside of Silvan. Queens Road is a long straight ribbon of tar between paddocks and orchards on the very edge of Melbourne’s sprawling mass, the Dandenong Ranges looming just to the west. The ute begins to slow and the Landcruiser gently brakes, the driver and his passenger looking ahead to spot the driveway the ute is aiming for.

The motorbike feels good between Trent McGaffin’s legs as he nudges the speed limit of 80 kilometres an hour. The 19-year-old has just finished work, driving tractors. He’s wearing protective pants, a reflective safety riding jacket, gloves, boots, helmet, and has his kid brother’s backpack on his back. He’s thinking about two thoroughbred horses, Bruce and Beau, that he needs to feed, ideally before dark. Less than a year ago he had a dirt bike, but that went very wrong and he ended up in The Alfred’s emergency trauma bay 2, eventually leaving hospital with a plate in his left arm. He has moved out of home and bought this Yamaha R3 road bike to get around. Now, barely 200 metres from work, he sees a Landcruiser ahead of him, halfway down the hill and driving slowly. The road is clear coming the other way. Trent accelerates and moves out to pass.

The ute turns right.

‘Will I know the victim?’

It’s not long after 5pm. Leading senior constables Peter Edyvane and Glenn Barkway from Monbulk Police are on the road when the call comes through. “Motorcycle solo accident. Any units available?”

If nobody replies, the police radio operator will start calling individual local units, asking what they’re up to and whether they can attend, but there’s no need this time. Edyvane and Barkway are between jobs and nearby. They radio confirmation and hear a unit from Lilydale also respond. As they drive, Edyvane, a 22-year veteran of local policing in a small community, has the same thought he always has: will I know the victim?

Within minutes, they arrive at the scene, and the policeman is relieved to see an ambulance arrive simultaneously. “That’s good for us,” he tells RoyalAuto. “A sigh of relief, because we don’t have to worry so much about the injured person, giving first aid and such.” If the police beat an ambulance to a scene, they will check for anyone trapped in a vehicle and whether immediate first aid is required. But the paramedics are already unloading equipment.

And Trent McGaffin desperately needs their help. He’s lying in the gutter where he landed, at least 20 metres from the wreckage of his bike, having catapulted through the air until rubbish bins and a pole violently stopped his trajectory. Now a gaggle of pale-faced strangers are standing around him, including the driver of the Landcruiser who is trying to nurse him, along with the other occupants of the cars and a few people who have wandered out from the farm, having heard the crash.

Trent is “very conscious”, according to Edyvane, and screaming in pain. As the paramedics go to work, the fallen rider shouts and screeches with agony if they attempt to move him or to cut away his clothes to assess the damage. And the damage is severe. The right side of his chest is tender, his left arm might be broken and his left leg is smashed and swelling alarmingly. One of the ambos makes a call and asks the police to prepare a landing space for the air ambulance.

The police unit from Lilydale arrives, and two groups of police block the road from both directions as the paramedics start working to stabilise their patient, giving the screaming teenager some heavy-duty pain relief, loading him onto a stretcher and moving him into their vehicle so they can work more easily. Edyvane thinks he might be able to hear a helicopter and takes a moment to consider the scene. How many crumpled road wreckage scenes has he attended in two decades? His gut says the kid won’t die. It’s only afterwards, talking to the 19-year-old’s mother days later, that he’ll discover Trent and his kids went to the same school. One degree of separation.

Finally, the air ambulance arrives. It tries to land in the closest paddock but the pilot isn’t happy with the space and the helicopter lifts again and finds another paddock. As it finally settles, a border collie goes wild, barking and leaping at the edges of the scene. MICA paramedic Toby St Clair briefly considers the dog as he emerges from the machine, his eyes locked onto the scene and his patient. Trent will be his responsibility from now and he will concentrate on that and nothing else, no matter a yapping dog, a kid trying to climb into the chopper to take photos, the local bystanders crowding his space.

An independent witness

As the local paramedics make way for St Clair, the Monbulk police take photos of the scene, breathalyse the drivers as standard procedure, and Edyvane starts taking statements from the bystanders. And finds gold: the passenger of the Landcruiser, who has no agenda and tells him straight what she witnessed and how the crash occurred. “A driver who might be in the wrong will try to massage the story, and even a driver who thinks they might be at fault will be looking to present things in a favourable light,” he explains later. “I was lucky; I found one of them (an independent witness) and she told me what happened.”

A half moon is rising in a pink and grey sky. The crumpled remains of the Yamaha lies in the grassy gutter, a red P plate still attached to the back. Everything is quiet apart from the yapping dog, the sounds of Trent’s moaning, and paramedic St Clair talking loudly and clearly to his patient, his voice becoming a lifeline to the world through his pain. “Are you with me, mate? Here’s what’s happening, Trent. I’m going to administer some Ketamine. Everything’s OK, mate. Nice and peaceful. Just relax.”

As St Clair works, policeman Barkway is going through the rider’s phone, looking for family phone numbers. He finds a number that might be Trent’s mother.

About 5.30 pm, Jandi Gibson walks in the door of her home in Yellingbo, only a few kilometres to the south-east, after a draining day. Her 17-year-old son has had to have a lump removed from his neck, which may or may not be a melanoma. The surgery is finally over and they find out the results in a few days. Jandi has encountered a lot of medical and general trauma, including family members injured in several car crashes, her own bout of surgery a couple of months earlier, as well as moving house after her marriage ended. This was not something she needed. Wilson has barely walked through the front door when the phone rings. “I’m leading senior constable Glenn Barkway from Monbulk Police, Ms Gibson. Are you Trent Trent McGaffin’s mother?”

Motorcyclist down. On his way

Fifty-one kilometres away to the west, in The Alfred’s emergency department, senior registrar Dr Peter Carter’s pager bleeps. He reads the screen and grimaces. Motorcyclist down. Hit a pole at an estimated 80km/h. On his way. The emergency trauma doctor is a former motorcycle rider himself. “I love bikes,” he tells RoyalAuto. “I had a big BMW bike.” He waves a hand at the emergency department trauma bays behind him. “Then I started working here. And I sold it.”

It’s just after 6pm and the sky is darkening as he stands inside a double sliding door, hearing the beat of the helicopter’s blades before he sees it, appearing from the left of the doors, and landing gently on the helipad that straddles Commercial Road. The brand-new air ambulance is shiny red and white, high tech and purpose built. The rotors stop and figures emerge from the flying machine. The door can now be opened and Carter and two orderlies stride out to meet the patient.

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Not much can be done while the air ambulance is flying. Even using a stethoscope can be tricky. But Trent is mostly stable. Ketamine is doing its job, so that his groans of pain are loud but indistinct, mostly guttural. As MICA paramedic Toby St Clair and the orderlies unload him from the helicopter, Carter asks questions.

Being a trauma doctor is largely about pattern recognition, Carter says. As soon as he knew the “mechanics” of the crash included “came off a motorbike at speed, hit pole”, he assumed if not the worst, then close to it. “Anything above 30 kilometres per hour (on a motorbike) is bad,” he says. But now the paramedic is reeling off his patient’s “vitals”, including heart rate and blood pressure, and Carter is wary for a new reason. “To be honest, his vitals were fine. That made me suspicious because the numbers were too good.”

Toby, the pilot, Carter, the orderlies and the stretcher can barely fit in the large stainless-steel elevator that carries them directly down one floor from the helipad to Emergency. Trent is wheeled into trauma bay 2 and Alfred staff members plaster stickers to their left breasts: “Trauma RN”, “Nurse Leader” and “Trauma Registrar”. Carter is already wearing the “Team Leader” tag. Dr Adam Bystrzycki, technically Carter’s superior but following his lead here, is already scrubbing as though for surgery. Others are pulling lead-lined smocks over their scrubs. Nine people fill the bay, around the stretcher, including Johnny Di Nunzio, the lead nurse, who is sitting in front of a computer screen ready to type. Four young women are huddled in the bay’s entrance. They are double-degree fourth-year nursing/paramedic students, wide-eyed and observing. Everyone is calm but concentrating intently as they turn their faces towards St Clair.

‘If you get excited, you’re not doing your job’

The paramedic stands by his patient and speaks loudly and clearly, giving a verbal handover. He gives the patient’s name and age, summarises the accident in one or two sentences and then lists the known and suspected injuries he and the road crew paramedics have identified, including the very tender right-hand side of the chest. He lists the exact drugs and amounts of pain relief already administered and other work done. In the trauma bay doorway, Carter is standing, hands behind his back, like a footy coach watching his team in the rooms, listening intently. Once the paramedic’s handover is done, Trent becomes his patient.

The entire bay, crowded with highly trained professionals, has an air of calm determination. “If you get excited, you’re not doing your job,” Carter explains afterwards. He and his team never once appear hurried, yet so much happens so fast.

Within one minute of St Clair handing over the patient, an Alfred doctor has listened to Trent’s chest and confirmed he can’t hear breathing on the right-hand side. A minute later, Carter is looking at a chest X-ray snapped by a large square machine in the ceiling, to confirm the collapsed lung, punctured by broken ribs. This is the injury that could kill the teenager if left untreated, as air continues to fill the chest cavity, but not within the lung. Eventually that air would crush his heart if left alone, but that’s not about to happen. Within another minute or so, Dr Peter Finnegan is performing a trial technique, for only the hospital’s 11th time, feeding a video-guided intercostal catheter (VICC), also known as a “chest tube”, into a small puncture in Trent McGaffin’s side, and watching the video feed to guide the tube past the working lung and other internals until it’s in the perfect position next to the collapsed lung. The camera is whisked out, leaving the tube to slowly suction the air from the chest cavity. This will take four or five days, by which time the lung will be able to reinflate in the resulting vacuum and begin to work again.

Six minutes after the patient arrived, Carter and his team have moved Trent from the ambulance trolley onto the trauma bay’s wheeled bed and the potentially fatal lung issue has been resolved. He is now deliberately placed on his side so they can check for any penetrative wounds or other trauma on his back that might have gone unnoticed. “You’d be amazed what ‘the turn’ can find sometimes,” a nurse says. This is not fun for Trent’s balloon-like left leg, which bends like a mushy banana. The Alfred team insert tubes into his mouth, placing him on a “life support” ventilator, which means the patient is now in an induced coma, his breathing artificially controlled. It sounds dramatic but the doctors are working on the theory that he has already had a lot of pain relief, and they need to control his breathing and heart rate to give him the extra pain relief he may still require, while also being free to perform certain procedures that would not be possible if the patient was awake and aware. And, anyway, one look at that left leg confirms he’s headed for some kind of surgery tonight, so he may as well be put under now.

Deep in merciful sleep

By 6.50pm, the air in the bay is almost peaceful. Trent McGaffin is mercifully in a deep, deep sleep, as the X-rays of his limbs show catastrophic breaks and trauma. Nurses gently wipe blood and dirt from his hands and face. Others explore whether blood loss into the swollen left leg is critical. The leg is bad, a “moving fracture” as they call it, which means all the bones are broken and the various sections of the leg are floating uncontrolled. The team places an old-fashioned wooden splint on the limb to try to prevent more damage. Di Nunzio, the nurse leader at the computer, has been diligently filling out the Emergency Department’s standard patient record and asking methodical questions, ticking off every piece of information, ensuring nothing is forgotten. Trent’s vitals are watched constantly, his heart rate still higher than Carter would like, which could be because of the pain or blood loss. He remains aware of that monitor at all times, even as the team prepares their patient to be moved 10 metres down a corridor for CT scans.

At 7.30pm, a white circular humming machine moves across Trent’s head, shoulders and chest. It’s taking a continuous spiral scan all the way to his feet.

The CT scan will show he does not have any brain injury, or neck or head injuries. His pelvic and abdomen areas seem OK. The collapsed lung has already been treated. He has major limb damage. The fractures in his left leg are so bad they could injure the blood vessels leading to his foot, although the foot retains good colour. Even so, The Alfred will scan the arteries to see if a stent or other intervention is required.

The scan shows that everybody has missed a fracture of the clavicle on the patient’s right side, but Carter explains that this is common in Emergency as they concentrate on life-threatening damage and stabilising patients. People might wake up a day or so later and complain of a sore hand, only to find that’s broken as well.

But they’re alive.

Trent and his horse

A son in trauma bay 2, again

Trent is returned to trauma bay 2 and his mother, Jandi Gibson, arrives, fragile and scared but calm and polite to the doctors who bring her up to speed on her son’s condition. She is the one who notes it’s exactly the same bay her son lay in a year ago. His father, Chris, is still on the road from where he lives in Wodonga. He won’t arrive for another hour and a half. “This was one time I didn’t have to worry about falling asleep on the drive,” he says.

Jandi Gibson peers at her son, who is deeply unconscious and wrapped like a mummy in hospital blankets. Carter is handed three vials of blood taken from the teenager. This is routine for any road trauma and is known as “police bloods”. Carefully marked with his name, patient number and other details, the bloods are placed in a safe within the Emergency Department, where they are collected by police once or twice a week. One vial will be kept, unopened, for the patient, one is for the hospital and one is checked by the police laboratory for alcohol or other illegal substances. It’s a reminder, in the middle of the immediacy of saving patients’ lives, that potential criminal charges, and legal, insurance and logistical tangles, may all lead out from this moment.

At 9.15pm, Trent finally leaves trauma bay 2, surrounded by four or five Emergency staff and carted in a large medical elevator to the Intensive Care Unit upstairs. Now it’s Carter who is giving a verbal handover to the ICU team, detailing everything that has happened in his patient’s treatment so far. “This is Trent,” he begins. “He’s had his second motorbike accident in two years…” The handover is a mix of complex medical jargon and very human elements. “The mother is here, she’s great, the father is coming, they are separated, Trent’s got four siblings at home …”

Jandi is in the waiting room outside, with its airport lounge-style uncomfortable chairs and clusters of strangers looking scared and drained, eyeing one another and wondering what hell each group is enduring. A nurse appears at one stage to ask pre-surgery questions, some of which are surreal but all have purpose. “Are they all Trent’s own teeth?” she asks, ticking boxes. “Any caps or crowns?”

Jandi answers numbly, adrenalin starting to dip and the reality of what’s happening sinking in. She will be in this room, apart from one pre-surgery visit to her son, for the rest of the night. Chris McGaffin arrives and sees his son for the first time. He is quiet, walls up, processing everything.

At 11.30pm, as the 19-year-old is finally wheeled into surgery down the hall from ICU, his father is breathing heavily and keeps walking down the long corridor, just needing that moment. Watching the trolley with his broken son disappear through large double doors into a “no access” area that contains The Alfred’s surgical theatres, rooms that run 24 hours a day. Trent is wheeled into a room that looks like a science classroom, with bright fluoro lighting, computer screens and high-tech machines scattered around. Under the world-leading systems pioneered by The Alfred (and Royal Melbourne Hospital), many departments work together for the good of the patient, which means that this shattered teenager is attended to by experts from vascular, orthopaedics, plastics and any other relevant pockets of Alfred expertise, even at 11 on a Tuesday night. As a starting point, the surgeons need to ensure the floating bones aren’t damaging veins in the left leg, and they plan to stabilise Trent’s left hip and leg as best they can. This will be the first of several operations and might take seven hours. His parents resume their seats in the waiting room. It’s already been an impossibly long day and it’s going to be a long night.

No end in sight

And, in fact, it soon becomes clear that it’s going to be a long week, and a long month, and a long year. Jandi shuttles between The Alfred and her home, half a city away. She checks her other kids are OK and calls in favours from family and friends. Dylan, the 17-year-old fearing melanoma on the night this all started, has figured out the oven in her absence, and has been tirelessly babysitting and making meals for the other kids. Jandi struggles to mix bedside vigils with everyday life, all the while darkly fearing the CT scan that ruled out brain damage won’t have been correct. In The Alfred, her son is held together with rods drilled into shattered bones, and the rogue air continues to be sucked from his chest. Two days after the accident, Trent emerges briefly from the haze of painkillers to ask what has happened. When told by a nurse that he has been in a motorbike accident, he mumbles: “Ah well, WD40 and duct tape fixes everything.” Which gives his mother hope because that’s her Trent, with the cheeky humour.

Dangers remain. He lost a lot of blood during the 10-and-a-half-hour second surgery and his collapsed lung has been “lazy”, which sees him return to Recovery for a while when he struggles to breathe properly. Another day brings intense chest pains, almost convulsions, which have trauma doctors scrambling and an ECG monitor attached. There is brief fear of a blood clot, but the teenager’s vitals resettle.

Trent wakes up again, some time later, to find his dad next to him, and the 19-year-old is now alive enough to notice that an attending nurse is not unattractive. He whispers to his dad that he hopes she might give him a sponge bath and only realises after he’s said it that his internal filters seem to be off and the intended whisper was more of a shout. He’s mortified and would cringe if it didn’t hurt so much. Dad gets a rare laugh before he has to head back up the Hume to Wodonga.

A few days later, Trent is finally stable enough to be moved out to Donvale Rehabilitation Hospital, a long, low-slung building on Doncaster Road, which will be his home for many months. It’s closer to his actual home, which is a relief for his mother and friends, who drop by with USB sticks full of TV shows for him to watch. Trent has been horizontal for more than three weeks now, with no end in sight, and his left foot remains in plaster, but everything else is uncovered, plates under the skin holding his arm and leg together.

Life is a constant stream of medical visitors to Room 24, from a TAC-appointed psychological counsellor to physiotherapists and rehab professionals, to hospital staff asking him what meals he’d like for the next day, and care nurses asking Trent where his pain sits on a scale of zero to 10 (“A ‘one’ ”, he tells the nurse, before admitting, “It’s been 10 a few times. But I try not to overdo the painkillers.”)

Almost a month since he flew through the air and landed hard, Trent is battling an uncomfortable bowel blockage, probably from lying down for so long, his body immobile. His broken ribs and shoulder are hurting, as they hopefully heal – “I can feel the break in my shoulder, where the new bone is building up,” he says brightly, rubbing it – and he is battling some demons. Even before the accident, anxiety and bouts of depression were not strangers and now, lying here, day after day, unable to move easily, he has too much time to think. More than anything, he misses his horses. They are what calm his mind, and they feel a long way away.

Written by Nick Place, Photos by Meredith O'Shea
October 01, 2016