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continuing to transfuse him.
    Once we started, we moved very quickly, because every movement, especially removing the largest pieces, resulted in blood loss, sometimes fairly significant blood loss. If we hadn’t moved quickly, Ben would surely have died. There were a number of scares, and a number of times when his vitals dropped dramatically, and a number of times when we couldn’t stop the bleeding in what I considered a timely manner. But Ben wouldn’t die, and now, at this point, after everything, I believe that what we did that day probably didn’t matter very much. Ben was not going to die.
    Nine hours after we started, we tied the last suture. He had a total of 745 stitches, both internal and external, and an additional 115 external staples. We had used 40 units of blood, which is approximately double the amount any human has in their body at any given time. We also gave him multiple units of platelets and fresh frozen plasma. And for him, the day was far from over. There was a team of cranio-facial surgeons and neurosurgeons standing by to deal with his skull and brain injuries. As I stepped back from the table, I saw one of his hands twitching, which I took to be a good sign, and I stepped over and took hold of it, hoping that somewhere, on some level, he might find it comforting. To my great shock, his grip was very strong, very firm, and I immediately felt something similar, but deeper and more profound, to what I feel in those moments just before surgery, an intense calm and sense of peace and contentment. It was unreal, and obviouslyunexpected, and it ultimately changed my life in so many ways. I didn’t want to let go. I didn’t want that moment to end and I didn’t want that feeling to ever leave me. But all things leave us, all people, all feelings, no matter how we want them to stay, no matter how tight we hold on to them. We lose everything in life at some point. I lost that moment the instant I let go of his hand.
    After he was hemodynamically stable, he needed a CT scan of his head to determine the extent of intracranial injury. Moving a patient as critical as he was can be very difficult, very complicated, and very slow, so I knew I had some time to take a break, and I needed one. I went to our break room and took a shower and tried to take a nap but couldn’t fall asleep. I was extremely awake, felt electric. I imagine I felt the way people feel when they take cocaine or ecstasy, though I have never used either of those or any illegal drugs. I got dressed and found Ben back in the OR , where the surgeons were now working on his brain, and I gowned up so I could watch the procedures. They had basically completed what was already a craniotomy, and evacuated both epidural and subdural hematomas. I watched the surgeons do some skull reconstruction using titanium plating, though they appeared to leave much of his skull as it was in case of cerebral edema, swelling of the brain, which can lead to brain herniation downward and death. Four hours after they started, Ben was taken to the post-anesthesia care unit.
    He was later moved to the surgical ICU , and even though he was stable, he remained on life support: supplementary ventilation, intravenous therapy with fluids, drugs, and nutrition, and urinary catheterization. He was kept sedated using propofol so that we could monitor brain swelling and function. The ICU took over his day-to-day care, though I would continue to treat him, as would the cranio-facial surgeons and neurosurgeons. When I left the hospital, I felt very good, given the extreme nature of the situation and the trauma, about the care we had provided and Ben’s prospects for some type of recovery. It was very early in a case like this, and normally it takes quite a while for us to really know how and if a patient is or is not going to recover. I assumed that I would come back the next day and everything would be more or less the same. I should have known better.
    When I arrived, there