26 May 2013


In the wee hours of the morning, the emergency department intercom came to life, crackling that a patient with serious trauma would be arriving within minutes. A dozen of us rushed over to the trauma bay and started suiting up in gowns and face shields. Someone said that the victim had suffered multiple gunshot wounds. We ran around grabbing equipment: blood, an ultrasound machine, chest tubes. I went to the ambulance bay and spotted the patient's stretcher being wheeled in. "The patient arrived!" I shouted.

"Patient's here!" they echoed.

The patient loud yelling was muffled by his oxygen mask. That he was screaming was actually a good sign, because it meant that his airway was intact and that he was breathing. The doctors set to work, placing IVs, hooking the patient up to "the monitor" (the machine that displays vital signs), checking for gunshot exit and entry sites, palpating pulses. One doctor yelled that the patient's breath sounds were muffled on one side, a sign that the patient had hemothorax (blood accumulating in the chest). Another doctor got out a scalpel and, making a deep incision, jammed in a plastic tube to drain the blood. This made the patient scream, but he seemed to be drifting off. Another doctor injected anesthetics that paralyzed the patient and put him to sleep, while another intubated the patient and hooked him up to a ventilator. Standing at my out-of-the-way perch at the end of the bed, I checked the patient's feet. They were cold and clammy. This confirmed what we already knew: that the patient was in shock, probably due to internal bleeding. The doctor checking for gunshot wounds kept finding more and more, over ten by now in the patient's abdomen, chest, and extremities. One doctor yelled that he had a large hematoma (pool of blood) in one of his arms and no pulse in that hand. Bad news. A bullet must have severed the main artery to the arm. Two doctors using the ultrasound machine pointed excitedly at the screen. "Free blood in Morison's pouch," one yelled. "We have a positive FAST exam!" This meant that the patient was bleeding heavily into his abdomen. He'd have to go the operating room right away.

The X-ray crew cleared the room so that they could obtain an image. Taking advantage of the pause in the action, I threw out my bloodied gown and gloves, ditched my white coat, and put on my operating room attire. Then I guided the patient's hospital stretcher into the giant elevator that would whisk us up to the operating suites.

In stark contrast to the din of the past few minutes, the elevator ride was quiet. There were only three of us in the elevator, each of us stock-still, deep in his own thoughts. I gazed at the patient's vacant face and realized I didn't even know his name. "Who are you?" I wondered. "Who did this to you?" Was it a drug dealer? The police? An ex-girlfriend? I invented version after version of this man's story. With each iteration, I asked myself, couldn't this scenario have been avoided, through forward-thinking laws, more schooling, better funding for social services? Why are we so cruel to each other, why must guns even exist? This anonymous young man, blood oozing from his side and a machine breathing for him, seemed to indict our society's ills. There had to have been some opportunity we missed to prevent his being pumped with so many slugs of lead. And now, at an ungodly hour when we should all be asleep, dozens of us were working furiously on this man's behalf. Why was it only now, when he was already in the clutches of death, that we were sparing this man no expense?

The chime of the elevator interrupted my ruminations. As the doors opened onto the sterile halls of the operating suites, I steeled myself for the grim hours in the operating room that laid ahead.