I’ll be the first to admit, National Rifle Association, that your “stay in your lane” tweet about doctors not consulting you is correct. I did not stop to consult you the last time I had someone bleeding out from gunshot wounds on the stretcher in front of me. Before his arrival, I’d been far too preoccupied listening to the overhead alert from the emergency medical service: “Young male. Unknown age. Multiple gunshot wounds. Heavy bleeding. Becoming less responsive. Other victim on scene already pronounced dead. ETA, 3 minutes.”
I was too busy letting the blood bank know I would need to activate the massive blood transfusion protocol and alerting the trauma surgeons that they might need to open this young man’s chest in my trauma bay.
I also took a few moments to prepare myself for what I was about to see. I needed to be in control of myself if I was going to have any control of the trauma bay in front of me, the one filled with emergency physicians, surgeons, pharmacists, techs, and nurses.
I was also busy dressing for what I anticipated would be a bloody event — just like the last patient with gunshot wounds. I grabbed one of the thin, pastel-blue plastic gowns stored at the entrance to the trauma bay. I also spent a few precious seconds putting on shoe covers, something I had neglected to do for the last gunshot victim I treated. Gunshots mean blood. And splatter. I’d learned the hard way that if you don’t cover your shoes, they won’t be spared. The last time around, I had some difficulty explaining blood-soaked sneakers to my other patients.
Then, in the few short moments before the patient arrived, I spent what time I had assigning roles to my team. I explained to each of them how we would prevent this young man’s death by cutting into his chest, putting a breathing tube in his throat, and placing an intravenous line in any vein — the bigger the better — we could find.
Even before he was in front of me, my attention was focused on the scene coming around the corner. I could hear the paramedic counting out his CPR: Five. Six. Seven. Eight. I could see the security team clearing a route to the trauma bay. I could smell the blood that I saw dripping onto the floor.
I made a mental note of the man’s brightly colored hoodie, now tattered with bullet wounds and stained with blood. He’s younger than me, I thought, and missing a pulse.
I listened to the paramedics tells us what they knew. And then I focused on the team’s descent on this patient. We cut off his belt and shoes and that brightly colored hoodie to expose him: you can’t control bleeding if you can’t see where it is.
We started his resuscitation with a scalpel: One physician made an incision on the skin over his ribs to spare the arteries and nerves under them. Through that incision, a surgeon dissected her way down through his skin and muscle and tissue and, finally, into his chest. With bloodied gloves and focused concentration, I’m sure she, too, felt regret at not being able to reach out to consult the NRA. She was too busy attempting to pull blood out of his chest from places it shouldn’t be.
All she and I and everyone in that room wanted was for our patient to regain a pulse. Regardless of the presence or absence of belief in a God, we all silently prayed that he wouldn’t die in front of us. But his pulse didn’t return.
Despite the hot and nauseating smell of blood and despair, we made a final attempt. Accompanied by the gleam of metal and the sound of cracking bone, we were more aggressive about opening our patient’s chest this time. We exposed his heart and lungs to search for the bullets. All we found was an inert heart.
But despite the finality of this young man’s death, it was not over. And if I could do this case again, this is where I would consult the NRA: After I’d pulled off my bloodied gown and gloves and wiped the sweat from my face and the tears from my eyes, you and I would stand at the opening of the trauma bay and look at the floor around us. Littered with blood and tubes and our failed attempt at bringing this young man back to life, we would — and should — force ourselves to never forget what we saw in front of us. Something we both know has been seen countless times before and what, unfortunately, will be seen countless times again.
Your tweet about a position paper by the American College of Physicians on reducing firearm injuries and deaths said, “Someone should tell self-important anti-gun doctors to stay in their lane.” You’re wrong there. The NRA and I both know that this is doctors’ lane. Treating gunshot wounds has always been our lane. Sadly, without better ways to control access to firearms, it always will be.
Christopher Lee Bennett, M.D., is an emergency medicine resident at Massachusetts General Hospital and Brigham and Women’s Hospital, both in Boston.