My First Time… Treating a Gunshot Victim

Photo: Keliy Anderson-Staley

I’m a resident at St. Luke’s–Roosevelt, but had rotated down to Jackson Memorial Hospital in Miami. At around 2 a.m., the paramedics called in saying there was a guy who’d gotten shot multiple times in the chest. It’s all very dramatic—you hear the ambulance, you see the lights, the doors shoot open, and the paramedics run in with the patient. I think my attending realized how sick the guy was, because he was right behind me going into the room. Which was a good thing, because the guy lost his pulse in front of us within ten or fifteen seconds.

I’d seen gunshot victims before, but even on the few that I’d seen who had wounds to the chest, I wasn’t the one doing the cutting. This kid was 17 or 18 and had anywhere between three and five holes in his chest. He was barely alive. I was trying to calm myself down; one of my professors used to remind us that you should always check your own pulse before you go into something like this, because the adrenaline is rushing. I looked at my attending and we paused, and then he started a thoracotomy on the left side of the chest and told me to put a chest tube in the right side.

A thoracotomy is the technical term for opening up the chest. You need to drain the blood around the heart, because that pressure can cause cardiac arrest. Normally, with a chest tube, you can get blood back, but mostly you get air. But when I stuck the chest tube in this patient, it came back as this constant stream of bright-red blood. There was more blood than I’d ever seen before. I just stared at it. It didn’t make any sense to me. The attending was like, “You need to open up the right side of the chest.”

Before that night, I’d never performed any procedure like that, so I paused for a second to collect my thoughts. The whole procedure is supposed to take less than a minute, because you don’t have much time, so I worried for a moment that I was pausing too long. And then I started scrambling for stuff. I asked the nurse for a scalpel, and just mirrored what my attending did on the left side. The whole time, my attending and chief resident and everyone in the room was watching me, which was definitely a lot of pressure. You have so little time—to save the brain you need to get the heart pumping within five minutes. And we did, but by then I wasn’t calm at all.

My attending found a bullet wound through the heart, so he shut it with a staple gun and threw a bucket of warm water on the heart, and it restarted. It was pretty amazing. When the patient came in, his heart was barely beating, and by the time we rolled him into the operating room, three or five minutes later, it looked normal to me. I thought, “I think we might have saved this kid.” Then we pushed him into the operating room, and there was another team ready to take him. It was weird to just hand him over to someone else.

I think I took five, maybe ten minutes to calm down after the thoracotomy. I had to clean up, take off my gown and gloves. I was completely covered in blood. During the shift I wanted to know what happened to him. I was excited because I thought we might have saved his life. He was still alive the first few times I checked. When I found out he died in the OR, I was pretty bummed out. It was the only procedure I thought about for weeks. Still, I was just so surprised that I was able to do what I did. We got his heartbeat back.

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