GSW to the Abdomen

Last night, I was called to the OR by a colleague who was covering trauma call (I had been covering the CVICU). Young adult male, gun shot wound to the abdomen, bleeding like stink. I arrived to the OR to see the floor covered in blood. The senior anesthesia resident hanging blood via the rapid transfuser, the anesthesiologist placing a central line, and the surgical team working hard to control the bleeding. I stepped in and started giving pressors, hanging fluids, ordering blood, etc. We worked our asses off to keep up with the blood loss- trying to replace the blood with fluids and more blood, squeezing the vasculature with pressors to temporize while we tried to catch up. At several points, his heart had stopped, only to re-start again after some cardiac massage. We got a rhythm. We got a pulse. Okay, looking good, looking good. Crap, more blood loss. Blood pressure's dropping. Can't feel a pulse. More epi. More blood. FFP. Platelets. After several rounds of this, and what seemed like hours, they finally closed. He had a rhythm, he had a pulse, he had blood pressure. They left the OR to transport the patient to the ICU, while I remained behind with some of the nurses to clean up the battle zone. We stood in awe of the stench of death that hovered about, a stench that was dismissed repeatedly throughout the case, only to follow the patient out of the OR to finally triumph.

Although I had heard scant details of the shooting before I entered the OR, it wasn't until afterwards that I heard that the patient was the perpetrator of awful crimes. I had an inkling of this when I first entered the OR, having had to pass several police officers and detectives to get to the room. But those details got pushed aside once I entered the OR to work. As members of the trauma team, we set aside the personalities and the ethics that accompany the pathologies that we treat. We see a problem with the human body and we try to fix it. We don't ask who the patient is or what awful things he has done. We gather details about the injury and other co-existing disease, but that is it. No passing judgement; no deciding on whether someone deserves to be saved or not. That is not our job. Saving lives is.