At 7:21 p.m., I arrive at the hospital for the first overnight shift of my medical career. It’s not a great start — the bus was late, and I didn’t sleep nearly enough this afternoon in preparation for the night ahead. I downed two cups of coffee at home and have two more in a thermos in my backpack, along with a book of surgery shelf review questions and a hodgepodge of snacks, because I’m not entirely sure what you’re supposed to eat overnight. Lunch? Dinner? Breakfast?
But I put all that out of my head when I get to the trauma bay because the first patient is already here: a man who fell off his bike. I begin my primary and secondary survey, the same as on every patient I’ve seen since I started the trauma surgery rotation two weeks ago: airway, breathing, circulation. “Can you tell me your name, sir?” I ask. “Thomas Jones.” It’s a deceptive question: if he can talk, it means he’s able to breathe. “Airway intact,” I call out to the nurse taking notes. The rest of my exam runs smoothly: some bruising on his ribcage and some tenderness in his wrist. We get him in the CT scanner, call orthopedics, and sit down to write notes.
That’s what we’re doing at 7:56 p.m. when the alarm goes off. A siren blares over the loudspeaker and jolts us from our work. “Male, unknown age, multiple gunshot wounds. Arriving now.”
Everyone starts moving at once, scrambling for our gear: gown, gloves, mask and hat. I’m tying up my gown when the patient is rolled in, flanked by two cops. A police drop-off is a bad sign already because it means he was too unstable to wait for an ambulance. He’s on the stretcher, breathing heavily, his white T-shirt almost entirely saturated with blood. He looks like a kid — maybe 21 — and barely over 130 pounds. I jog alongside him to start my survey.
“Can you tell me your name?”
He looks up at me and tries to speak, but when he opens his mouth, he chokes, and a pinkish foam gurgles up between his lips. I feel my chest constrict, and my eyes widen in horror.
“Airway not intact!” I yell.
Suddenly there are about 15 people around his bed. Amid the madness, I do as much of my exam as I can. I put two gloved fingers in his palm. “Can you squeeze my hand?” I think he may have moved, but I’m not sure. “Can you open your eyes for me?” Nothing. I try again, louder. “Hey! Can you open your eyes for me?” His heavy lids lift just enough to reveal a sliver of bloodshot eye. “Following commands!” I call out.
His vitals flash on the screen behind him. “65/40!” “Pulse 145!” He’s losing blood fast. A doctor at his head: “Son, we’re going to put you to sleep now.” An x-ray is shot — his left chest is filled to the brim with fluid. The attending rushes in, a blur of scrubs and questions, and takes charge. “He needs more blood!” Three nurses put in as many IVs as they can. “He needs a chest tube!” Who, me? The hierarchy breaks down when a life is slipping away. I help with the tube, a procedure that’s normally sterile, but here there’s no time or space. “More platelets!” A yellow bag flies past my head, hurled by an unknown person on the sidelines. I put my fingers on his ankles — his pulses are thready. “50/30!” I lose his pulse. “I lost his pulse!” Someone starts CPR, pounding on his chest with blood oozing from bullet holes with every push. Still no pulse in his ankles. V-fib on the EKG. “Calcium!” No change.
“We need to open his chest.”
The resident has a knife in her hand, and in one swift move, she flays him open and slashes his left chest from his sternum to the table. She pulls his ribs apart, and at least a liter of blood spills out, splashing on the linoleum floor. Her green scrubs are drenched in red. Her arms are in his chest with his heart in her hands. She’s pumping it for him, a human life support machine. More blood flies across the bay. She sticks a needle into his heart and keeps pumping. The attending stands up.
We take our hands off. “Time of death: 8:14 p.m.”
And like that, a patient becomes a body. A patient whose name I don’t know, whose story I’ve never heard and who looked in my eyes just 20 minutes ago.
We retreat to our computers — death begets paperwork. No one knows his name, so it’s filed under “Unknown AQP,” a new identity on the last night of his life. Another announcement comes over the loudspeaker, this one calmer: “Cleanup needed, trauma bay, bed 2.”
The nurse and I count the bullet holes — we get 15 in total. She shakes her head. “Someone must have really wanted him dead.”
The resident asks me to close the gaping wound on his chest, the biggest and most gruesome of his injuries, and the only one created in an attempt to save his life rather than to end it. I suture him shut, veiling his collapsed lung and motionless heart beneath his skin. Once I’m done, the nurse zips a white body bag around him and wheels him to a far corner of the bay to wait for the coroner, leaving stark bloody footprints with each step.
A custodial team arrives. They mop the blood, sweep the floor and clear away wrappers, tourniquets, needles, scissors, gloves, syringes and empty bags of blood products — casualties of the struggle for his life. When they’re done, the bay is shiny and sterile. The coroner comes in and wheels the body away.
A few hours go by. We talk about it a little. Mostly we sit. I sip my coffee and try to study. Across the bay, in the same corner where our last patient had lain under his plastic burial shroud, the resident sleeps in a spare bed.
That’s when the siren rings out again, ripping through the midnight silence. “Male, unknown age, gunshot wound. Arriving now.”
The resident sits up. “You’ve got to be kidding me.”
We get dressed. A police officer busts through the door, pushing a stretcher with a man on it. Another young thin guy, still and expressionless. Another officer is performing CPR — he says he’s been going for almost 30 minutes. This time I don’t bother asking the patient for his name. We swarm around him. I cut off his bloody shirt and see a single hole that is almost dead center in his chest. I check his ankles for pulses. Nothing. The blood pressure is undetectable. The EKG silent. Two IVs are in, and the blood is flowing. Two units, three and then four. The resident skips right to the Hail Mary: she reaches for the knife, and another chest is carved open before my eyes. Another torrent of blood, another heart pumped by a stranger. The attending materializes, assesses and gets his hands on the heart. He gives it a few pumps and lets go.
“Time of death: 3:09 a.m.”
The attending tells us that maybe the thoracotomy wasn’t warranted. With no pulses on arrival and no signs of life for nearly half an hour, maybe we should have pronounced him immediately. The resident nods in understanding. “There was only one bullet,” she says. “I thought it at least deserved a shot.”
Who could argue with that?
The police tell us he was outside a pizzeria. That’s all they’ll reveal, but from their voices, they seem to think he was innocent, just a guy in the wrong place at the wrong time, after midnight in the City of Brotherly Love.
The rest of the night is less eventful. A lady whose neighbor accidentally backed into her with a slow-moving car — she has a small break in her pelvis that ortho can fix in the morning. A blackout-drunk college kid who apparently leaped from a moving go-cart, although he doesn’t remember a thing. He’s got a facial fracture and an impressive bump on his forehead. His livid parents will be here any minute, but otherwise, he’s going to be fine.
At 7 a.m., we meet with the day team. We briefly mention the dead, summing their stories in a few clinical sentences, the world’s coldest elegy. Mostly we focus on the living, the ones we can still help.
It’s 8:15 a.m. when I leave the hospital, emerging from the linoleum, the air-conditioning and the unremitting fluorescent light. Outside, it’s a radiant June morning. I squint in the sun and trudge to the corner. When the bus pulls up, 10 minutes behind schedule, my body crumples into the nearest seat. Around me are people tending to their Sunday morning business: heading to church, carting their groceries and reprimanding their children. I look down at my scrubs, flecked with the blood of two nameless dead men. I’d probably cry if only I weren’t so tired.