In honor of the first anniversary of the Newtown shooting, I want to share a memory I have from my time as an Emergency Physician. Warning: It is graphic, so stop reading here if you don’t want to read about something pretty gory.
It was 1996 and I had just finished my residency training in Emergency Medicine. I was working as an attending physician in the Pediatric Emergency Room, a role I was still getting used to. The overhead pager called: “Trauma Team to the Trauma Room.” This time, there was an addendum: “Pediatric Trauma Team to the trauma room for GSW” (short for gunshot wound). I heard nurses and techs talk about a 3-year-old who was as an incidental victim of a drive-by shooting, apparently hit by a bullet in the jaw while eating his dinner. Everyone flew into preparation for a potentially complicated airway emergency. When the medics arrived everyone became still. They gave their report: “Drive-by shooting with a high caliber assault rifle, shot through the front window of a home, likely targeting another member of the family.”
We saw that the child was breathing on his own but the wound in his jaw was already causing swelling around his entire neck. I admired his long eyelashes and curly hair. When I saw that he had a Pull-Up on, my knees almost gave out. “This should not be happening!” I thought. I also realized that this was the making of an airway nightmare: the disrupted anatomy, blood and other tissue blocking the view…. I was near panic; I knew we had to put a breathing tube in before the blood and swelling blocked the airway for good. When I went into place the tube, nothing I saw was recognizable. The tongue had become hamburger meat. I lifted up the macerated tongue with my instrument to look for the vocal chords, the portal to the airway and lungs. No luck. Blood and pinto beans were everywhere. I stuck a suction device in and vacuumed out the back of the throat, then grabbed the tube and passed it through the vocal cords. Success. The tube misted up with air from the lungs and sensors detected the tube was in the right place. I had been successful in a difficult airway maneuver and saved a life, but I felt rotten.
Although we had saved the child, we all knew his life and appearance would never be normal. After the surgeons whisked him to the operating room, I walked outside the hospital to take a breath. I had recently learned I was pregnant and would be a mother for the first time. I had tears rolling down my cheeks and the first real flash of anger at what I had seen. Although I treated gunshot wounds regularly and had seen more than my fair share of trauma and death, I was really furious about this one. What kind of society was I going to bring my child into? Was it one in which weapons of war were available for purchase at the local Walmart? Or one that had little access to mental health or drug and alcohol treatment, but plenty of access to guns? These were the thoughts that crowded my head.
The child I was carrying that night turned 16 a few months before the Newtown shootings happened. In her lifetime, the number of children killed or wounded by guns has increased dramatically. According to a 2013 NBC News report:
“About 500 American children and teenagers die in hospitals every year after sustaining gunshot wounds — a rate that has climbed by nearly 60 percent in a decade, according to the first-ever accounting of such fatalities. In addition, an estimated 7,500 kids are hospitalized annually after being wounded by gunfire, a figure that has spiked by more than 80 percent from 1997 to 2009, according to Boston doctors presenting their findings at a conference of the American Academy of Pediatrics”.
It is unconscionable to me that the number of children harmed by gun violence has risen so sharply during that time. I feel terrible that I had such strong feelings that night, but have not spoken up more publicly about this issue. Perhaps it is because I have friends and family who are hunters and staunch Second Amendment defenders, or perhaps I fell victim to the insidious normalization of our gun culture. I am not practicing emergency medicine any longer, but I want to join my colleagues in the field to call for real action on gun laws in the US. It’s not that I naively think that is the whole solution. Don’t get me started on mental health access or our ultra violent popular entertainment. Nonetheless, as first-hand witnesses to the damage that guns cause in people of all ages in the country, emergency responders and staff should share their stories with the public so that we can all feel the resolve to curb the “terrible tally”of children harmed and killed by guns each year.
I am thinking of the first responders in Newtown who witnessed the carnage. They had no opportunity to save a life, as I did. My own reaction to the sight of disfigurement and destruction in a previously perfect little body was visceral. How did they feel seeing so many riddled and lifeless bodies? What we saw on TV was horrific enough, but to have actually been there must have been more than some could bear. Maybe when a little more time has passed they will all speak up as well.
-Jennifer Brokaw, MD
December 14, 2013