GSW!

The Setting:

I work in a private community hospital. The “community” we serve is in a dangerous part of town. There is a fair amount of earned non-taxable income. This is slang for drug dealing and prostitution. Drug dealers have a vested neighborhood interest and that is they don’t want any other drug dealers in their neighborhood. I didn’t say it was a happy community. Interlopers here frequently get introduced to the business end of a gun.

I don't live in this community. When I moved into my neighborhood we got cookies!

My neighbor, Chris, has much better looking flower beds than me. Still, I haven’t shot him…..not yet.

Anyway people always want to hear about Gun Shot Wounds. We are wonderfully blessed to be located near Vanderbilt University. The chaps down at Vandy have a most excellent Trauma Center, but they don’t take it all. There is a screening process.

We get 2 kinds of GSW’s at Skyline: the quick and the dead. EMS takes GSW’s to the chest and abdomen to Vandy, if the patient is alive when they arrive. These are the serious but saveable patients. This is good for multiple reasons. Primarily they have the staff to take care of it. They also get state funding. My surgeons are a great bunch of guys. They would love to take out your appendix or gall bladder. They don’t do so well with exploded livers and spleens. They also like to get paid and dealers and hookers don’t get health and dental.

First the Dead:

The first type of GSW’s we get are the “not quick” - meaning dead. EMS is called to a volatile scene, they scoop, they run. They don’t take the patient to Vandy if the game is already over. A tragedy has occured. It’s a failure on multiple levels. Having no where else to go, EMS comes to the ER. There is usually nothing for us to do. The police come and take a lot of pictures. I’ll speak to family members where I never really know what to say.

The family is ushered into the “Quiet Room”, every ER has one. This is where we break the news. I have some standard phrases I have honed over the years. There is a real art to this and we even practiced this in residency. “Your son is dead”, “I am sorry for your loss”, “This is as bad as it can ever get”. Sometimes everyone is real quiet, sometimes not. I go back to the bedside and help the nurses with the body if I can. There is a lot of gravity in this situation. Someone will inevitably try to crack a joke just to break the tension. This is an ER coping mechanism, not disrespect. I am sure we have all developed some deep psyche repression issues because of this, but it comes with the territory. Thick skin or at least the semblance of it.

And then there are the quick:

The quick are extremity shots and I can’t begin to explain what a non-event this has become. We get a call “GSW to the arm” and it’s really no big deal. If the arm is not blown off and no major bones, arteries or nerves are broken, the patient gets discharged. This summer alone, I have personally taken care of different patients with GSW’s to the arm, leg, both legs, in leg/out butt, in arm/out shoulder, etc. All of these patients were discharged. These people have been shot! Frequently they are out of the ER in less than 90 minutes.

Ironically every single patient has the exact same history.

Me: What happened?
Patient: I got shot.
Me: Who shot you?
Patient: Some dude.
Me: What were you doing?
Patient: Minding my own business.

“Some dude” has major issues with people minding their own business, he has shot over 20 patients this year. That’s the bad news. The good news is that Dude has pretty lousy aim.

I have seen several patients who have been shot multiple times and they are fine. Can you believe their luck? With my luck, someone could accidentally drop a bullet in a fireplace, it explode, bounce off 5 different things and hit me right between the eyes.

We saw a "Dude" this week who had been shot in both arms. How does that happen!? How can a bullet travel through both arms and miss everything between? No kidding, I have seen TWO patients in my career who got shot in their freaking head and the bullet glanced off the skull and the patient got away with minor injuries and a hell of a headache. These guys should drop whatever they are doing and immediately move to Vegas.

So anyway, One of the purposes of this blog is to try to give helpful ER insider tips. Here is this months entry.

Don’t get shot.