My friend Mo is a surgeon in San Pedro, California. Much of the time he loves his job and is happy for the opportunity to help so many people.
Sunday was not one of those good days. With his kind permission, I am going publish the email he sent me yesterday. If the first line is something that is very upsetting to you then you should not read further.
"I just finished sewing up a dead boy.
I pronounced him dead at 10:34 PM. It's now 11:27 PM. I know I won't be able to get to sleep for a long time. I feel like I shouldn't.
I'm a trauma surgeon, down here at St. Mary's. I was sulking in my call room on Palm Sunday because I missed yet another important moment in my 5-year-old son's life. A tarantula crawled all over him at his best friend's birthday party, and my wife had e-mailed me a glorious photo of this big, hairy arachnid on my son's face.
The phone rings, and I am summoned to the ER for a "gunshot wound to the chest". That's bad, but around these parts, sadly not a surprise. Then the ER secretary adds, "...in a 12-year-old." That changes things a bit.
As I hurry down to the Emergency Department, I play out several horrific scenarios in my head...a mental exercise in preparation for what certainly was to be a difficult situation.
I arrive to a room filled to capacity with doctors, nurses, techs, volunteers, firemen, policemen, and paramedics. The strictly medical people are swarming around an impossibly small figure, in a flurry of needle sticks in search of a vein, monitor-pad placement in search of a vital sign, stethoscopes vainly searching for a breath sound or a heart beat. The non-medical personnel had formed a concerned and curious peanut gallery. One ER doctor blurts out the important points, "GSW to the chest, pulses in the field but..." while another ER doctor is prepping this small chest for an ER thoractomy.
In English, an "ER thoracotomy" is where you flay open a chest in a soon-to-be-dead patient, in the hopes of finding a hole you can quickly but temporarily fix. Once that is done, it gives you a chance to give the patient necessary things like blood and IV fluids (where they now will not simply flow out of those repaired holes), and get him to the OR so you can fix him properly. It is the trauma surgery equivalent of a "Hail Mary" football pass. This is not a "difficult situation", this is a nightmare.
The ER doctor sees me, and literally hands me the knife, as if to say, "Here. It's yours." I think the kid is dead, or if not dead, then he certainly is "unsalvageable", which is a horrible word to use for a human being. I don't think he's fixable. However, if he is to have any hope of survival, the ONLY way to save him is to crack him open and try to plug up the holes. Cracking open a 12 year old boy is going to tear my own heart in half, I think to myself, but this is part of what I do, so I slip the gloves on and take the knife. There is precious little skin to cut through, and I'm in the chest in a few seconds.
His chest cavity is filled with blood, which spills out of his chest like a macabre waterfall to the floor. There's a shredded tear in his lung, and a big, ragged hole in his heart. All the IV fluids that my associates are pouring into the patient are flowing out this hole and on to my shoes. I put my finger in this hole...such a big hole in such a small heart...but blood and fluids still flows unfettered. My other hand finds another, larger hole on the other side of his heart. My fingers touch. His heart is empty. Mine breaks.
His family is brought in while I am bathed in his blood, as "studies have shown" that this is better for everyone involved, to be present as the end nears. I scramble for a way to just stop the bleeding. I just want it to stop. It's spilling over my hands on to the gurney. His mother is begging me to do what I can. I know I can't do anything. She tells me to take her heart, and give it to him. I know that's not possible, and she knows that's not possible, but she could not be more serious. The first ER doc is sitting alongside the mom, gently telling her that we've done everything we can do. His mother looks at me. My hands are still in the boy's chest, trying to do something, anything. In her eyes, I see a soul that I am about to crush with a little nod of my head. I do so.
As the howl of unimaginable grief shakes the entire ER, I am filled with anger. Why do we still sell guns in this country? What is this child doing on the streets after ten o'clock at night? Why are we killing our innocent young soldiers overseas, and ignoring the merciless gangbangers...terrorists in their own right...that are invading our streets here at home? I try to put these thoughts away, because now, in front of his family, I have to sew him up. I have to close this huge gash in his left side, that I made.
I place the first stitch, and as I'm tying the knot, I look at the boy's face. He's small for 12, not that much bigger than my son Ben. All the adrenaline is gone. My shoulders sag. I feel myself start to cry, and I know that I can't stop it. I have no way of hiding because literally everybody is looking at me, including his mother, and my hands are busy, so I can't wipe the tears away. I make eye contact with the mom, and whisper "I'm sorry." I finish closing his chest up, and shuffle off to the sink to wash this child's blood off my arms.
I sit down in the doctor's area, to start filling out the pointless paperwork. Several nurses and doctors come over to offer encouraging words, or a consoling hand on the shoulder. I want to quit. I don't want to do this anymore. I want to quit because that means I can go home. When I go home, I can quietly open the door to my son's room, and sit on the floor right next to his bed. I'll watch him sleep, that blissful sleep only found in young children. I'll watch him for hours, and tell myself how lucky I am to have him in my life. I want my son to put my heart back together.
But I can't go home, as I'm on call until 8:00 AM. I can't quit. Tomorrow I have patients, surgeries, rounds...the usual stuff. Hopefully, I'll be home for dinner. When I come through the door, I'll hear his cheerful yell of "Daddy!" and he'll jump into my arms. He will in all likelihood never know how much that moment means to me, but it is precisely that resuscitative energy that will restore me. To keep coming back to this sort of work.
I will sneak into his room after he falls asleep. I'll give him an extra kiss goodnight. And then, just maybe, I'll close my eyes."
Thank you Dr. Mo for the work that you do even when you can't manufacture miracles and thank you for giving us a glimpse into a small part of your world.