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Volume No. 2 Issue No. 63 - Monday, December 22, 2008
Life and death in the ER - Gunshot wounds

A patient in rushed to the Emergency Room.
I walked toward room 19 and saw the night nurse slip quietly out of the room to report off to me. There was something different about her today. I said, �Your eyes are red, it must be very bad.� I had worked with Jan for a while and knew her to be a hard core Critical Care nurse. She was a nurse I would allow to care for me if I was in an emergency. She looked at me as if to say, �I need a hug;� and then she wiped the tears from her eye.

�You will be fine, give me the report so you can go home to rest. I�m sorry you had a bad night.� As nurses we have learnt the art of keeping our focus when it matters and breaking down later. I knew I was walking into something that was going to demand shrewd and tactical execution while pulling at my heart strings.

I made the calculated decision to receive the report at the bedside so that she could remain focused. Then she could have a cup of coffee before breaking down in the seclusion of her car in the parking lot.

�It�s terrible, it is just so senseless�, she said softly as we braced ourselves to enter the room. �My father in heaven will help me today!� I muttered under my breath. It was heart wrenching. A 25 year old Hispanic woman was kneeling at the bedside of her fianc�. Please don�t leave me now, she pleaded. Why? Why? Why? Dios mios�.

This sounded like it came from the depth of her belly. I fought the lump in my throat and I swallowed hard. I felt her pain and I realized that this situation was going to need the love of Jesus to minister comfort to this young lady while I tried to keep this 25 year old man alive.

I called for Pastoral care and while they ministered to her in the quiet room, I got the report I needed to continue the excellent care, which the veteran critical care nurse Jan had started. �25 year old Hispanic male with 2 gunshot wounds to the occipital lobe. No exit site.

Cat scan shows that the bullets are embedded where they cannot safely access them. GCS on arrival 1:1:1.� The GCS is the Glasgow Coma Scale is a neurological scale which provides an objective assessment of a person�s conscious state. 3 was the lowest score he could get.

Wow! This is somebody�s son, a little boy�s father and a young lady�s finance. My heart ached for him but there was no time to be distracted. �So what is our goal here?� I must have a strategy for this. Jan had regained her composure by then, she calmly said, �he is barely here but we have to keep his organs well perfused.

Organ donation has been called maybe he can help someone else or some other people. My goals suddenly crystallized in my mind. I was no longer trying to save this guy. I was working diligently to save his kidneys, lungs, heart, small bowels, eyes, liver etc. I am sure that there were many gravely ill but viable patients waiting for these organs.

The day went by and I worked quietly to ensure that this young man�s blood pressure was high enough to perfuse his brain, his heart rate did not drop, and his oxygenation was optimal. The family members were very solemn and respectful.

They tried so hard not to get in my way. The mood was somber as the reality of that tragedy was setting in. His father asked me when we were alone. �What are his chances? How bad is it?� I asked for wisdom before answering, �It is not good. It is critical� I said, �Come I want to show you something�. I flashed a light in the patient�s eyes; they were fixed and dilated at 6 mm. No sign of any movement.

I squeezed his fingers and toes with my pen. � no movement. He is not here with us.� I said in a monotone voice. �I am so sorry. I wish I had better news for you�. The father looked at me with a haunted look in his face. As if to say, this cannot be happening. I offered him some tissues and asked him to sit. I knew that the last 25 years was flashing right before his eyes.

He told me that the young man was set to graduate from college next year, and was set to get married. His brother was apparently involved in drug and gang activity and he was shot in the back of his head while he stood outside the family house talking after he came from work.

We immediately changed the name of the patient to ensure that there was no gang retaliation activity. The goal here was to work on convincing the family to donate the organs. I thought of the many people who could benefit from these donations including our own Charles Lawrence and prayed that the family would do the right thing.

However, there are still many hang ups about organ donation in Black and Hispanic communities. So the job of organ donation is always handled by the professionals trained to do so with the utmost sensitivity. In the meantime, I continued my job of caring for the hurting family and making sure that the patient was cared for with dignity and the highest level of skill.

After my shift, I check my driver�s license again to make sure that I was listed as an organ donor.
Saving the young in the ER

Editor�s note: This is the another story in a fascinating series of articles surrounding the isses of life and death at America�s hospitals penned by a highly respected Dominican ICU/ER nurse working at a major hospital center in the Western United States. E-mail to a friend

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