Just Here Trying to Save a Few Lives: Tales of Life and Death from the ER (17 page)

His partner took a bite out of his drive-in burger, than tapped his shoulder pack experimentally with his other hand as he watched his partner slam the door.

The first officer began the cop walk, saunter speed, up to the Toyota, flashlight held overhand at shoulder level. As he did, the driver opened the door—instant problem—and stepped out of the car. For the second officer it was hard to see because of the glare of the oncoming cars, but the driver appeared to be a white male, thirtyish, in a Tecate beer T-shirt. The driver took a step forward, and that was when the second officer saw the gun—a rifle—no, an assault rifle with a scope. The man with the Tecate T-shirt pointed the gun forward at the first officer. It was at waist level when he fired the first and then a second shot. The first officer took a step forward and reached for his gun as the man from the Toyota went down on one knee and fired an unknown number of additional shots. As the second officer came out of the car, gun cocked, the shooter stood up, aiming at the second officer. The second officer then fired three shots, all aimed at the man's chest. The man fell to the ground.

The first officer had fallen as well. The second officer shouted, “Officer down!” into his shoulder pack. He ran around to the side of the car, where he found his partner lying in a pool of blood—one hand to his neck.

The first officer reached his other hand out. “No,” was all he said.

The “red phone” rang. It was a dedicated line connected to City Emergency Services. We almost always used the radio connection, so that when this phone rang it was usually a wrong number.

“You've reached Ambulance Med Command,” I said into the receiver. I was the closest to the phone.

“We've got an officer down, coming to you by squad car.”

“Who is this?”

“This is police dispatch.”

“What did you say?”

“Shooting. An officer is down. No other details available.”

“Are the paramedics going to radio—“

“That's a negative, Med Command. Transport in squad car.”

I dropped the phone, fumbled for it and hung up. “Mary,” I said to the unit clerk, “page Surgery.” And don't get all worked up, I told myself. The last “police shooting” we'd had, I had activated the entire hospital trauma system for an officer who had sustained an abrasion on his palm.

“
This is a trauma alert,”
I said over the intercom. “We
need a nurse to the trauma room and a gurney in the ambulance bay.
Repeat—
that's a nurse in trauma and a gurney in the ambulance bay.”

Mary, the unit clerk, looked up from filing her nails. It had been a mysteriously slow evening for a Saturday.

“What's up?” she asked.

“Officer shot, coming in by squad car.”

“Uh-oh,” she said. “I better page public relations.”

“And page the surgeon overhead. Where
is
everybody?”

“Mental health break,” Mary said.

That meant everyone was out in the ambulance bay already. Smoking.

“And what lucky surgeon do we have on tonight?”

It was Don “the Doberman” Doberstine, AKA Dr. Love. Good surgeon, though.

Bill had already started pulling the gurney out of the trauma room. He rolled it behind me as I walked through the ambulance bay doors. Outside in the warm summer evening Tracy and Donna stood smoking and complaining.

“Hey,” Tracy said to me. “It's actually nice out here.”

“Not anymore.”

“What?” Donna asked flatly.

“Policeman reported down. Shot. That's all I know.”

“Who's bringing him in?”

I shrugged. “I think he's coming in the squad car. City Emergency didn't know anything. They just said he was down.”

As I said that, there was the wail of a police siren off in the distance.

I looked at my watch. It was 8:12
P.M
. The police car turned down the drive. In a moment I could even see the frightened face of the officer behind the wheel. I felt nauseated first—it took a moment more before I consciously registered that it was Dino behind the wheel.

“Oh my God,” Tracy said, sotto
voce.

Dino pulled to a hasty stop and leaped out. “It
was a routine traffic stop
…” he shouted. He had blood on his uniform, blood on his hands.

We all ran to the passenger side. There an officer sat, head lolling back, covered in blood.

It was Sheldon.

Inside the car there seemed to be blood everywhere—on the ceiling, on the windshield, an inch or more on the floor, where a fast-food burger, still half wrapped in paper, sat soaked with blood.

Everyone pulled, trying to get Sheldon out of the car and onto the gurney. Dino pushed from the inside. Sheldon was completely limp, not helping us at all. He had a wound of some kind in his neck and his uniform was soaked in blood.

“What happened?” I shouted to Dino.

“The guy had a fucking bazooka. I think he got him once in the neck and then twice in the belly.”

“Come on,” I yelled at Bill, who was in the process of yelling something at me.

This is where TV gets it right. The simultaneousness of a thrash. Everyone started yelling orders at everyone else; we all pushed and pulled Sheldon onto the gurney and ran, tripped and stumbled toward the door. I only managed to grope momentarily for a pulse and got nothing more than my hand covered with blood. There was a bullet hole in the neck.

“CPR,” I shouted. “We need CPR. I can't get a pulse.
Mary, Mary,
tell the Doberman to get his ass down here now. Tell him this time it's real.”

The respiratory therapist met us in the trauma room, took one look at Sheldon and panicked. “Oh, Jesus, it's a cop.” She grabbed for the Ambu bag and the mask. She dropped the mask, retrieved it from the floor, fumbled trying to connect it to the Ambu bag and then dropped it again.

“Bill,” I said, “there's no pulse here. Start CPR.”

I needed to intubate. We had almost everything laid out, but I hadn't hooked up the suction yet. I cursed myself. I should have been in here setting things up before the squad car arrived. I grabbed up my supplies: the laryngoscope and its blade, the endotracheal tube, a stylet to put down the tube to stiffen it while I intubated. How many times had I done this? I had no idea—but how many times had I done it on someone I knew?—never. I balked for a moment as I stood there looking down. This was Sheldon's face. I can't be intubating Sheldon. I can't do this. Then with my left hand I adjusted his jaw in order to get the laryngoscope in. His face stayed slack, even as I got my thumb in to open the jaw. I wanted to slap him. “Sheldon, wake up. Wake up, Sheldon.”

Instead I slipped the laryngoscope blade into his mouth, lifted his tongue and mandible up out of the way and slid the tube in place. I inflated the cuff to make an airtight seal. The respiratory therapist attacked the Ambu bag and began squeezing like mad. Good breath sounds.

My fingers kept slipping out of place, though, because of the blood. As I looked beyond the endotracheal tube, I saw the bullet hole in the neck and thought—No, no, it's too lateral to have caused any serious damage—too lateral to have struck the carotid. If it had hit the carotid we might as well just stop now.

I looked up. Bill was doing CPR, bearing down on Sheldon's chest. Up, down, up, down. Tracy was hacking at his uniform with a pair of trauma scissors while Carol struggled to get the ECG leads in place. I checked for a pulse again. When Bill gave CPR, I thought it was there, faintly, but when Bill stopped, it stopped.

I started calling out injuries for the charting nurse to record.

“We've got a through-and-through neck wound, right side. It looks like it went lateral to the carotid.”

Bill paused from CPR so we could yank at the Velcro straps and undo Sheldon's bulletproof vest. “No chest wounds,” I went on. “It looks like two gunshot wounds, entrance wounds, to the abdomen. One in the left upper quadrant and one just above the umbilicus.” I motioned for Bill to stop CPR and help me roll Sheldon. “We've got what looks like one exit wound here. Right flank.”

Two gunshot wounds in the middle of the abdomen; nothing in the chest, no blood pressure. He must be bleeding out into his abdomen, I thought. The bullet must have struck the abdominal aorta. We might be able to stop the bleeding by cross-clamping the aorta within the chest, tying off the artery until the surgeons could repair it. That would mean a thoracotomy.

I palpated Sheldon's belly. It was distended and dull to the tapping of my finger.

“Restart CPR,” I told Bill.

“Someone take these bloods,” Carol said. “I've drawn enough to cross-match for four.”

Our volunteer, a diminutive, nerdish creature—actually premed at a local college—stood out of the line of fire, one hand raised to his white face and his open mouth—
The Scream
embodied. I pointed at him. “Tell Mary we need four units of type-specific blood now, now, now.”

He fled out through the ER doors, passing the Doberman and the second-year surgical resident, who were coming in.

“What's this?” the Doberman asked, stopping before the bed.

I leaned over Sheldon, the back of my hand to my forehead. “Thirty-seven-year-old male, shooting.”

The Doberman looked at the patient, puzzled. He must have been sleeping and was only now waking up. “But this guy is a police officer,” he said.

“…shot in the gut and the neck. 1 don't think the neck one got the carotid.” I pointed out the neck wound and then I looked up at the Doberman, looking for reassurance. “But I'm sure whoever shot him nailed his abdominal aorta. We gotta open his chest. That's his only chance.”

“Blood pressure?” he asked.

“Not here; not now.”

“Oh, Jesus. How many shots to the abdomen?”

I raised my fingers. “Two. One exit wound.”

The Doberman looked down at Sheldon's chest and sighed. “Vitals in the field?”

“We dunno. His partner brought him in.” I put my hand on Sheldon's chest. “I know him,” I told the Doberman. “We've got to get him back.”

Even I could hear the pleading in my voice. I looked at him, then at the surgical resident, who was panting with puppy-like eagerness at the thought of cracking a chest.

The Doberman slid his hands over Sheldon's chest and then along his belly, pausing to press deeply over the bullet holes. He looked up at me, shaking his head.

“We could try to cross-clamp the aorta,” I went on.

The Doberman cast a weathered eye up to the monitor and then down the length of the patient. “Well,” he said, “if that's what you want, somebody should hand me the thoracotomy tray.” He turned to the resident. “You start a central line.”

The resident, pissed because he wasn't doing the thoracotomy, slunk off for the kit.

Donna passed me a bottle of Betadine—brown and viscous disinfectant—used everywhere in the ER. I anointed the chest with it, a token gesture. This procedure would be anything but sterile.

Donna pointed out that the desk clerk was saying my name over the loudspeaker.

“What!!”

“EMS phone. They're calling about another trauma.”

Somebody handed me the phone receiver. “Yeah?”

“This is EMS twelve, Doc. We've got a twenty-eight-year-old gunshot to the abdomen here. He's awake and alert but he's only got a pressure of ninety over palp—”

“Just bring him in—”

“Doc, he's the shooter.”

I put my head down. “Just bring him in. We'll see you when you get here.”

The Doberman had the thoracotomy tray opened up and was pawing through the instruments, the scalpels, the Fienchetto, Mayo scissors, twenty towel clamps (enough to crack ten chests). Carol handed me a package of sterile gloves, and I opened it up and slid them on—more ceremonial sterility.

“The shooter is coming in,” I announced to everyone.

Nobody said anything. Donna was working on another IV; Tracy was helping the surgical resident start the central line. The respiratory therapist was bagging Sheldon. The Doberman and I bent over his chest.

He traced a long curve with the scalpel, a sketch mark embossed in skin, and then followed the same path, going deeper this time. Another cut went down to the ribs. Then the Mayo scissors; the lung collapsed back into the cavern of the chest, only to swell and fall in tandem with the squeezing of the Ambu bag. Now the Fienchetto. We worked clumsily to try to fit the rib spreaders into place.

I glanced up for a second and saw the surgery resident working the central line, a picture of total concentration. You can never be like that as an ER physician—totally focused—you always have to have your mind placed in a hundred different spots.

I looked back down at the chest, Sheldon's chest. Think, I told myself.
This is Sheldon.

The Doberman finally wedged the Fienchetto in place and began cranking the handle. There was the sound of splintering bones as the ribs inched apart. Finally, when the Doberman had cleared about four inches, he got down, nose to chest wall, peering deep into the thoracic cavity. “Nothing,” he said. He gingerly stuck his right hand between the bars of the Fienchetto.

“I've got the heart here,” the Doberman said. “I can feel it pretty well.” He had his hand deep into the chest by now. “It feels really, really…empty.”

That's when the paramedics from ambulance 18, our home squad, hustled in with the ambulance stretcher. No CPR, thank God. Following them, improbably enough, was Sheldon's partner, Dino, literally snarling as he came in after the stretcher. The security guard trailed impotently behind him.

“
I want this sucker dead
,” Dino shouted, pointing at the shooter. “
This guy needs to be one dead motherfucker
.”

I came over to the curtain. “Who let him in here?” I yelled to security.

Dino bore down on me. He pointed behind me, into trauma bay one, where his partner was, and shouted, “
That's the man you need to save,”
while I shouted back, “Dino,
get the fuck out of this ER
.”

Dino was up nose to nose with me. “That asshole is toast, man. I shot that bastard, and if he doesn't die I hold you responsible.”

I shouted back, still trying to override him.
“Get the hell out of here. I want you out. Security, get Dino out of here.”