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this episode contains descriptions of violence and may not be suitable for everyone please use discretion
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am I going to die and what do you say I tell them no [Music] of us expect to be injured none of us
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expect to be in a car crash certainly none of us expect to be shot foreign expect those things to happen
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but I know they do we had four young men all the victims of gun violence who passed away in one
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evening and you know four times that evening I had to walk out and tell the families that they had lost their 20
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year old son to violence and you know I had a young resident with me probably 30
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32 years old and by the you know the third or fourth time that night I just couldn't make him go out that last time
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with me to to talk to those families here are three of the country's most experienced trauma surgeons who sat down
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with us to speak frankly about what happens when someone is shot I'm Phoebe judge this is Criminal
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what happens when you hear that someone's coming in with a gunshot when will you take me through the whole
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process yeah so most um you know most places have the whole chain sort of set up right so there's
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usually a phone call that comes in EMS picks a patient up they'll call in a report to the emergency room that
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they're coming in with a gunshot wound victim Dr David Spain is the chief of trauma at
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Stanford he may get variable amounts of information about where the gunshot wound is and how the how the patient
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looks whether or not they're in shock or or whether or not they're vital signs are normal so you may get some of that
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information and most emergency rooms will have an alert system they'll go out to the trauma team at the
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hospital and so at our place that'll alert the emergency medicine physicians it'll work the trauma team it'll alert
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the operating room to to be ready it'll work the blood bank to get ready and so there's a whole broadcast of uh
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of a gunshot wound coming in that sort of sets the whole Hospital in motion it gets everybody prepared to be to be
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ready to deal with anything once it hits the door and what happens when the patient gets
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to the door um that first we called it the golden hour right so that's your opportunity to
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sort of find the injuries and address the life-threatening injuries we're kind of we're kind of simple we use this
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mnemonic called the ABCs and so A is for Airway is the airway patent and can they
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breathe on their own and if not then we need to help them and then B is breathing and so can they get oxygen in
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get carbon dioxide out and then see a circulation so are they in shock are they bleeding how do we get them to be
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stable with their Vital Signs and so that's the big area of focus in the first 10 15 20 minutes when the
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patient's emergency room is there any special look that a gunshot victim has when they come in you know you can you
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know after you've done it a while it there's a you can sometimes just tell like there's a certain book
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you know um the way our emergency room is set up the first thing I see when I walk in a room is the soles of their
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feet and so if the soles of their feet are pink I kind of like I'm okay for a little bit and if I walk in the soles of
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their feet are white and pale then I know we're in trouble but there is a certain look sometimes that people will
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get that you know if they're in shock and they're usually not calm and there's a little bit of panic look in there so
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there's sometimes you can get a get a feel about how sick somebody is just by just by eyeballing them
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so anytime you see a gunshot victim do you think a crime has occurred well usually right sometimes there's
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accidents um not often um there's usually some intentionality to it I'll say right that's kind of the
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word we use so either somebody intentionally shot this person or they intentionally shot themselves once in a
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while there's pure accidents but most of the time there's some intentionality to
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it when someone comes then who's been shot in their abdomen or arm or they're awake
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and conscious what are they saying if they're saying anything to you know the worst thing anybody can say you
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know you're taking the or just just to look at you and say you know don't let me die and um you know and obviously
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people talking about wanting to live and see their family again those are the kind of things that um you know they
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it's it's human nature for people but you know the last thing any of us want to hear us is have a patient look at
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this and say oh please don't let me die [Music] my name is Amy Goldberg I am chair of
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the department of surgery at the Lewis cat school of medicine at Temple University in Philadelphia Pennsylvania
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and I'm a trauma surgeon how long have you been a trauma surgeon I've been a trauma surgeon for
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25 years I was speaking with them with Dr Spain in California and we were talking about
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when he's taking people into surgery and the worst thing that he said he can hear
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is when a patient says just don't let me die well they ask you am I going to die
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and what do you say I tell them no I tell them no we're going to do everything you know we're going to take
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good care of you no and what do people say to you when they wake up after surgery
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sometimes nothing at all which is perfectly fine you know I um there is no doubt that so many of the
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patients are incredibly incredibly appreciative incredibly appreciative and say thank you it's really it's it's
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really incredible gives me a moment of pause every single time it happens how much do you want to know about
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someone when they come in with a gunshot wound nothing's important other than how
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we evaluate that patient in our trauma bays and what our next steps are that's the only thing that's important when
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that patient arrives foreign I guess death is not an abstract concept to me Ronald Stewart is chair of the
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department of surgery at UT Health San Antonio he acted as the triage physician during
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the Sutherland Springs Church shooting in November of 2017 where 26 people were killed and 20 more were injured I've
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treated hundreds and hundreds probably thousands but definitely hundreds and hundreds of
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firearm injuries and uh we we've seen multiple fire injury victims at the same time but to have
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children patients and to also have the situation where families are searching for for victims
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who are not in your trauma center and then to realize that the reason why they're not there is because they're
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they were they're dead we had done a region-wide preparation drill six months earlier for how to
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how to address it as a as a system by a system I mean the way the way ambulances
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the way EMS the way the Trauma Centers work together the way the the teams of people across the region work together
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that that's our job as professionals we know that uh we have to be prepared because even though it's a a very very
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low probability event that is true it's very low probability however we know that based on the current situation that
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it's extremely high probability that it that it's going to happen somewhere and so so it's it's our it's our work our
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professional obligation to be prepared you know I you have been doing this for a long time
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you are used to life and death I don't know if you used to is the right word but you see it an awful lot more than
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most people but I wonder on a day like that where you see such a a high toll of violence
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is it different when you go home at night do you feel a different way it is it is different yeah yeah it is
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different I mean objectively you would think it's not different objectively you would think it would be
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the same it's not that when 50 people when 50 people are in church and 46 of them are shot
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and they come to your your hospital it's it's it is it is different and it does have a different
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impact it does just just literally a few weeks before we were working with my colleagues in
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Las Vegas of talking about Lessons Learned at the American College of Surgeons and one one of the things that that I
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didn't I didn't fully understand at the time is that the surgeons is a group generally all of them said the same
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thing that we take it personally that's what the Las Vegas surgeon said is that we take this personally
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and and I will say after Sutherland Springs uh it's from the mass shooting point of view I totally understand
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it's I do take it personally [Music] that makes any sense at all [Music] foreign
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[Music] what have you seen change in the gunshot wounds that you've seen over the last 25
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years I see patients arriving with larger caliber bullet injuries and I see patients coming in with many more
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gunshot wounds so this isn't this is someone who before it was rare to see someone with two or
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three bullets in them now yes and previously we would see 22 caliber gunshot wounds
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which is a very small caliber bullet maybe the patient was shot once or twice and now we could be you know seeing a
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high energy AK-47 wounds and patients are shot a multitude of times in the spring of 2017 The Huffington
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Post published an in-depth profile of Dr Goldberg's work the reporter Jason figoni talked with her about what
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happened in 2012 at Sandy Hook Elementary School when 20 children and six adults were shot to death
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in that piece Dr Goldberg said that if the public had been shown the autopsy photos of the children the gun debate
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would have been transformed I asked her about it I had hoped that some good would come from that terrible tragedy at
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Sandy Hook and that the country would be moved from the death of so many young innocent
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students and I was quite disappointed to see that nothing changed and I think the
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only way that I could um wrap my my mind around it was that people needed to see it they needed to
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see the injuries they needed to see and I'm not being disrespectful at all to those children
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but they needed to see what young children look like riddled with bullets that they couldn't even transport them
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to the hospital to be saved I mean that's the thing is that none of us ever see it but you do
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right I mean what uh what they show are our pictures off of Facebook well that's not reality that's that's that's
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not what we're seeing in our trauma base what is it like reading the news or does
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this happen often that you read the news um and see an article about a victim that you've treated
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uh yeah sometimes the next morning after I've been on call there'll be something
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uh um in the newspaper or on the news on television or on the website I think sometimes what distresses me
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more is when patients are shot and die and we see nothing in the paper and hear nothing on the news
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have you prepared for a mass shooting uh yes we have here uh at Temple is that something that
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preparation and training that has come about in the last few years or has well I guess it was back in 2015 when the
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Amtrak train crashed here in Philadelphia so many of the patients actually came here to Temple so we we
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unfortunately had an experience of mass casualties the difference between a train accident
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and a mass shooting would be that many more patients would need to go to the operating room and it would really
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change the resources that the hospital would need to provide you've gotten tougher
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over the years uh no actually I think uh I think it's been harder and harder for me to
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continue to deal with this um after all these years I don't think it's gotten any easier whatsoever and and I I
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surely know that I have not gotten hardened to it in fact I think I've gotten much more sensitive to it
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why do you think that is [Music] because I think there's only a certain number of
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patients fathers and mothers and grandmothers and brothers and sisters and kids that you can say I'm sorry your
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loved one has died and then brace yourself and wait for the whales and the screaming and the overwhelming
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sadness that follows I think it's the the worst job in the world to explain to a mom or a family how a
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child or a loved one who was normal at breakfast is now is now not here because they've
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they've died from an injury that's the worst there's just no good phrase or term to use but I do think you
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have to be definitive right I try not to use euphemisms and you know saying he passed or they're
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gone or I think you just say you have to be direct and just tell them specifically that their loved one has
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died and it's hard but they need to hear those words very clearly from you know and then you just gotta try and do
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what you can to to support them I I try whenever I do it to take our chaplain and social worker with us and
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try to provide some support but it's it's never enough I told one of the residents the other
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night that it won't be the long hours and hard work that finally do me in it will be the
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um emotional strain of telling just one more family member that their loved one has died
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I think that we want to believe that people who are who are often so close to death as you are
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as Funeral Directors are somehow have this great wisdom or Insight that we shouldn't be afraid to die
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you that it's okay uh do you feel that way no maybe when the time comes sure for some
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people right you know um you know I look at my 87 year old father who's you know having some health
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problems and slowing down and and day-to-day life is not as as um enjoyable for him as it once was
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and when he's coming to peace with it that his end is coming and you know and he's he's he's at peace with it
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um you know that's and I think that's fine right but you know if you're 30 or 40
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years old no like no there's there's no good there's no good answer and and I've
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just seen it happen so many times that people think their life is okay and then in the blink of an eye everything
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changes so I just don't fight with my wife I don't fight with too many people actually it's just Life's too short and
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you know you just never know when when some something like that's going to happen you're going to have a major
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change in your life so I I have a I do think I have a different attitude in general about you know getting along and
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disagreeing and you know um based on what I see at work you know we wanted to speak with you and
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Dr Spain and Dr Stewart because to us it seems surprising to hear doctors speak publicly about guns
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well uh doctors say don't have a lot of salt and exercise because that's what's good
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for their for patients hearts you know stop smoking it's not good for lung disease or lung cancer
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so it would only be natural for doctors to say that this is a public health problem and
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it's preventable [Music] Dr zimi Goldberg David Spain [Music] criminalists produced by Lauren Spore
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Nadia Wilson and me audio mix by Rob Byers and we're saying goodbye to our intern Matilda fellino we've loved
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working with her and we're excited to see what she does next Julian Alexander makes original
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illustrations for each episode of Criminal you can see them at thisiscriminal.com where on Facebook and
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Twitter at criminal show Criminal is recorded in the studios of North Carolina public radio
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wunc we're a proud member of radiotopia from PRX a collection of the best podcasts around
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I'm Phoebe judge this is Criminal oh [Music] from PRX