“Hang in there, buddy, we’d like your insides!” says someone in the trauma bay. I cringe briefly at what’s been said, but don’t quite digest the intent. I am too busy supervising the various procedures being carried out on the young man lying before us.
His bullet-ridden body is naked, and brain matter extrudes from one of the holes in the back of his head. His corneal and gag reflexes are intact and there is some extensor posturing, so he is not quite brain dead— yet. To the police officers and detectives who are observing, the scene might perhaps appear disorganized; there is, indeed, a lot happening simultaneously, but with people aware of their specific tasks. In no time, what I see is a limp body in front of me on a stretcher, tubes emanating from almost every orifice. The biggest tube is connected to a ventilator.
All that’s important to me right now is that a human being is on the brink of death. As a surgeon, my task is to keep him “alive” or in a resuscitated state until his family arrives to say their goodbyes.
Later, when I think about the “we want your insides” statement made in the midst of resuscitation in the trauma bay, I realize that the person was referring to the patient’s valuable organs. This once-strapping young human being has now been reduced to a precious set of organs: a heart, liver, pair of kidneys and lungs (not to mention skin and cornea), that are no longer precious to him, but could possibly be salvaged and transplanted into another human being. It is the ultimate irony of the trauma room: that an act of violence, a homicide, can result in the gift of life for another human being.
As a surgeon, I like to believe that I’m in the business of saving lives; but perhaps I am into the business of ‘fixing’ body parts and making them functional again. Patching up holes in hearts, sewing up intestines, fixing comminuted fractures – that’s what we are trained to do. But what is a good surgical repair worth, if we send these individuals back into the social chaos that they come from? To ‘save a life’ would mean intervening beyond the trauma bay or the operating room…and dealing with the drug and gang related violence that pervades so many of our inner cities. I believe we need to worry and get as involved with fixing the ‘outsides’ as the ‘insides’…something that will require the collective efforts of healthcare professionals, policy makers and the general public.
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