I was a third year medical student at Tulane working in the Charity Hospital Emergency Room which on a good night looked like an overrun clinic filled with STD patients, drunken fight victims, and people with heart problems of various sorts. And on bad nights—like this night—the ER more closely resembled an Army field hospital engaged in combat medicine, a continuous mill guided by the Charity mantra that, if crass, we all knew so well: Greet ‘em, Treat ‘em, and Street ‘em.

On this night in 1988, during my third year of medical school and first year in the hospital, I was minding my own business, drinking bad coffee out of a small Styrofoam cup with a few of my classmates, when I heard the double doors of the ER burst open. I knew that sound. I heard it on the drive home from the hospital when I was trying to unwind by listening to music in my car. Some nights the sound woke me up from a dreamless sleep in the middle of the night. But this night, the sound called me to duty so I tossed my half-filled cup into the biohazard trash nearby and raced over. 

A surgical resident who I was assigned to was helping wheel a young black boy on a stretcher to the Trauma Room with the help of 3 paramedics. As always, my resident—an uptight, chronically sleep deprived guy with a thick New Jersey accent—was in a foul mood and looking for someone to yell at, and there I stood. “Weill, get your thumb out of your ass and get me the shit to crack this dude’s chest.”
My eyes widened. We were going in. 

I did a quick exam of the patient and found 3 holes in his chest. “17 year old black kid, gunshot wound to the chest, hypotensive, fluids running in wide open,” one of the interns said, rattling off the “bullet,” the ironic designation for the thumbnail sketch of a patient we were all trained to deliver to our attention-challenged superiors.  

I went to the bedside looking not at the kid’s chest, which was spitting blood everywhere, but instead right into his eyes which were wide open with fear, the look I would soon learn to associate with impending death.

The nurse behind me nudged me in the back and handed me a chest tube tray. I quickly opened it and pulled out a long tube that resembled a garden house. I hadn’t put one of these in yet—at least not yet in a human (poor little pigs)—but knew the idea was to insert it between the ribs and into the chest cavity to drain any blood that was accumulating in the chest cavity. 

I made an incision that was too big and then cut through some muscle and cartilage tissue and stuck the tube in the patient’s right chest, feeling a release of pressure as I entered the blood-filled cavity. Bright red blood started pouring through the tube, dripping onto the floor until the nurse could attach the container that was designed to collect whatever came out of the tube.

Feeling self-satisfied, I looked up and saw my resident sawing through the sternum, with quite a bit of haste and with a blank expression on his face that I think would have been the same if he was doing some woodwork in his garage.

Once he got the patient’s chest open, I could see the young kid’s heart, pumping erratically and spilling blood everywhere from a two inch hole in the right ventricle. Holy shit, I thought. “Suture,” the resident barked and a nurse handed him utensils that he could use to sew this guy’s heart wall back together.

Just then, I heard another commotion behind me. In the next bed over, a new patient had come in—a car accident victim, I heard someone say—a white girl who looked to be college aged. “Tulane student. T-boned in her BMW by a drunk driver. Multiple fractures and head trauma. Parents live uptown and are on the way.”

My resident, in the middle of repairing our gunshot victim’s heart, overheard all this and turned to the team around him and said, “This guy’s done. There’s a real person in the next bed.” 

And with that everyone at the bedside moved in lock step to the young woman’s bed and started treating her—hanging IV fluids, putting EKG leads on her chest, ordering x-rays and lab tests. 

Confused—but really more than that, paralyzed—I stayed at the young black kid’s bedside watching his respirations become more shallow and the bleeding begin to stop, reminding me of the line from the classic book House of God by Samuel Shem that was required reading in medical school—“all bleeding eventually stops.” My eyes tracked up to his eyes that were still open, glassy and looking through me. 

As he lay there dying, I began to wonder what his last thoughts would be, of me, of us. 
Then my trance was broken, “Weill, could you get over here sometime today? Get a central line in this girl. That guy’s history.”

I turned slowly and moved to the girl’s bedside. We had a real person to treat.