About six o’clock in the morning, we got a call from an ambulance that they were bringing in a pediatric gunshot victim. I asked myself, “A little kid shot this early in the morning? What the heck?”
In our trauma system, “pediatric” means up to age 18, so I immediately started picturing a seventeen-year-old gang banger shot in the line of duty. This thought was disturbed by a clarification from the nurse: a nine-year-old shot in both legs. That is really strange and left me wondering what the story would be behind this one.
As the trauma team began to assemble in the trauma room in preparation for the arrival of the little gunshot victim, an overhead announcement was heard: “Minor trauma in the department now.” That is said when a trauma patient comes in by private car, rather then by ambulance, and presents to the triage desk in the front of the emergency department.
This patient was also a gunshot victim and the coincidence made me think, immediately, that these two events had to be somehow associated with each other. I assumed we had two victims from the same firefight.
I met the man just as they were going to move him from the wheelchair onto the hospital bed. There was a hole in the top of his athletic shoe with a bit of blood oozing out. He was middle-aged and of slight build. He was in a lot of pain and was very upset. He told me he was getting ready to go to work when his gun accidentally went off. I was unable to get him to explain why he had the gun while getting ready to go to work or why there was a bullet in the chamber. “It was an accident, I swear!” he hollered over and over again.
I tried to reassure him as we started in on all of the treatment he needed: get him undressed and get his shoes off; start an IV for fluids, pain medicine and antibiotics; get an x-ray of the foot; get some more information about just what happened; find if he had any medical history and if he needed a tetanus shot.
As all of this was getting started, the boy came in. He had been shot with a single bullet as he lay on his side in his bed. The bullet entered one of his legs just below the knee, tore off a huge hunk of flesh, shattered the shinbone and passed into the other leg, breaking that shinbone, as well, and lodging just under the skin. We entered into the same plan of care for this gunshot victim.
When I went back to the bedside of the man, I learned that he shot himself through the foot with a high-powered rifle. There was a nasty hole through the middle of his foot leaving one of his toes almost detached. I also learned from the police that, after going through his shoe and foot, the bullet had also gone through his floor and come out of the ceiling in the apartment below, striking the nine-year-old boy as he slept in his bed.
To clarify, I went back to the bedside of the little boy and greeted the mother who was just arriving in the room. She spoke only Spanish so I served as her greeter, translator and explainer. She corroborated the story that a bullet had come down out of the ceiling, striking the boy as he slept in bed.
Both patients were admitted to the hospital. They both needed to go to the operating room to have their injuries surgically repaired. Both would probably end up with some sort of disability because of the accident. Both may well be emotionally scarred as well.
As I was finishing things up, word came back through the police that the wife of the man who was shot in the foot reported he had written a suicide note and had his rifle out with intentions of killing himself when it accidentally went off into his foot. If he was depressed before, how much more depressed will he be now?
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