I still remember those two blood vessels deep in that boy’s brain, shredded by a bullet fired into a crowded playground. The same bullet that blew fragments of one side of the teenager’s skull into his brain on its way in and a larger chunk of skull on the opposite side of his head off. There was so much damage that it didn’t even look like a human brain. As he entered, there was blood gushing out of the entry and exit. We would soon find out the truth about those deep injured vessels. He sustained so much damage that it was hard to believe he made it to the hospital. That was what I thought as we moved him unisonly from the stretcher into the OR bed. These kids who get shot in their heads die on the spot. That’s been the case for as long as I’ve done this work.
We were able remove a greater portion of the skull of the patient to allow for better access. Bright red blood came up from his frontallobe and passed my head as well as that of my assistant. This senior neurosurgery residency calmly performed my surgery and was very efficient. Both of our surgical loupes had been covered with a red powder and were smudged to the sides where the nurse was trying to assist us. No matter what we did, the blood kept coming from deep inside the boy’s head.
“Clip!” I called out to the scrub nurse, louder than intended but above the chaos of the operating room as everyone struggled with trying to save his life.
“Which one?” she asked.
“I don’t care,” I came back. “Any of them!”
I was handed a straight spring-loaded aneurysm clips on the ends of an instrument by the doctor. This would allow me to remove the clip from the end and close the vessel. Blindly, I placed the clip-applier between my frontal lobes where blood was pulsating in quick pulsating geysers. It was released, in the hope that some bleeding would cease.
“We’re losing the blood pressure,” came from the anesthesiologist on the other side of the surgical drapes.
My brain began to swell and move out of my skull. After a few more seconds, I could no longer see the actual two vessels—I think it was two vessels—that were pumping this boy’s life away and onto the floor.
We had already applied four clips in the gap. The rapid blood loss stopped by the time we were done. We moved the boy to the pediatric intensive-care unit. The boy lived long enough to see his parents and say good-bye. His brain began to swell one more time, and then he died. I can still hear the screams of his parents as I returned to the ICU. It was a difficult conversation, one that every parent shouldn’t have. They realized that their son wouldn’t be coming home.
The last weeks have been filled with emails coming from organized pediatric neurosurgery leaders, who I’ve known for years and are from almost every state in the U.S. There is a sense of frustration evident.. It is our responsibility to make a difference.. Everyone has to be responsible. Why is this happening so often?
We are left as surgeons trying to repair the terrible effects of gun violence in this country. There is an idea among my colleagues that we should write something up and send it “somewhere where a lot of people will read it.” A colleague from St. Louis mentions me and it takes off from there.
“When you write it, Jay, you tell them about the kids we see who come in after a gunshot to the head where it looks like a bomb went off on their CT,” one said. “How the parents cry and cry and cry when we tell them their child is brain dead. Tell them how awful it is when there is nothing you can do.”
We all know this.
“Or tell them about my patient,” said Tina, an experienced pediatric neurosurgeon at Massachusetts General, “who spurned the advances of her brother’s ‘friend’ enough times that he finally took out a handgun and shot her in the neck, immediately paralyzing her and committing her to a ventilator for the rest of her life.” She continued, “I still remember her mouthing several days later, ‘I thought I was doing all the right things.’”
“Yes,” said Sam, a pediatric neurosurgeon from Seattle who co-founded a start-up trying to make spinal surgery safer. “You tell them The storiesTell them, “Please do not!” Demand action on the part of our leaders.”
Then from a colleague in Connecticut, Jon, a military veteran and leader of our field in advocacy for common sense gun laws: “Understand that the events in Texas this week are the result of deliberate choices, actions, and policies that have been pursued over the last half century by citizens, industry, and politicians. Guns are protected by the Constitution and legislature, which is unlike other public health issues. This makes firearms more difficult to use than those used for tobacco and motor vehicle safety. Any solutions will require a well-considered strategy and long-term commitment.”
Jon and I speak offline. We have been friends for many years. The time he spent in the United States Army impacted his entire life. He was also affected forever by his time in the emergency room near Sandy Hook Elementary many years ago, when the calls started to come in. His surgical team and he were dressed in medical gowns to assist the thousands of children who had been injured. It was a long wait and much waiting before they finally realized. There is no one coming. It is impossible for anyone to survive and make it this far.
Our field continues to get emails from pediatric neurosurgeons. Ideas, stances, arguments on how strong to come out with a position, how political to be, who to team up with, ‘should we act now or is it too late?’, ‘Who do we call’, ‘Does anyone know a Senator?’ All of it, the back and forth, the frustration, the anger, welling up from a place of completely helplessness. As pediatric neurosurgeons are used to being there for others, they can be used to pulling back, running into the inferno, saving lives and seeing solutions. You can do something about it.
I want to be clear: the death of children due to any injuries or reasons is tragic. Gun-related deaths are more common than childhood cancer and motor vehicle collisions.—These are the things our medical journals revealed to us during the last several months—This is an example of societal failure and must be corrected. The first room a shooter enters is not going to be stopped by drills. A proven failure is the reliability of guards with guns. Finding a common ground between those on both sides should not be so very hard if we start with, “No child should be shot at school.”
My political views are not my own. I am a South-South son.—I’ve lived in Mississippi, North Carolina, Alabama, and now Tennessee—I am a firm believer in gun culture and guns. As children, my friends and I learned the value of responsible gun use. Just a few months ago, I found my old .22 rifle as we cleaned out our family’s Mississippi home of fifty years. It was a gun I had brought back from my father’s Mississippi home fifty years ago. After cleaning it up, I taught my daughter and son how to shoot safely around the firearm. The same day I found that gun in my father’s old gun cabinet, however, I also found a baseball nestled in a little golden baseball glove in a trophy that was sitting on top of that that same cabinet. My entire Little League team signed it when I was a ten year old. I am amazed that two of these 14 young boys were shot to death in their youth, almost 40 years before the incident.
Modern weapons with high-velocity, large capacities, and low recoil have been missing for some time. They are now readily available, but they don’t seem to be around as often. As it should be, surgery and weapons of warfare have been close friends. Both have often been aided by advances in one. The ability to take back medical knowledge from the civil world is one of the benefits that comes with war. It was the Civil War that we finally understood aspects of wound care after surgery. From the Great War, there were advances in modern resuscitation techniques and antibiotic usage. Modern war has seen the destruction of armaments increase exponentially. This would not have been possible just a few generations ago. Nowadays, body armor is a standard requirement. Infection is the most likely outcome of being hit with a musketball. An AR-15 round explodes flesh and shatters bones, creating a large cavity of destruction that is larger than the bullet. It also causes irreparable damage to everything around it. As a junior member of Army faculty fifteen years ago, I recall a lecturer from the Army telling us how even the best helmet design could expose the occipital regions of the head. This makes it a prime target for snipers during Middle Eastern conflict.
However, we’re not speaking of war. Civilians don’t have Kevlar helmets and body armor, unless the shooter has bought body armor with his assault weapon. Modern weaponry has far more damage than our abilities to educate and resuscitate. People at a church, school or bus stop don’t think about how they can best defend and attack their positions. How to escape from a room and light a fire. And they shouldn’t have to. The very idea that one of the recent victims covered herself with her dead friend’s blood in order to trick the killer into thinking that she was also dead should stop every citizen of this country cold.
My role is a brain surgeon. I will not be involved in politics. If these children suffer severe injuries, there are no medical professionals that can help them. While we can tell our children how to flee, hide, wait for police and fight back, it is impossible to teach them to use assault weapons. It has become a routine to see the unimaginable. If only people saw what our colleagues and me see in the trauma bays all across this country, then their politics of extremeism would yield to humanity and we would have commonsense legislation.
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