This article was originally published on my old website in 2013….I have decided to re-publish for obvious reasons. 

Just after finishing my residency in Emergency Medicine, I was the attending physician in the Pediatric Emergency Room, a role I was still getting used to. One evening, the overhead pager blared: “Trauma Team to the Trauma Room.” This time, there was an addendum: “Pediatric Trauma Team to the trauma room for GSW” (short for gunshot wound). I heard nurses and techs chatter about a 3-year-old who was an incidental victim of a drive-by shooting, apparently hit while eating his dinner. My body and mind innervated. No one would bail me out if things didn’t go well. I was in charge. Chaos in the trauma room came to a halt when the medics arrived. Everyone suddenly still. They gave their report: “Drive-by shooting with a high caliber assault rifle shot through the front window of a home targeting another member of the family.”

An agitated toddler writhing against the restraints of the stretcher, emitting garbled whines. The wound in his jaw was already causing swelling around his entire neck. I admired his long eyelashes and curly hair. But, when I saw that he had a Pull-Up on, my knees almost gave out. “This should not be happening!” I thought. I also realized that this was the making of an airway nightmare: the disrupted anatomy, blood and other tissue blocking the view…. I was near panic; I knew we had to put a breathing tube in before the blood and swelling blocked the airway for good. When I went in to place the tube, nothing was recognizable. The tongue had become hamburger meat. I lifted up the macerated flesh with my instrument to look for the vocal chords: the portal to the airway and lungs. No luck. Blood and pinto beans were everywhere. I stuck a suction device in and vacuumed out the back of the throat, then grabbed the tube and blindly passed it through where I imagine the cords should be. Lung mist filled the tube, revealing that I had been successful in putting the breathing tube in the right spot, I had saved a life. Still, I felt rotten.

Although we had saved the child, we all knew his life and appearance would never be normal. There would be plastic surgeries and intensive speech therapy to restore his appearance and ability to eat and speak. After the surgeons whisked him to the operating room, I walked outside the hospital to take a breath. I had recently learned I was pregnant, would be a mother for the first time. At that moment, I tasted the salt of my tears and the first bitterness of what I had seen. Although I treated gunshot wounds regularly and had seen more than my fair share of trauma and death, I was really furious about this one. What kind of society was I going to bring my child into? Was it one in which weapons of war were available for purchase at the local Wal-Mart? One that had little access to mental health or drug and alcohol treatment, but plenty of access to lethal weapons?

The child I was carrying that night was 16 when the Newtown shootings occurred.  In her lifetime, the number of children killed or wounded by guns has increased dramatically. According to a 2013 NBC News report:

About 500 American children and teenagers die in hospitals every year after sustaining gunshot wounds — a rate that climbed by nearly 60 percent in a decade, according to the first-ever accounting of such fatalities….In addition, an estimated 7,500 kids are hospitalized annually after being wounded by gunfire, a figure that spiked by more than 80 percent from 1997 to 2009, according to Boston doctors presenting their findings at a conference of the American Academy of Pediatrics,….

In addition to the families of the children who were killed in Newtown, I am thinking of the first responders who witnessed the carnage. They had no opportunity to save a life, as I did that night. My own reaction to the sight of disfigurement and destruction in a previously perfect little body was visceral. How did they feel seeing so many riddled and lifeless bodies? What we saw on TV was horrific enough, but to have actually been there must have been more than some could bear.

I am not practicing emergency medicine any longer, but I want to join my colleagues in the field to call for real action on gun laws in the US. It’s not that I naively think that is the whole solution. I acknowledge our enormous under response to mental health services or our ultra-violent popular entertainment culture. Nonetheless, as first-hand witnesses to the damage that guns cause in people of all ages in the country, emergency responders and staff should share their stories with the public so that we can all resolve to curb the “terrible tally” of children harmed and killed by guns each year.

—Jennifer Brokaw, MD

December 14, 2013

Addendum: Since I first published this on my website in 2013, there have been about 26,000 more children killed by guns in the US.


Posted by Jennifer Brokaw

Dr. Jennifer Brokaw worked for fourteen years as a board-certified emergency physician before becoming a private consultant, patient advocate, writer, and speaker on the topics of end-of-life planning, medical decision-making and medical advocacy.

One Comment

  1. While I didn’t work this case with you, I do recall many others in Peds ER with you and it was one of the most influential times of my life. I was a mere 5 miles away when Newtown occurred and it will always be in my mind. My child was in high school and endured painful hours of lock down as they worked through this horrific situation. I don’t want any others to endure this feeling. Both as a mother and through what my son told me during those stressful hours. It’s time for change.


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