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Academic Medicine:
doi: 10.1097/ACM.0b013e3181b6c808
Other Features: Teaching and Learning Moments

The Burden of Judgment

Newton, Mark R. MD

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Dr. Newton is a first-year resident in urologic surgery, University of Iowa, Iowa City, Iowa; (mark-r-newton@uiowa.edu). At the time he wrote this essay, Dr. Newton was a third-year medical student, Vanderbilt University School of Medicine, Nashville, Tennessee.

Level One trauma: GSW to the abdomen, intubated, hypotensive. Bodies materialize, crowding desks and hallways while throwing on plastic gowns and masks. Another gun shot. Ten days on the trauma unit and I could already tell the story. They were all the same.

Time draws out as we each run through our assigned roles. Suddenly the elevators burst open—the Life Flight team is performing chest compressions as they barrel toward us. In quick rehearsed movements, the patient is transferred to the trauma bed. Clothes are sheared off. Chest exposed. Skin and muscle incised. Incision extended. Ribs spread and cracked. Chest open. Pleural cavity dissected. Aorta clamped. And then … there are no more interventions. Silence settles, and people vanish. There are other patients.

My chief turns at the door, “Why don’t you close him up? It’d be good practice. We’ll see you upstairs.”

Then I’m alone at his side. He’s sprawled on the table, the now-disconnected tube jutting from his mouth. His clothes, neatly bisected, hang draping down like curtains anchored beneath his body. As I begin gathering supplies, the ring on his finger catches my eye. In the midst of everything, it never occurred to me that he could be married. Increasingly unsettled, I find the suture and needle drivers and sit down to work. Engrossed in my task, I slowly become aware of three figures outside the room.

“Hi,” I venture.

“These are two nurses from Children’s. They come over sometimes to observe our traumas,” the elder nurse replies, answering my unspoken question.

Oh. I pause as they slide over to inspect the body.

“Here’s the incision, and you can actually see here ….” She inserts a gloved hand and touches a vessel. “That’s the aorta. There’s the heart, the lungs.”

One by one, the other two nurses lean over for a closer look; one even tentatively ventures a hand inside. With curiosity satiated, they leave us in uneasy silence, the weight of their intrusion swirling in my thoughts. I work for the better part of 10 minutes, my unpracticed hands slowly throwing stitch after stitch, working bottom to top, attempting to restore peace to his broken form.

As I finish the last few stitches, several techs carry in large black bags. Without glancing at me, they collect the shoes, wallet, and other belongings scattered around the room. I overhear bits of their conversation as I quietly pack up the extra suture materials.

“Can you believe it? Just a manager at his restaurant …”

“Yeah …. Wrong place at the wrong time …. Where’s the justice, huh?”

My heart sinks as “GSW” becomes abruptly innocent. A victim. An untold story. Pagers don’t communicate that kind of nuance.

Intrusive thoughts preoccupy me for the rest of the night as I attempt business as usual. No one else seems to miss a stride, out of practice or necessity, I can’t tell. Maybe it’s both. I do my best to do the same.

It isn’t until I’m driving to the hospital days later that the full significance of what happened finally hits me. What about his wife? His children? His dreams? I feel tears burning down my cheeks before I even know I’m crying. How was any of this fair? A prayer finds its way to my lips, at first for him but then for me. God help me to do better next time. I sit in my parking space, slowing regaining my composure. Then I’m late. Grabbing my mug and my coat, I hurry toward the stairs, steeling myself for another day.

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Acknowledgments

The author would like to thank Dr. Michael G. Richardson at Vanderbilt University Medical Center for his encouragement to write about this experience and his constructive criticism.

Mark R. Newton, MD

Dr. Newton is a first-year resident in urologic surgery, University of Iowa, Iowa City, Iowa; (mark-r-newton@uiowa.edu). At the time he wrote this essay, Dr. Newton was a third-year medical student, Vanderbilt University School of Medicine, Nashville, Tennessee.

© 2009 Association of American Medical Colleges

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