There are two kinds of silence in the hospital—the calm before the storm and the silence that comes in its wake.
After an ominously quiet Sunday as a medical student on general surgery call, I received word that there had been a shooting. I made it to the trauma bay just before the first victim arrived and the typical sequence of trauma protocol events ensued. Nurses, physicians, and clerical assistants were working together in a whirlwind. Organized chaos. Then the second victim arrived. And then the third. I heard the overhead intercom announce a code orange. Amid the handover from police officers and paramedics, I realized that multiple people had been shot in the Danforth neighborhood of Toronto.
My thoughts started racing. Was there a city event tonight? Isn’t it a Sunday night? How many more victims are on the way?
Running between stretchers, I scribbled down each patient’s vital signs, injuries, and imaging findings. In one of my first lectures in medical school, I was introduced to the concept of “imposter syndrome.” It was a feeling that I had often struggled with over the last few years, but it became startlingly apparent that evening. As I blended into the background of the trauma bay, I tried to balance being useful with staying out of the way, a calculated skill I had been working to master since my preceding months as a clinical clerk. I wanted to appear confident, competent, and in control. In reality, I felt like I didn’t belong, and that I shouldn’t witness what I was seeing. It was an unsettling feeling. At what point during training do we transition from feeling useless to useful?
I scrubbed into my first trauma laparotomy that night and learned, with equal parts surprise and horror, the extensive and unpredictable damage a single bullet can inflict. The surgery ended in the early hours of the morning and the hospital was quiet once more. When the day team arrived, we were back to business as usual. I found it difficult to concentrate, as images of the night played on repeat in my mind. I wondered if I was overly sensitive when others seemed unphased—another mark of my imposterhood.
I was inspired by Virginia Mathers’s photograph An Imposter Amongst the Chaos, on the cover of this issue. I see the image as an attempt to reconcile my roles as a care provider and learner in the aftermath of the shooting, but it cannot do justice to the unfathomable loss of life and those left with life-altering injuries. This image captures the uncertainty of myself, a medical student, when surrounded by experienced clinicians. Akin to a starfish thrown out of the water, being a junior trainee in a high-acuity setting can be disconcerting and uniquely challenging. My efforts to lend a helping hand are depicted by the multiple reaching arms of the starfish. This lone red starfish stands out against the muted background of round gray rocks—almost like an imposter, too. The starfish contributes little to the overall landscape and seems out of place, as if it had been left behind when the water receded after a storm.
The chaos settles; life returns to normal. Yet, we are left to pick up the pieces in the silence after the storm.
Acknowledgments: The photograph was taken by Virginia Mathers. Dr. Bernard Lawless and Dr. Najma Ahmed are trauma surgeons at St. Michael’s Hospital in Toronto, Ontario, Canada, and were on call the night of the Danforth shooting.