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Second Opinion: The Last of the Cowboys, Riding to the Rescue

Leap, Edwin MD

doi: 10.1097/01.EEM.0000421865.12387.25
Second Opinion

Dr. Leapis a member of Blue Ridge Emergency Physicians, an emergency physician at Oconee Memorial Hospital in Seneca, SC, a member of the board of directors for the South Carolina College of Emergency Physicians, and an op-ed columnist for the Greenville News. He is also the author of three books, Working Knights, Cats Don't Hike, and The Practice Test, and of his own blog. (See FastLinks.)





I had the coolest classmates when I was a resident. We worked, laughed, and learned together, and many of us stay in touch to this day. Our practices have crossed the gamut of emergency medicine, with some in academics, some in private practice, some administrators, two involved in auto-racing medicine, one a bush pilot/fishing guide, and one an amateur mountaineer (recently evacuated from a mountain by helicopter...moron. I love you, man.)

But one of the things that united us, one of our favorite activities when the shifts were over and a little time was our own, was shooting. We had a little money for the first time in many of our lives (especially when we began to moonlight). With that money our longing eyes fell on the shiny objects of our affection: assorted firearms.

We discussed them between educational sessions. We read articles about them. We searched for the best deals in the gun-friendly city where we trained. And when we finally had them in our hot little hands along with our concealed carry permits, we took them to the range and fired at the silouhette targets before us in the holy confines of local indoor shooting facilities.

Those were good times, and we formed quite a bond. One of the places we went to shoot was slightly seedy, and while on the range, one of us always tried to keep an eye out in case a local gang member tried to rob the store. It never happened, and it was probably a product of our overactive imaginations and overstimulated lives. I know, I know. Sounds crazy. But then, what we did was crazy, wasn't it?

We were emergency medicine residents. We inserted ourselves into some of the most horrific situations imaginable. Stabbing victims rolled past us at work, cardiac arrests were commonplace. Burns filled the ED with the smell of dead skin. And into all of it, we plunged with the vigor of new recruits, fearless and confident.

Not only that, we flew with our hospital's medical helicopter. We landed, mid-day or midnight, in summer heat or winter cold, at the scenes of accidents. We stopped in tiny hospitals where the staff had virtually no training to handle the complex cases that came to their EDs. I did fasciotomies on pediatric and adult burns, for heaven's sake! As PGYII. (I had never even seen one!) At the referral hospital. By myself. It wasn't so much emergency medicine. It was cowboy medicine.

Maybe that's part of why we loved our guns and still do. They represented capacity. We were physicians dedicated to responding to crisis. We knew cricothyrotomies and CPR, defibrillation and thoracotomies. We placed tubes, removed foreign bodies, and managed poisons. We were being sent into the world to intervene. Not to stand by but to plunge into the storms of life.

I'm convinced to this day that emergency physicians probably own more firearms than any other specialty. (I did know orthopedists with belt-fed machine guns and an intensivist with a penchant for the Uzi ... he really loved the classics.) I think it's explained, in part, by what I just said. We want to be ready, to be able to save lives, even our own. Because we all know what it's like to have to wait on someone else to do a job that needs to be done and to see them delay and avoid until someone dies, or we have to do it ourselves in the end.

Even as we try to help people, emergency medicine exposes us (as few other fields do) to the realities of human behavior. Let me be clearer: our work puts us in proximity to the realities of human evil. We are seldom deluded about the capacity of people to harm others as we close the lacerations, order the CT scans, and call the surgeon, the police, and the coroner.

I understand that this may rankle some readers. We all have our own opinions about things like gun rights and gun control. I'm not trying to initiate a debate. Rather, I'm trying to celebrate good times with friends. I'm hoping to bring a smile to the faces of my fellow physicians who find time on the range relaxing and who value their rifles, pistols, shotguns, and revolvers (and never hurt anyone with them).

I'm ultimately hoping to explain why we are so often armed to the teeth. We are, in the end, among the last of the cowboys and cowgirls of the world. We ride to the rescue. We don't shirk. We have a frontier fatalism combined with a frontier hope. And what's a cowboy without his trusty six-shooter, I ask you?

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