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Letter to the Editor: Trying to Make Sense of Nonsense in Newtown

doi: 10.1097/01.EEM.0000428267.80244.87
Letter to the Editor

Editor:

One of our greatest strengths as emergency physicians is our ability to deliver bad or even devastating news compassionately and quickly and then move effortlessly to the next patient to tend to his need. We are required to tell patients that they have metastatic cancer, a family member that his loved one died unexpectedly, or that a horrific car crash claimed a loved one. As quickly as we do this, we use our innate reset button, and see who needs our attention next. It is often as dramatic as going from a cardiac arrest with unsuccessful resuscitation to tending to an ankle sprain or chronic back pain.

This quality may seem insensitive or even cruel to the lay public, but it is the level of objectivity we must create for the good of the same lay public. The next patient requires our undivided attention and for us not to be distracted. Often, this clarity must be gained in seconds or minutes after an unsuccessful resuscitation, telling an expectant mother that she is miscarrying, telling a patient who previously battled lung cancer that there are multiple masses in his brain, or telling a family that all that can be done for an elderly parent is comfort care.

We find resilience and objectivity in the pathology of disease. We can rationalize death because we understand pathophysiology. Although this helps us cope with death and tragedy, the family members do not understand these processes often and have a very different path of coping and grieving.

All of this brings me to the topic at hand, which is the unspeakable evil that occurred in Newtown, CT, that unexpectedly took the lives of 20 babies and six adults. On the day of the event, I woke up groggy from a prior night shift after four hours of sleep and put on the TV. For the next two to three hours, I sat numb. Initially the death toll was maybe two people, but as time passed, it climbed and climbed, and worst of all, the majority of the dead were little kids. I have two daughters, 6 and 4, and my immediate attention went to my oldest who was at school as I watched this horrific massacre.

So there I sat, as I am sure many of you did, numb and in disbelief that this was occurring on our soil and that the safety and innocence of an institution such as a grammar school had been so violently taken from us. I tried to switch hats from shocked father to emergency physician. I tried to somehow make sense of this and find closure with a reasonable explanation and then move on. I could not.

There is no reasonable or scientific explanation for this unspeakable act of evil. There is no teaching in my time in medical school, internship, residency, or as an attending that has ever taught me any disease process or pathology that can explain how a human being looks at an innocent child and pulls a trigger that ends that innocent life. Worse yet, my coping skills learned in all that time were not the least helpful. Although my daughter returned safely that afternoon to my wife and me, we felt as though we lost a child that day. I felt this unbearable sadness and an overwhelming urge to cry.

A grammar school, which should be a place of innocence and one of the safest places for children, had become a nightmare. I imagined my daughter in the cafeteria eating lunch without a care in the world. That image was interrupted by a violent image of a stranger walking into the cafeteria and firing a semi-automatic gun. These are the haunting images that have affected our national psyche now. Places like malls, schools, churches, movie theaters, and even our beloved place of work, the emergency department, have become targets of senseless violence.

Today I stand here as a father and an emergency physician changed forever. I cannot hit a reset button, and I cannot move on. I am not able to gain clarity, and like many of the family members to whom we have on many occasions delivered bad news, I stand in shock and disbelief, going through the stages of grieving. I am in my angry stage right now. I look over my shoulder now. We hold our children much tighter and mundane events like placing a child on a school bus, going to school, or even sitting in mass have become tense, anxious events filled with fear. This event has affected our national psyche and added to our collective anxiety and neurosis. As emergency physicians, we face many horrific things, but we deliver care, maintain our composure and professionalism, and even check our emotions at the door.

I learned on that awful day that there are simply acts and events from which people and even emergency physicians cannot recover from nor rationalize. This is what makes us human.

Lasanta S. Horana, MD Hamilton, NJ

© 2013 Lippincott Williams & Wilkins, Inc.