Lucky Day

I had a good night shift. It was slow and I decide to go down to the Physician lounge to grab a....forgive me...white chocolate mocha. Before leaving I said to the MS4 "You have the floor" which is what my old surgery resident told me after helping to put out a fire and leaving me to finish off a night of call in the ICU. Obviously, dropping it on a MS4 who wants to go into Peds is something different, but....so be it. In the hallway I heard a commotion and then around the corner they wheeled this young black guy with blood streaming from his eyes. It was horrifying, and I felt totally inadequate to the task that I knew lay before me, but the first thing that popped into my mind was some obscure allusion to Oedipus. I just knew that the guy was going to need care and that I would have to provide it as best I could. From his friend I got the following story: Minding their own business, driving through P-town at 2am, and shot in the head. We put the guy on a gurney and, yes, he has a hole big enough for me to stick my thumb in about three millimeters lateral to his right eye. Holy shit! I'm struck by the fact that the guy looks pretty good for a GSw to the head, but I figure it's early and things are only going to get worse before they get better. I decide to step in with some early aggresive management and then reassess the situation. I page Neurosurg, tube the guy, and then take a closer look at the guy. This requires some pretty aggresive blood clot debridement. The bleeding is not coming from the eyes, but from a few lacs around the orbits. And there is an exit wound over his right ear---well I'll be damned! This guy may have lucked out! And a CT shows he has--bullet ran right along his temple, never penetrating the cranium. In fact, the worst thing that happened to this guy tonight was some panicky ER doc put him down and intubated him. Well, the ICU doc can rememdy that in the morning. I check his ocular pressure to make sure I don't have to do a (shudder!) lateral canthotomy and eventually send him upstairs. Miraculous! When his brother shows up he tells me this guy has been shot twice before, and when the police show up they arrest the buddy who drove him in and explain that some recent paroles of gang members has led to a surge of violence in P-Town. Apparently black gang bangers trying to reclaim turf from the Mexicans who have moved in. Great. Fucking great. Glad I could help out. It just goes to show that what we say is really true: Nobody gets shot who doesn't deserve it. U-561