Criminal - The Doctors

Episode Date: May 27, 2022

In 2018, we talked with three of America’s most experienced trauma surgeons about what happens when someone is shot. We wanted to spend some time with that conversation again this week. Special thanks to Dr. Amy Goldberg, Dr. David Spain, and Dr. Ronald Stewart. Say hello on Twitter, Facebook and Instagram. Sign up for our occasional newsletter, The Accomplice. Follow the show and review us on Apple Podcasts: iTunes.com/CriminalShow. We also make This is Love and Phoebe Reads a Mystery. Artwork by Julienne Alexander. Check out our online shop.  Episode transcripts are posted on our website. Learn more about your ad choices. Visit podcastchoices.com/adchoices

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worth your attention, and they call these series essentials. This month, they recommend Wondery's Ghost Story, a seven-part series that follows journalist Tristan Redman as he tries to get to the bottom of a ghostly presence in his childhood home. His investigation takes him on a journey

involving homicide detectives, ghost hunters, and even psychic mediums, and leads him to a dark secret about his own family. Check out Ghost Story, a series essential pick, completely ad-free on Apple Podcasts. This is an episode from 2018.

We wanted to spend some time with it again, this week. This episode contains descriptions of violence and may not be suitable for everyone. Please use discretion. Well, they ask you, am I going to die? And what do you say? I tell them no. None of us expect to be injured. None of us expect to be in a car crash.

Certainly none of us expect to be shot. None of us expect to be in a car crash. Certainly none of us expect to be shot. None of us expect those things to happen, but I know they do. We had four young men, all the victims of gun violence, who passed away in one evening. And, you know, four times that evening I had to walk out and tell the families that they had lost their 20-year-old son to violence. And, you know, I had a young resident with me, probably 30, 32 years old. And by the, you know, the third or fourth time that night, I just couldn't make him go out that last time with me to talk to those families.

Here are three of the country's most experienced trauma surgeons who sat down with us to speak frankly about what happens when someone is shot. I'm Phoebe Judge. This is Criminal. What happens when you hear that someone's coming in with a gunshot wound? Will you take me through the whole process? Yeah, so most places have the whole chain sort of set up, right? So there's usually a phone call that comes in.

EMS picks a patient up. They'll call in a report to the emergency room that they're coming in with a gunshot wound victim. Dr. David Spain is the chief of trauma at Stanford. You may get variable amounts of information about where the gunshot wound is and how the patient looks, whether or not they're in shock or whether or not their

vital signs are normal. So you may get some of that information. And most emergency rooms will have an alert system that'll go out to the trauma team at the hospital. And so at our place, that'll alert the emergency medicine physicians. It'll alert the trauma team. It'll alert the operating room to be ready. It'll alert the blood bank to get ready. And so there's a whole broadcast of a gunshot wound coming in that sort of sets the whole hospital in motion and gets everybody prepared to be ready to deal with anything once it hits the door. And what happens when the patient gets to the door? At first, we called it the golden hour, right? So that's your opportunity to sort of find the injuries and address the life-threatening injuries. We're kind of simple. We use this

mnemonic called the ABCs. And so A is for airway. Is there airway patent and can they breathe on their own? And if not, then we need to help them. And then B is breathing. And so can they get oxygen in, get carbon dioxide out? And then C is circulation. So are they in shock? Are they bleeding? How do we get them to be stable with their vital signs?

And so that's the big area of focus in the first 10, 15, 20 minutes when the patient's in the emergency room. Is there any special look that a gunshot victim has when they come in? You know, you can, after you've done it a while, you can sometimes just tell. There's a certain look. The way our emergency room is set up, the first thing i see when i walk in a room is the soles of their feet and so if the soles of their feet are pink i kind of like i'm okay for a little bit and if i walk in and the soles of their feet are white and pale then i know we're in trouble but there is a certain look sometimes that people will get that you know if they're in shock and they're usually not calm and there's a little bit of panic look in there. So sometimes you can get a feel about how sick somebody is just by eyeballing

them. So anytime you see a gunshot victim, do you think a crime has occurred? Well, usually, right? Sometimes there's accidents. Not often. There's usually some intentionality to it, I'll say, right? That's kind of the word we use. So either somebody intentionally shot this person or they intentionally shot themselves. Once in a while, there's pure accidents, but most of the time there's some intentionality to it. When someone comes in who's been shot in their abdomen or arm or they're awake and conscious, what are they saying if they're saying anything to you? You know, the worst thing anybody can say, you know, when you're taking them to OR is just to look at you and say, you know, don't let me die. And, you know, and obviously people talking about wanting to live and see their family again, those are the kind of things that, you know, don't let me die. And, you know, and obviously people talking about wanting to live and see their family again, those are the kind of things that, you know, it's human nature for people. But, you know, the last thing any of us want to hear is have a patient look at us and say, you know, please don't let me die. My name is Amy Goldberg. I am chair of the Department of Surgery

at the Lewis Katz School of Medicine at Temple University in Philadelphia, Pennsylvania, and I'm a trauma surgeon. How long have you been a trauma surgeon? I've been a trauma surgeon for 25 years. I was speaking with Dr. Spain in California, and we were talking about when he's taking people into surgery, and the worst thing that he said he can hear is when a patient says, just don't let me die.

Well, they ask you, am I going to die? And what do you say? I tell them no. I tell them no, we're going to do everything, you know, we're going to take good care of you. No. And what do people say to you when they wake up after surgery? Sometimes nothing at all, which is perfectly fine. You know, I, um,

there is no doubt that so many of the patients are incredibly, incredibly appreciative. Incredibly appreciative. And say thank you. It's really, it's really incredible. Gives me a moment of pause every single time it happens.

How much do you want to know about someone when they come in with a gunshot wound? Nothing's important other than how we evaluate that patient in our trauma bays and what our next steps are. That's the only thing that's important when that patient arrives. I guess death is not an abstract concept to me. Ronald Stewart is chair of the Department of Surgery at UT Health San Antonio. He acted as the triage physician during the Sutherland Springs church shooting in November of 2017, where 26 people were killed and 20 more were injured.

I've treated hundreds and hundreds, probably thousands, but definitely hundreds and hundreds of firearm injuries. And we've seen multiple firearm injury victims at the same time, but to have children, patients, and to also have the situation where families are searching for victims who are not in your trauma center, and then to realize that the reason why they're not there is because they're dead. We had done a region-wide preparation drill six months earlier for how to address it as a system. By a system, I mean the way ambulances, the way EMS, the way the trauma centers work together,

the way the teams of people across the region work together. That's our job. As professionals, we know that we have to be prepared because even though it's a very, very low probability event, that is true, it's very low probability. However, we know that based on the current situation, that it's extremely high probability that it's going to happen somewhere. And so it's our work, our professional obligation to be prepared. You know, you have been doing this for a long time. You are used to life and death. I don't know if used to is the right word, but you see it an awful lot more than most

people. But I wonder on a day like that where you see such a high toll of violence, is it different when you go home at night? Do you feel a different way? It is different, yeah. Yeah, it is different. I mean, objectively, you would think it's not different. Objectively, you would think it would be the same. It's not. Then when 50 people are in church and 46 of them are shot

and they come to your hospital, it is different. And it does have a different impact. It does. Just literally a few weeks before, we were working with my colleagues in Las Vegas of talking about lessons learned at the American College of Surgeons. And one of the things that I didn't fully understand at the time is that the surgeons as a group, generally all of them said the same thing, that we take it personally. That's what the Las Vegas surgeons said, is that we take this personally. And I will say after Sutherland Springs, it's from the mass shooting point of view, I totally understand.

I do take it personally. I don't know if that makes any sense at all. Support for Criminal comes from Apple Podcasts. Each month, Apple Podcasts highlights one series worth your attention, and they call these series essentials. This month, they recommend Wondery's Ghost Story, a seven-part series that follows journalist Tristan Redman as he tries to get to the bottom of a ghostly presence in his childhood home. His investigation takes him on a journey involving homicide detectives,

ghost hunters, and even psychic mediums, and leads him to a dark secret about his own family. Check out Ghost Story, a series essential pick, completely ad-free on Apple Podcasts. Hey, it's Scott Galloway, and on our podcast, Pivot, we are bringing you a special series about the basics of artificial intelligence. We're answering all your questions.

What should you use it for? What tools are right for you? And what privacy issues should you ultimately watch out for? And to help us out, we are joined by Kylie Robeson, the senior AI reporter for The Verge, to give you a primer on how to integrate AI into your life. So, tune into AI Basics, How and When to Use AI, a special series from Pivot sponsored by AWS, wherever you get your podcasts. What have you seen change in the gunshot wounds that you've seen over the last 25 years? I see patients arriving with larger caliber bullet injuries, and I see patients coming in with many more gunshot wounds. So this is someone who before it was rare to see

someone with two or three bullets in them now. Yes, and previously we would see.22 caliber gunshot wounds, which is a very small caliber bullet. Maybe the patient was shot once or twice. And now we could be, you know, seeing high energy AK-47 wounds and patients are shot a multitude of times. In the spring of 2017, the Huffington Post published an in-depth profile of Dr. Goldberg's work.

The reporter, Jason Fagoni, talked with her about what happened in 2012 at Sandy Hook Elementary School when 20 children and 6 adults were shot to death. In that piece, Dr. Goldberg said that if the public had been shown the autopsy photos of the children, the gun debate would have been transformed. I asked her about it.

I had hoped that some good would come from that terrible tragedy at Sandy Hook and that the country would be moved from the death of so many young, innocent students. And I was quite disappointed to see that nothing changed. And I think the only way that I could wrap my mind around it was that people needed to see it. They needed to see the injuries. They needed to see, and I'm not being disrespectful at all to those children, but they needed to see what young children look like riddled with bullets

that they couldn't even transport them to the hospital to be saved. I mean, that's the thing, is that none of us ever see it, but you do. Right, I mean, what they show are pictures off of Facebook. Well, that's not reality. That's not what we're seeing in our trauma base. What is it like reading the news, or does this happen often that you read the news and see an article about a victim that you've treated?

Yeah, sometimes the next morning after I've been on call, there'll be something in the newspaper or on the news on television or on the website. I think sometimes what distresses me more is when patients are shot and die and we see nothing in the paper and hear nothing on the news. Have you prepared for a mass shooting? Yes, we have here at Temple. Is that something that preparation and training that has come about in the last few

years or has? Well, I guess it was back in 2015 when the Amtrak train crashed here in Philadelphia. So many of the patients actually came here to Temple. So we unfortunately had an experience of mass casualties. The difference between a train accident and a mass shooting would be that many more patients would need to go to the operating room, and it would really change the resources that the hospital would need to provide. Do you think that you've gotten tougher over the years? No, actually, I think it's been harder and harder for me to continue to deal with this after all these years. I don't think it's gotten any easier whatsoever, and I surely know that I have not gotten hardened to it.

In fact, I think I've gotten much more sensitive to it. Why do you think that is? Because I think there's only a certain number of patients, fathers and mothers and grandmothers and brothers and sisters and kids that you can say, I'm sorry, your loved one has died, and then brace yourself and wait for the wails and the screaming and the overwhelming sadness that follows. I think it's the worst job in the world

to explain to a mom or a family how a child or a loved one who was normal at breakfast is now not here because they've died from an injury. That's the worst. There's just no good phrase or term to use. But I do think you have to be definitive. I try not to use euphemisms and, you know, saying he passed or they're gone. Or I think you just, you have to be direct and just tell them specifically that their loved one has died. And it's hard, but they need to hear those words very clearly from you. And then you just got to try and do what you can to support them. I try whenever I do it to take our chaplain and social worker with us and try to provide some support, but it's never enough.

I told one of the residents the other night that it won't be the long hours and hard work that finally do me in. It will be the emotional strain of telling just one more family member that their loved one has died. I think that we want to believe that people who are often so close to death as you are, as funeral directors are, somehow have this great wisdom or insight that we shouldn't be afraid to die, that it's okay.

Do you feel that way? No. I mean, when the time comes, sure. For some people, right. You know, I look at my 87-year-old father who's having some health problems and slowing down. And day-to-day life is not as enjoyable for him as it once was. And he's coming to peace with it, that his end is coming. And he's at to peace with it, that his end is coming. And he's at peace with it. And I think that's fine, right?

But if you're 30 or 40 years old, no. Like, no, there's no good answer. And I've just seen it happen so many times that people think their life is okay. And then in the blink of an eye, everything changes. So I just don't fight with my wife. I don't fight with too many people, actually. It's just life's too short, and you just never know when something like that's going to happen.

You're going to have a major change in your life. So I do think I have a different attitude in general about getting along and disagreeing based on what I see at work. You know, we wanted to speak with you and Dr. Spain and Dr. Stewart because to us, it seems surprising to hear doctors speak publicly about guns? Well, doctors say don't have a lot of salt and exercise because that's what's good for patients' hearts. You know, stop smoking. It's not good for lung disease or lung cancer.

So it would only be natural for doctors to say that this is a public health problem and it's preventable. © BF-WATCH TV 2021 Our technical director is Rob Byers, engineering by Russ Henry. Julian Alexander makes original illustrations for each episode of Criminal. You can see them at thisiscriminal.com. We're on Facebook and Twitter at Criminal Show, and Instagram at criminal underscore podcast. Criminal is recorded at North Carolina Public Radio WUNC. We're part of the Vox Media Podcast Network.

Discover more great shows at podcast.voxmedia.com. I'm Phoebe Judge. This is Criminal. The number one selling product of its kind with over 20 years of research and innovation. Botox Cosmetic, Adabotulinum Toxin A, is a prescription medicine used to temporarily make moderate to severe frown lines, crow's feet, and forehead lines look better in adults. Effects of Botox Cosmetic may spread hours to weeks after injection causing serious symptoms. Alert your doctor right away as difficulty swallowing, speaking, breathing, eye problems, or muscle weakness may be a sign of a life-threatening condition. We'll be right back. Allergic reactions can include rash, welts, asthma symptoms, and dizziness. Tell your doctor about medical history, muscle or nerve conditions, including ALS or Lou Gehrig's disease, myasthenia gravis, or Lambert-Eaton syndrome in medications, including botulinum toxins, as these may increase the risk of serious side effects. For full safety information, visit BotoxCosmetic.com or call 877-351-0300.

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