The other day I had a patient come in who had basically all but shot off his "little man". For some strange reason known only to himself, mr.big man was carrying a loaded weapon in his belt, in close proximity to his little man. He was obviously either very new to carrying said loaded weapon (he was young), or he was just having a bad day, because somehow he fired the weapon while it was still in his belt.

Anyway, when we heard the news (more like the yell) that there was a GSW coming in our ambulance bay, we were all like "WTF?" See, while we're quite a busy ER, we're not a trauma center. Sure, we can handle traumas if it comes down to it, but there's trauma center quite close to us. Well, all was explained when we realized that he had not been brought in by ambulance, but rather was driven in by one of his friends (who quickly did a Houdini as soon as he heard the ER doc say "Call the cops").

Everything moved in rapid fire fashion after that, except for the pregnant pause when we all realized where the bleeding was coming from. As the newbie, I think I was the most shocked, but over and above that, I felt pretty useless, and very very sorry for mr.big man. In record time, mr.big man had two IVs inserted, fluids running in wide open, as well as a bag of antibiotics. We cut his clothes off so the doc could inspect the damage and see if anything else was injured. The bullet had managed to make it's away through his little man, ripping it open and then exiting through his foot. So we had a nice gaping hole in his foot to content with, in addition to the mangled flesh where no mangled flesh should be. The only thing we could do was irrigate, hang fluids, get EKGs, get antibiotics on board, and get him ready for transportation to the trauma center, all the while doing our best to stop him from bleeding out from both sites.

For the entire time, I stood there holding pressure to mr.big man's little man, which was oozing blood faster than I could switch out sterile pads of gauze. We had managed to dress his foot so that it wasn't bleeding too profusely, but how do you bandage and secure a mangled little man? We tried strapping it to the thigh but it just wasn't working, so manual pressure it was.

As he kept asking me "am I going to be okay?", all I could tell him was "you need to breathe; relax and take deep breaths." I didn't know what I could possibly say to this young man who had obviously just ruined a major part of his future, almost irreparably, except to tell him "take deep breaths, we're working on getting you stable to get you to the trauma center."

I felt extremely incapable in that moment, but i my mind that faded exponentially in comparison to what he must have been experiencing.

People do stupid stuff every day, and sometimes it's stupid and tragic, I guess some part of my job is going to be about dealing with the consequences of this truth.