The Doctors | Criminal Podcast | Forensic Files

this episode contains descriptions of violence and may not be suitable for everyone please use discretion
am I going to die and what do you say I tell them no [Music] of us expect to be injured none of us
expect to be in a car crash certainly none of us expect to be shot foreign 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 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 when will you take me through the whole
process yeah so most um you know 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 he may get variable amounts of information about where the gunshot wound is and how the how the patient
looks whether or not they're in shock or or whether or not they're vital signs are normal so you may get some of that
information and most emergency rooms will have an alert system they'll go out to the trauma team at the
hospital and so at our place that'll alert the emergency medicine physicians it'll work the trauma team it'll alert
the operating room to to be ready it'll work the blood bank to get ready and so there's a whole broadcast of uh
of a gunshot wound coming in that sort of sets the whole Hospital in motion it gets everybody prepared to be to be
ready to deal with anything once it hits the door and what happens when the patient gets
to the door um that 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 we're kind of simple we use this
mnemonic called the ABCs and so A is for Airway is the 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 see a 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 emergency room is there any special look that a gunshot victim has when they come in you know you can you
know after you've done it a while it there's a you can sometimes just tell like there's a certain book
you know um 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 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
there's sometimes you can get a get a feel about how sick somebody is just by 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 um not often um 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 then 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 know the worst thing anybody can say you
know you're taking the or just just to look at you and say you know don't let me die and um you know and obviously
people talking about wanting to live and see their family again those are the kind of things that um you know they
it's it's human nature for people but you know the last thing any of us want to hear us is have a patient look at
this and say oh please don't let me die [Music] my name is Amy Goldberg I am chair of
the department of surgery at the Lewis cat 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 them 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 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 foreign 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 uh we we've seen multiple fire injury victims at the same time but to have
children patients and to also have the situation where families are searching for 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
they were they're dead we had done a region-wide preparation drill six months earlier for how to
how to address it as a as a system by a system I mean the way the way ambulances
the way EMS the way the Trauma Centers work together the way the the teams of people across the region work together
that that's our job as professionals we know that uh we have to be prepared because even though it's a 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 that it's going to happen somewhere and so so it's it's our it's our work our
professional obligation to be prepared you know I you have been doing this for a long time
you are used to life and death I don't know if you 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 a high toll of violence
is it different when you go home at night do you feel a different way it is 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 that when 50 people when 50 people are in church and 46 of them are shot
and they come to your your hospital it's it's it is it is different and it does have a different
impact it does just 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 one of the things that that I
didn't I didn't fully understand at the time is that the surgeons is a group generally all of them said the same
thing that we take it personally that's what the Las Vegas surgeon said is that we take this personally
and and I will say after Sutherland Springs uh it's from the mass shooting point of view I totally understand
it's I do take it personally [Music] that makes any sense at all [Music] foreign
[Music] 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 isn't 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 a
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 figoni talked with her about what
happened in 2012 at Sandy Hook Elementary School when 20 children and six 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 um wrap my 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 uh what they show are our pictures off of Facebook well that's not reality that's that's 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 um and see an article about a victim that you've treated
uh yeah sometimes the next morning after I've been on call there'll be something
uh um 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 uh yes we have here uh 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 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 you've gotten tougher
over the years uh no actually I think uh I think it's been harder and harder for me to
continue to deal with this um after all these years I don't think it's gotten any easier whatsoever and and I 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 [Music] 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 whales and the screaming and the overwhelming
sadness that follows I think it's the 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 is now not here because they've
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 right I try not to use euphemisms and you know saying he passed or they're
gone or I think you just say 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 know and then you just gotta try and do
what you can to to support them I I try whenever I do it to take our chaplain and social worker with us and
try to provide some support but it's 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
um 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 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
you that it's okay uh do you feel that way no maybe when the time comes sure for some
people right you know um you know I look at my 87 year old father who's you know having some health
problems and slowing down and and day-to-day life is not as as um enjoyable for him as it once was
and when he's coming to peace with it that his end is coming and you know and he's he's he's at peace with it
um you know that's and I think that's fine right but you know if you're 30 or 40
years old no like no there's there's no good there's no good answer and 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 know you just never know when when some something like that's going to happen you're going to have a major
change in your life so I I have a I do think I have a different attitude in general about you know getting along and
disagreeing and you know um 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 uh doctors say don't have a lot of salt and exercise because that's what's good
for their 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 [Music] Dr zimi Goldberg David Spain [Music] criminalists produced by Lauren Spore
Nadia Wilson and me audio mix by Rob Byers and we're saying goodbye to our intern Matilda fellino we've loved
working with her and we're excited to see what she does next Julian Alexander makes original
illustrations for each episode of Criminal you can see them at thisiscriminal.com where on Facebook and
Twitter at criminal show Criminal is recorded in the studios of North Carolina public radio
wunc we're a proud member of radiotopia from PRX a collection of the best podcasts around
I'm Phoebe judge this is Criminal oh [Music] from PRX

Three of America’s most experienced trauma surgeons speak with us about what happens when someone is shot. This is an unfiltered look at the damage that gunshot wounds inflict upon the body.

Special thanks to Dr. Amy Goldberg, Dr. David Spain, and Dr. Ronald Stewart.

Music in the episode “Brushed Bells Leaving Home” by Daniel Birch “Slow Dial” by Blue Dot Sessions “Come As You Were” by Blue Dot Sessions “Memory Wind” by Podington Bear “Turquoise ” by Podington Bear

Criminal is a show about people who’ve done wrong, been wronged, or gotten caught somewhere in the middle. Hosted by Phoebe Judge. Part of the Vox Media Podcast Network.

Follow the show on Apple Podcasts, Spotify, or wherever you get your podcasts. https://link.chtbl.com/n33u0HsA

Say hello on Twitter (@CriminalShow), Instagram (@criminal_podcast), and Facebook https://www.facebook.com/ThisIsCriminal/.

Sign up for our occasional newsletter, The Accomplice https://bit.ly/accomplicenewsletter.

We also make This is Love and Phoebe Reads a Mystery.

Artwork by Julienne Alexander http://www.yssrs.com/.

Check out our online shop https://store.dftba.com/collections/criminal.

Episode transcripts are posted on our website https://thisiscriminal.com/.

Episode 98 originally published 9/7/2018 https://thisiscriminal.com/episode-98-the-doctors-9-7-2018

Brief Summary

Three trauma surgeons discuss the impact of gun violence on patients and healthcare providers.

Key points

A Patient's Plea. In the emergency room, a patient’s desperate words resonate deeply with trauma surgeons.
The Weight of Words. Surgeons face the emotional burden of telling families their loved ones have died.
Life's Fragility. Surgeons reflect on how quickly life can change, urging a focus on what matters.
Gun Violence as a Public Health Issue. Doctors advocate for recognizing gun violence as a preventable public health crisis.

Episode highlights

Episode quotes

Don't let me die.

A patient's desperate plea in the emergency room.

5:01WatchJan 16, 2023

Tension

70/ 100High tension

More from Criminal | A Podcast About Crime

Solve the Crime

Read a real case one clue at a time, then see how your call held up against the investigators.