That Patient, That Feeling, You Just Can’t Shake

Dark is an emergency medicine physician.

“The most impactful story I can tell you,” Brian H. Williams, MD, said to me, “is from July 7, 2016, which is the Dallas police shooting.”

The day prior, a Minnesota police officer killed Philando Castile at a traffic stop. I remember the news about Castile, a young, vibrant Black man just 4 years my junior. He had the legal right to carry a firearm but was gunned down by a cop while his girlfriend sat in the passenger seat and his 4-year-old daughter lay buckled in the back. His death struck me closer than any other police shooting ever had. I, too, had a young child. I, too, was a Black man who legally owned a gun. I, too, could have been Philando Castile.

The following night took a sick, hate-filled twist in Dallas, Texas. A gunman initiated a murderous rampage targeting white police officers. A former army reservist, the assailant had a long-standing violent history. Like many others who have perpetrated mass violence, he had a protective order filed against him by another soldier alleging sexual harassment. But because he left the Army with an honorable discharge, nothing barred him from owning or purchasing the firearms that killed five law enforcement officers. Nine other officers and two civilians were also wounded.

Williams, the trauma surgeon on duty at Parkland Hospital that night, described it to me as the worst of his professional career: “Even for someone like me who’s cared for hundreds of gunshot victims, it was the intersection of a lot of social issues that were important to me.” Since the incident, he has thought more about the police use of force against Black men and women — going all the way back to Rodney King — as opposed to interpersonal gun violence in the Black community.

“Over the last decade I think the public is seeing how those two issues intersect,” he continued. “There is a piece of me that goes with every single gunshot death … but that July 7 night … That is a seminal event for me. Because it was gun violence. Because there was race involved. Because there were police involved. And because of the time when it happened, as far as what was happening in the country. The large discourse about racism and use of force and where our society was going.”

After another long pause to conjure the memory of that fateful night, Williams recalled the moment when seven police officers, some mortally wounded, would roll into the trauma bay at Parkland Memorial Hospital.

“It was a night I was not initially scheduled to work, but I agreed to take my partner’s shift. Of the 12 trauma surgeons, I was the only Black surgeon in the group. And I am quite certain if I were not there, the discussion we are having now would not be happening … I saw the intersecting social issues through a lens that none of my partners could appreciate.”

That context — a Black trauma surgeon called to care for police officers who had just been ambushed by another Black man intent on exacting revenge for the death of Philando Castile at the hands of their brothers in blue — would not be felt in the immediacy of the event.

When the doors to the emergency department first flung open, Williams went to work, falling back on years of training and preparation to deal with the onslaught of one trauma patient after the next. “When there is a time of crisis, a medical crisis, you don’t think about all of these things,” Williams explained. “You’re trained [to] go on autopilot. You fall back on [that] training. When the officers came in, you know, I’m doing the ABCs of trauma.”

Williams was referring to the pattern taught in Advanced Trauma Life Support (ATLS) to surgeons, emergency physicians, and others that help standardize the approach to patients who have been shot, stabbed, hit over the head, or injured in a car wreck.

The ABCs of trauma are simple: Is the patient’s airway intact? Is the patient breathing? Is the circulation pumping around the patient’s body adequately — or has the patient lost too much blood? Then begins the search for injuries — holes from bullets, cuts from knives, deformities from broken bones. But, when seven people roll through the doors in rapid succession, it can become overwhelming.

Physicians must reprioritize their thought processes. Mass casualty situations tax minds and bodies beyond capacity. Resources shift from seemingly unlimited to finite. Physicians make split-second decisions to optimally move from one person to the next, doing the best for the most people, while minimizing negative consequences.

With seven cops in front of you, how do you decide who to see first? Who becomes the last?

The gruesome reality is this: some people on whom we might normally expend excessive effort and energy to save are more quickly recognized as unsalvageable. Curt decisions permit focus on those with a stronger chance of survival. A patient who can breathe on their own and who can hold their own bandages in place must wait until others — those who need a lifesaving emergency bedside procedure or are in need of immediate surgery — can be stabilized.

Of the seven that came to Parkland that night, three died. After Williams learned the circumstances of the ambush, he thought to himself: “What is going on in this country?” His moment to reflect was ephemeral; the emergency department at Parkland quickly became militarized.

Hospital security personnel roamed with assault weapons and body armor. Dallas police officers flooded the department. The mayor arrived, the chief of police came, and several local politicians showed up.

Williams pushed the chaos into the background as he went from patient to patient, prioritizing those requiring the greatest surgical needs. The job was simple: focus on patient care. While caring for the police officers, “we’re also caring for other patients that continue to come in. Because we didn’t stop our emergency department operations.”

Every so often, a patient encounter burns its way into your memory. Unforgettable experiences that live within us, moments that serve as lessons of what we may have done wrong, what we could have done differently, and sometimes — even more unsettling — what we were powerless to control. In the distance, ambulance sirens wailed, announcing the arrival of another patient.

Williams, resting a hand on a clean-shaven head, waited for my next question about that night.

I ask him if he’s been able to shake off the feeling.

“I don’t know if I want to shake it … if I ever [want to] lose that ability to feel pain and sorrow when one of my patients dies. For me, if I’m going to go that way, a bit of humanity, the part of me that makes me human, and also what makes me a good doctor, that’s gone … I don’t ever want to lose that feeling.”

Cedric Dark, MD, MPH, is an emergency medicine physician, and an associate professor in the Henry J. N. Taub Department of Emergency Medicine at Baylor College of Medicine in Houston. He is the author of the forthcoming book, Under The Gun: An ER Doctor’s Cure for America’s Gun Epidemic. This essay was based off Dark’s interviews with Brian H. Williams for this book.

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