What I Really Care About During A Trump Presidency

Originally posted on heelskicksscalpel.com

The internet is ablaze with images and commentary about our new president. They focus on a baby blue dress with an interesting collar or lack of chivalry or delusional views of a crowd or pithy signs about that which cannot be combed over, but let me tell you what I do and don’t care about when it comes to our new president.

I don’t care what his wife wears; but, I do care about how his trade policies will impact the price of everyone else’s clothes since most Americans cannot afford 4-figure price tag garments made in America.

I don’t care how he treats his wife or the two wives that preceded her; but, I do care about what he is doing to dismantle women’s healthcare and reproductive choice.

I don’t care what size of his crowds were compared to my crowds; but, I do care that  he has no qualms about every person in either of those crowds or in any other public space carrying a loaded weapon.

I don’t care how bad his spray tan is or how awkward his combover looks when the wind gusts; but, I do care that he is going to decimate our environment and exacerbate global warming.

I don’t care about his son’s personality or medical history; but, I do care that he is going to dismantle a public school system and higher education financing mechanism that educates the rest of our children.

I don’t care that he hasn’t released his tax returns; but, I do care that he intends to give the top 1% tax cuts while everyone else pays more and loses necessary services.

I don’t care that he is not as amazingly healthy as his hyperbolic doctor purported him to be; but, I do care that he is going to significantly reduce access to health care for millions of our most vulnerable citizens.

I don’t care that he was obsessed with promulgating the “alternative fact” that our 44th President was not born in the US; but, I do care about him oppressing those among us who were not born here especially if we do not bear a white European ethnicity or do not practice Christianity.

When our new president cares only about stroking his own ego and pandering to those who simply cannot tolerate a progressively diverse society and increasingly global economy, we must have a laser like focus on the values and policies we really care about.

Self-Inflicted

“Not again,” we all silently sigh when the page comes through. He arrives under lock and key and stays that way no matter what our plan.  Every trauma surgeon and nearly every resident has previously participated in his care over the years.

He has a life sentence.

The abdomen is socked in. There is no more retrieving the foreign bodies piercing his abdominal cavity. We have been there and done that. If something is visible on the outside we can pull it out. Now we just have to hope whatever was injured causes a process that walls itself off and does not cause too much physiologic compromise.

But what about the psychologic compromise? He does not wish to end his life; that much is clear. But he is looking for escape. The lure of the secondary gain is strong. He has admitted to us:

The food here is better.

The nurses are cute.

I don’t want to be near the pedophiles.

With our incarcerated patients, it is not our place to address these cries for help. We can’t imagine the fortitude it must take to clandestinely acquire a sharp object and then meticulously drive it through the abdomen wall into whatever organs lie beneath; but, we must stay focused on the anatomic issues and potential complications.

He is screaming at us now. The guards tell him to calm down. Now it is his words that pierce our ears:

You have to cut me open.

Please put me to sleep.

I am not a bad person.

As trauma surgeons we view all patients as equal. They all deserve the same compassion and high standard of care no matter what the circumstances of the injury, no matter what the personal status of the patient. We never, not ever, inquire as to the circumstances of the crime(s) for which the patient is serving his sentence or how long the sentence is. None of that matters. He is our patient and we provide him the best care possible.

Today the best care possible is to provide minor bedside care with local anesthetic to remove a foreign body. To calm him down I take his hand while the residents work. I lock his eyes so he will stop trying to see their sterile field. I ask him about himself. I am not sure why but it seemed like the natural thing to do.

He tells us where he grew up. He describes his childhood. He takes a sentence to describe his crime and then speaks more in detail about how the next 37 years of his life sentence led to today. He says:

I wasn’t always like this.

I used to be normal.

Now, this is the only way I know how to cope.

The self-inflicted stab wound will be fine. No hospital food needed. No bedside care from nurses needed. But before he goes back to his bunk with the pedophile, I tell him that we are sorry things turned out this way for him. We wish him luck trying to cope better but we fear he won’t be that lucky.

Unimaginable Grief: Reflections on the Newtown Film

Originally published on heelskicksscalpel.com

I grew up in a home with the subtle lingering sorrow of parents who have lost a child. An older brother I never got to meet.

I have dear friends who have lost their children. Mothers and fathers who will never be the same.

I am gripped with grief every time I enter a windowless family waiting room to tell a parent that their child is dead. I often wonder how they are doing now, months or years later. How do they move on the way my parents and my friends who have lost children have moved on?

This is the hardest thing I ever do in my job. I operate on beating hearts. I cross clamp aortas. I whip out spleens 20 minutes skin to skin. But this, this is the hardest thing I have to do as a trauma surgeon, telling parents their child is dead. 

Last night at a trauma surgery professional meeting we were privileged to watch the Newtown Film documentary with the filmmaker and an ER physician who provided care that day and is a Newtown resident. It was a gut wrenching story about the evolution of grief.  It followed the parents who lost their children in this particularly gruesome and entirely preventable way. The grace and dignity with which they tackled life after 12/14 was remarkable, inspiring, and heartbreaking. It followed the teachers, the students, and the first responders who saw and heard what was simply unimaginable in even our worst nightmares…until then. Until 12/14/12.

Carnage: 20 dead first graders. 6 dead educators.

We are having myriad civil discussions at this meeting on what we as a profession can do to reduce firearms injuries. To be sure it’s a careful line to walk in our current societal climate. Avid readers of this blog already know where I personally stand on this issue based on my experiences as a trauma surgeon and the fact that I am human.

But today, today I just can’t get my mind of those dead children. They were loved and cherished lives filled with infinite potential. A lone gunman whose mother thought it appropriate to have a semi-automatic weapon and multi-round bullets in her home took them all away.

They didn’t stand a chance. Not with that weapon. Not with that kind of ammo. All gunned down in <5mi.

How many of us wave good bye to our little tykes, back packs all snug on their shoulders, expecting them to return home at the end of the school day? My own child was a sitting in a first grade classroom not too far north of Newtown, CT on that day. Any of us could be these parents experiencing unimaginable grief.

I am once again listening to the words of Lin Manuel Miranda from Hamilton to try to buoy me through these emotions as a mother, as a surgeon, as a human with a soul.

In ‘It’s Quiet Uptown’ Eliza who has lost her son to gun violence sings:

There are moments that the words don’t reach.

There is suffering too terrible to name.

You hold your child as tight as you can

and push away the unimaginable.

The moments when you’re in so deep,

it feels easier to just swim down.

There are moments that the words don’t reach.

There is a grace too powerful to name.

We push away what we can never understand,

we push away the unimaginable.”

Her husband Alexander sings:

“If I could spare his life,

If I could trade his life for mine,

he’d be standing here right now

and you would smile, and that would be

enough.

I don’t pretend to know

the challenges we’re facing.

I know there’s no replacing what we’ve lost

and you need time”

The chorus repeatedly adds:

“They are trying to do the unimaginable.”

The Newtown Film chronicles a community trying to do the unimaginable. While I cried through most of the film watching the grief unfold, the most powerful moment for me was when David Wheeler who lost is son Ben was testifying to a CT legislative task force. He said “The liberty of any person to own a military-style assault weapon and a high-capacity magazine and keep them in their home is second to the right of my son to his life.” That line took my breath away like a sucker punch to my gut.

The Newtown Film is powerful and difficult to watch but I hope that all of us Americans- parents, teachers, first responders, policy makers, legislators, and professional organizations – all of us  see it.  With this film, I hope that the national dialogue will become less contentious as we realize that no one, no parent, no school, no community, should ever have to suffer such imaginable grief.