Medical conference – looking for answers.

Day 78: 05/18/2013 Entry

Yesterday I went to a presentation by one of the surgeons at my hospital on management and assessment of GSW’s (gun shot wounds) to the head. When my manager sent out a mailbox telling us about it, and that we could go if we wanted to, work load permitting, I knew immediately when I read the topic that I had to go. It hit too close to home, and I have had a desperate need lately to learn as much as I can about the medical and scientific aspect of the night Brandon died; I desperately need to understand. My therapist says that I need to prepare for the possibility that the autopsy and police reports won’t offer any conclusions; that I may never know what happened. I understand that, and I don’t think there’s anything I can do to actually prepare for it, but I still need to understand as much as I can about that night, even if it’s just facts and science things.

It was hard to sit there, to listen to the surgeon talk about guns, about the science behind the force with which they penetrate a person, about the damage something so tiny does to the body, about the statistics surrounding GSWs. I kept picturing the events of that night, and I could barely breathe as I thought of that damn tiny piece of metal going through my Brandon’s neck, about all of the damage it caused, about the pain he must have felt. Was he afraid? Did he think of me? I teared up on more than one occasion, and wanted to crumple and bawl, but I forced myself to keep it together, because the last thing I needed was to break down in a room full of doctors, nurses, and life flight pilots. It would raise many questions, since the only thing people know is that my husband died, no one knows the circumstances except my manager.

Some statistics I learned: there are 50,000 violent deaths per year in the US. Of those, 6,000 are due to GSWs to the head/related injuries. Of those 6,000 deaths, 56% are suicides, 28% are homicides, 15% are undetermined intent, and only 0.7% are accidental. Cranial GSWs have greater than 90% fatality rate, and if I take an educational guess, I imagine a GSW to the neck is not too far off that number, either.

Damn it…what if Brandon killed himself? How will I live with that?

More statistics: of all civilian GSWs, 87% are young males, between the 3rd and 4th decade of life. Suicide victims: 86% are white.

There are two things I took away from this conference/forum. One, I learned that because of the type of injury it was, Brandon didn’t have a fighting chance of living through it. All this time, I kept thinking, what if I had acted faster, what if I had called 911 sooner, what if I just…did something? Could the outcome be different? Was I too slow in reacting? Did I not do the chest compressions the 911 operator instructed correctly? Was there SOMETHING that I could have done? These questions have been plaguing my mind. Yet now, I know that there was nothing that I could have done, nothing would have given a different outcome, unless I got home much earlier that night, but we won’t go there.

The second thing I learned was the way paramedics and surgeons evaluate these situations. They look at the level of consciousness of the victim and assign numerical scores. For example: 56-86% altered conscious level, is a GCS score of 3-5, 8-9% altered level of consciousness is a GCS score of 6-8, 6-12% altered level of consciousness is a GCS score of 9-12, and so on. The surgeon that was doing the presentation showed a flow chart that they use. It basically said that if the GCS score is around 3 and the pupils are fixed, there is no treatment that they do; there is nothing they CAN do. If the GCS score is greater than 3 and the pupils are reactive, that is when they go about getting a CT scan done, surgery, etc. While I was listening to this, all I could remember is how empty, unmoving, and lifeless Brandon’s half opened eyes looked while he was lying on the floor and I was doing chest compressions. He was just staring at nothing; there was no reactivity in his eyes to anything.

According to Wikipedia, GCS is as follows, “The Glasgow Coma Scale or GCS is a neurological scale that aims to give a reliable, objective way of recording the conscious state of a person for initial as well as subsequent assessment. A patient is assessed against the criteria of the scale, and the resulting points give a patient score between 3 (indicating deep unconsciousness) and either 14 (original scale) or 15 (the more widely used modified or revised scale). GCS was initially used to assess level of consciousness after head injury, and the scale is now used by first aid, EMS, nurses and doctors as being applicable to all acute medical and trauma patients.”

So, I now understand why the paramedics did nothing. All this time, I was furious with them for not doing anything. I was furious at them for not taking Brandon into the ambulance, for not taking him to a hospital, for not TRYING to do anything. I hated them; I blamed them, I was so angry at them for leaving the house with an empty stretcher.

Now, I understand. I finally understand.

Upon their initial examination, he showed absolutely no responsiveness, his pupils were fixed. In their eyes, he probably scored a GCS of 3 or less. That’s why they did nothing. There was absolutely nothing they COULD do…it was too late. It was just too damn late. And that breaks my heart…it was too late to do anything that could possibly save his life. It was too late.