Deadly Rampage at Newtown Elementary School

12.17.12

Doctor Describes The Reality When a Child Is Shot

As politicians debate gun policy and gun-rights advocates trumpet antiseptic legal arguments, Christine Rizkalla, a pediatric ER doctor, remembers the first child she saw struck by gunfire.

The boy, I’ll call him Dylan, had run a few steps in front of his family as they strolled down a Bronx sidewalk one early evening in late November, a couple days before Thanksgiving. It was a few short blocks to Dylan’s grandmother’s house, but as Dylan reached the intersection, he walked directly into the crossfire of a gunfight. A bullet hit him square in the back. He was 5 years old.

I was working the evening shift in my last year of medical school when they wheeled Dylan into the pediatric emergency room. It was 11 years ago, but all the details of that night came flooding back to me last Friday when I heard about the school shooting in Newtown. I was on my way into work, and as I entered I heard the sounds of a normal day in the pediatric ER: A child declared, “I don’t want any needles!” Another child sat nearby, coloring wild streaks on a piece of paper while an IV dangled from his arm. A baby wailed while a doctor examined her ears. In the background, I could hear endless news updates about the massacre on the waiting-room TV.

In the aftermath of the Newtown massacre I’ve heard people arguing loudly about policy and politics, and it seems that what is missing from almost all of these debates is the central, horrific reality of what it looks like when a child is shot.  Outside of emergency rooms and ambulances, very few people have any idea what we’re actually talking about when we talk about a bullet ripping into a small body—even once, let alone 11 times.

So this is what it looks like:

Dylan was limp and unconscious, and his lips were colorless. His ski jacket had been thrown aside, and his T-shirt and jeans had been cut off. His chest was not rising. It was covered with a mix of fresh and dried blood, which obscured the small maroon hole the bullet had made as it tore into his soft back.

He had a breathing tube down his throat, and each time the doctors compressed his chest, blood bubbled into the tube. The monitor showed his heart was not beating. Everyone on shift came to his room to help: the nurses and doctors inserted IV tubes into his leg and arm and pressed down again and again on his delicate torso. Countless syringes were passed over his small frame, and it struck me that he had the body of any other healthy, strong child, except that he was completely motionless.

While the police and Dylan’s family gathered in the ER, doctors yelled orders back and forth for surgery, respiratory, fluids, epinephrine, a chest tube, more epinephrine, fresh blood … Every few moments the doctor doing the compressions would pause with a hand over his pulse, and everyone would look toward the monitor in the hope that his heartbeat would start up again. It didn’t.

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After about an hour of this, the doctors recognized they couldn’t bring Dylan back. One checked the clock and called the time of death. There was blood on the tubes, the wires, the walls, the doctors’ and nurses’ scrubs. Empty vials of epinephrine were strewn everywhere. At the center of it all was a still, small body. His father sobbed, and his mother screamed unintelligible words into her phone. I looked down and saw Dylan’s tiny sneakers on the floor, by the foot of the stretcher.

The doctors and nurses slowly filed out of the room in silence, their eyes red. Just as suddenly as Dylan had arrived, he was gone, and everyone returned to caring for the dozens of other children, some of whom had been waiting hours to be seen.

Countless syringes were passed over his small frame, and it struck me that he had the body of any other healthy, strong child, except that he was completely motionless.

I have watched many children die since that night, and I, like all medical providers, have mourned every one of them. But something about Dylan, shot simply because he was playing like all children do, has always stood out in my mind. He died a horrible, violent death—a death no one deserves, certainly not a 5-year-old boy with a gentle smile on his face and the energy of the world inside him.

For weeks afterward, I had dreams about faceless shooters firing guns at the people I care about most.

The conversation about guns in America is so often abstract or theoretical—what does the Second Amendment really mean? What if the teachers at Sandy Hook had been armed themselves? What does the latest study show about gun laws and gun violence? But for me, gun violence is about empty sneakers, colorless lips, and most of all, a strong young body lying dead still on a stretcher, covered in far too much blood.