Assault rifle toll familiar to ER surgeons

Thursday night in South Florida, a rapper named French Montana was shooting a video at a popular Miami soul food restaurant called The Licking. Dr. Arthur Berg was not far away, at his health club, exercising.

Outside the restaurant, a dispute among two groups in the crowd. Someone squeezed a trigger; 10 people were hit. A few minutes later, while Berg was sprinting on the treadmill, his phone rang.

It was about 8:30 p.m. Berg, who grew up in Oak Brook, had already worked a full day, starting 10 a.m., ending 7:30 p.m., removing two gallbladders and performing an appendectomy. But he left the gym and hurried to his central Miami hospital — he asked me not to specify which — answering the all-hands-on-deck signal they call a “mass casualty event.”

“Unfortunately, it’s not a very uncommon thing around here,” said Berg, doing his fellowship in trauma and surgical critical care. “I don’t know what it’s like in Chicago. But down here in Miami, the gun restrictions are a lot looser, and we see our fair share of pretty horrendous injuries. We’re talking about massive soft tissue injuries. We’re talking about shattered bones. We’re talking about mangled extremities.”

While legislators argue over defining “assault rifle” — a ban on such weapons passed the Illinois House on Friday and this week goes to the state Senate, where it is expected to pass — Berg has no trouble parsing the distinction. He knows right away what kind of gun made the wounds he’s struggling to treat.

“From a handgun you see a small aperture, in-and-out,” he said. “When you get shot with something like an assault rifle, these high-caliber rifles cause these really destructive injuries.”

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He had a surgeon’s tendency to refer to his patient by their problem, such as his last patient Thursday night when he arrived at the hospital.

“I ended up with a mangled upper extremity,” said Berg. He traced the bullet’s path. “It traversed his left elbow, left inner arm, armpit, went into his chest and came out his nipple.

Just one bullet?

“Hard to say,” Berg said. “It looked like the path of one bullet.”

However many bullets, the man was left with three big holes in him — though Berg didn’t use that term. “We say ‘aperture,’” he explained. “We don’t talk entry and exit. We don’t know. We’re not forensic doctors. “

He did measure the holes. The largest was 4-by-5-inches.

A hole the size of a large coaster.

“His whole bicep was torn off his arm,” said Berg. “His humerus — the bone in his arm — was shattered to the point I was picking bone shards in the soft tissue.”

Will the man lose his arm?

“It’s still too soon to tell,” said Berg. “If there’s unrepairable vascular injury, or if it’s essentially so much soft tissue damage that there is functional loss of the arm, he may lose it. You sew what you can.”

Provided

Berg was one of dozens of Miami medical personnel called in Thursday night. This is what they train for, why residents put in 24-hour shifts, practicing being pulled into complicated surgeries late at night.

“Preparation is everything,” said Berg. “The team is everything. It’s all about corralling the right people. You need nurses. You need techs. Even secretaries can be just as important as physicians. Someone rolls in, they need to register.”

He isn’t kidding. Even as doctors raced to stem the bleeding, Berg’s patient was given a bracelet identifying him as “Unknown” and then a word plucked from the Alfa-Bravo-Charlie NATO phonetic alphabet.

“In most places, you’re an Unknown, John Doe, you’re assigned some nomenclature just to get registered in the system,” said Berg. “In order so blood can be given. If you don’t, the system locks you out.”

Properly registered, the patient was issued an intubation tube, a chest tube to drain blood out of his lungs, a central line. He already had a tourniquet from the ambulance, but it was loose. So Berg gave the stick about 10 twists.

“You keep going until the bleeding stops,” he explained. This is what drew him to this specialty in medicine.

“I always loved it,” said Berg, 33. While attending Loyola University in Chicago, he worked as an EMT. “The s--- I saw in Chicago always stuck with me and bothered me. I chose to go into trauma.”

Though moments like Thursday are more than he bargained for.

“It was very intense,” he said — but not unprecedented. The ER, Berg added, routinely becomes “like a war zone.”

Thanks to skilled medical personnel like Berg, none of the 10 patients shot Thursday in Miami died, which is why the incident barely made the national news, eclipsed the next day by a 6-year-old who brought a gun to school in Virginia and shot his teacher.

I pointed out the vast amount of research and knowledge that gets put into treating bullet wounds versus the random, shambolic efforts to prevent gun violence.

“There’s very little funding that goes into gun violence prevention research,” he agreed. “In the ‘90s, there were so many motor vehicle accidents, they did a lot of research to prevent motor vehicle fatalities. They don’t do any of that for gun violence. There needs to be more funding for research. We don’t even know what laws work and what laws don’t work. States are all over the place. People don’t study it because there’s no funding for it.”

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