First Place 2022

It was only one bullet

Mark Chilutti, Ast VP Development, Magee Rehab

For almost three years, I used to park my car every morning and walk around the corner to my jewelry store looking forward to a day of helping people with meaningful purchases, andproviding the best customer service that I could. It was a daily routine, done six days a week, and one that I had worked towards for a long time. I never imagined that when I walked around the corner to my store on December 5, 1996,that it would be the last day that I would ever walk again. With the holiday season in full swing, it was a busy morning, and I finally got to take a quick break around 11:30. I sat down to rest and quickly finished my breakfast. A few minutes later the door opened and a man walked in. I greeted him as I would every other customer, saying, “hi, how are you?” He didn’t answer. The man behind him quickly pulled a gun and pointed it right at me. Having spent 9 years in the retail jewelry business (the first six years working for others), and being an Eagle Scout, I was always taught to be prepared, and take the best precautions that I could, knowing something like this could happen one day. I quickly threw my arms in the air while saying “please, take whatever you want. Just don’t hurt me.” As scared as I was, I knew that everything in that store could be replaced; everything except for me. I was hoping that my willingness to cooperate would work. It did for a few minutes. The guy with the gun took me to the back of the store, keeping his gun pointed at me, while he took jewelry and cash out of the safe. He also started taking the jewelry that I was wearing, while he gave orders to the guy who came into the store with him. “Tape him up. Tie him up. Break the cases and take the jewelry,” he yelled. Surprisingly, each of these commands was met with “I’m not going to do that.” These answers seemed to anger him, and, at that point, he turned around and shot me. For the next several minutes I laid on the ground, while I heard him go to the front of the store and break a few cases, take some jewelry, and eventually leave. I was bleeding, but was awake, alive, and conscious. I tried to get up, and I couldn’t. It was at that point that I knew something was wrong with my body. Rather than lay still, I managed to pull myself into the next room, and pulled a panic button to alert the police that I was in trouble. I stayed there, yelling for help, while the waiting began. It seemed like forever, but, in reality, it was only about a minute or two until I heard a familiar voice. It was Charlie, the bike cop, who routinely patrolled the avenue.

Mark, are you okay,” he asked. “No. I got shot,” I responded.

It was only one bullet, but, as I would learn later, it went in my chest, in and out of my lungs, and severed my spinal cord, leaving me paralyzed from the chest down.

More police officers started to arrive, and they made a quick decision to safely load me into police car and transport me to Nazareth Hospital. I was alert and conscious for the ride and was able to provide them with a description of the guys, and also told them the robbery was captured on video, which, in 1996, was not as common as it is today. remember getting to Nazareth and being rushed from the police car into a noisy room. I was still alert until they inserted a chest tube into me. Shortly after that, I got my first helicopter ride, as I was flown to Thomas Jefferson University Hospital. Meanwhile, back on Frankford Avenue, the neighborhood was in shock. Things like this just did not happen often, especially to nice guys. Officer Charlie knew that my brother was also a cop and had someone contact him. I have three brothers and two sisters, and they all started to receive the news. My brother Keith was the one who had the tough assignment of finding my parents at their weekly senior citizens meeting at church and telling them that their son got shot, and, contrary to what they would have guessed, it was not one of the two who were police officers; it was the jeweler. woke up around 8:30 that night after successful surgery, surrounded by my family. Nobody had to tell me that I wouldn’t be able to walk again, as I had already figured that out. The good news is that I was alive. I was lucky. I know it sounds odd that after getting shot and losing the feeling and control of over 70% of my body that I could feel lucky, but I did then, and I still do now; over 25 years later. After two weeks as Jefferson, I was transferred to this magical place on the corner of 16th and Race Streets called Magee Rehabilitation Hospital. It was there that I would learn how to begin to live a meaningful life in a wheelchair. I was 28 at the time and knew that life had too much in store for me to give up. After six weeks at Magee, I was finally able to go home, though I continued outpatient therapy for several months. I could write you a book on all of the good things that have happened in the 25+ years since that bullet changed my life, but, for the sake of this essay, I will just share a few of the highlights:

• I started driving again less than a year later, in a car equipped with hand controls that was purchased by friends and members of the community
• I began working at Magee Rehabilitation Hospital in 2001, and since then our team has raised over $40 million to improve the quality of life of people who, like me, have had their lives turned upside down in an instant
• I got married in 2003 and, together, we have traveled the world
• I played wheelchair tennis and won 2 national championships in my division
• I continue my involvement in the Boy Scouts of America, working hard to mentor and impact the lives of young people
• Finally, the best benefit of working at Magee is that I can be a real-life example of someone who had something terrible happen to them but could find a way to make something positive out of it.

One important detail that I saved for the end is that I had a license to carry a gun, was properly trained, and, had a gun hidden under my vest the whole time. However, with his gun always pointed right at my chest that did not really matter. This disproves the idea that if more people had guns they could better protect themselves. Even though I might make living with a spinal cord injury look easy, I sincerely hope there will come a day when this senseless violence will end. I got shot, but it affected so many others too.

I am a lucky man, as I lived to tell you this story. Too many people do not have that chance. For that, I am eternally grateful.

Second Place 2022

The Last Shot

Keyur Patel MD, PGY-5, Department of Surgery

The loudest moment of the night was not the police sirens or the clangs of instrument trays opening. Not the cries for blood and supplies. Not the heroic effort to save a life. Not even the shots that were fired. It was the silence. The silence after the pronouncement of death. The acknowledgement of life lost.

I met you minutes before you were dead. With no warning, the police pulled up in an SUV. I was told signs of life. Life but fleeting. I went outside to find you. There, in the back of the SUV, you were covered in your own blood. Dried. But breathing. Chaos ensued as we brought you from your world to ours. Into the operating room. We did the dance. You were intubated and breathed for. You were coded. Your chest was opened. Your heart was beat for you. All your visceral organs were starved of blood as we tried to get your heart and brain perfused. We said we’d deal with the consequences later. We tried to identify holes and trajectories to put together this puzzle that was you. But it didn’t work. We couldn’t catch up to your injury. We had lost too much blood that your heart did not know what to do with itself. Each piece of you that we found missing was more and more vital. Even finding a bullet wouldn’t do us any good. We couldn’t solve you.

So began the mutters. Whispers of what to do, if there was anything to do. Words almost reached our lips that we dreaded to say. I spoke up. Recounted our story of how we met and where we’d gone. How I’d gotten to know you, organ by organ. Then I asked if there were any objections to ending this story. So, with that most difficult of three-word phrases, “Time of death….”, it was closed. That was the pang. The rub. The silence. You felt heart rates slow down. You heard the dust settle. The previous cacophony of sounds finally reverberated out of the operating room. And I looked down at a life that once was. You were a task before. A victim of a gunshot wound. A set of tried and tested steps against hurdles to save your life. But you died as a person. The moment ended and slowly, the room emptied. The machines were turned off. The tools were packaged up. And so were you. The silence that encircled you so profoundly was lost once again to the orchestra of the hospital.

I talk as if I knew you. But you were forced on me. Through senseless violence of metal slugs against human tissue. Metal often wins against man, but sometimes we like to think we can defeat the odds. And we do. But you, like so many others, didn’t deserve to die. So that moment of silence after you bowed out, it wasn’t only for you. It was for each person that has died alone, without an audience to care. It was for me, so I could find the composure to keep going because the next one was not too far away.

Second Place 2022

One Surgeon’s Story of Gun Violence

Adam Frank MD, Department of Surgery

The consequences of gun violence are abhorred universally, but for the surgical trainee the benefits to training are also a reality of these cases.  Aggressive surgical action was highly encouraged in my residency.   The trauma bay was an area where large central lines, chest tubes, cricothyrotomies, and emergency anterior thoracotomies were performed.  It is in this context that I will relay the story of a gunshot victim that I encountered as I finished my fourth clinical year.

It was a hot early Sunday afternoon between Mother’s Day and Father’s Day in 1999.    I was in charge, being the most senior surgical person present in the Trauma Bay as the patient arrived.  I think back now and suspect that I was full of bravado.  I thought I had seen a lot.   By that time, I had accumulated a few saves for which I took genuine credit.  As the patient rolled in, I thought I was going to be the hero again.  I was wrong.  I did have attending back up, and I know he came in, but it would be after all that could be done, had been done.  The time constraints were just too short as my patient really didn’t have a golden hour left.

The African American teenager was still talking on arrival, but he was super scared.  He knew he was in trouble.  I didn’t get much of a story from him; that would come later.  He had on nice clothes, and I distinctly remember a nurse in the bay being concerned about properly protecting a stylish, simple gold chain with a cross he wore around his neck.  I remember that he struggled to follow an early request to lie down.  We knew that he had been shot in his left chest.  I saw the centimeter sized hole in his left mid axillary line at around the fifth rib level.  It was not an easy wound to spot considering the activity in the bay.  Even if he couldn’t lie down, everyone else in the bay was doing their job.  A seasoned nurse was picking a target for a 14 gauge IV.  The anesthesia resident was already present and setting up and the ER physicians were also helping.  I had a second surgical resident with me, and I distinctly remember a female ER resident, two years junior to me who had rotated with me on trauma when I was a PGY 3 and she a PGY1.  I knew her to be conscientious.  She knew how the trauma team functioned and knew the hierarchy.   I had good help, but that wouldn’t change things.  Our patient tried to help too, but some things just weren’t going to go right.  He suddenly vomited, involuntarily creating a mess that had to be addressed at least in some manner.  We got him to lie down and soon we had his airway secure.  But, as soon as one thing was achieved, something else went awry.   His first recorded blood pressure had been normal, now it vanished.  I could not feel a pulse anywhere.  Everything seemed to happen faster than it should. 

I knew that the next step in his management required me to transition from being a team leader to performing an emergency anterior thoracotomy.  We had our roles, and that was mine.  I can save him, I remember thinking.  We had seen his whole body by now and he definitely had come in alive and all that was visible was that small wound on lateral left chest.  It seemed so small.  “I can fix this!” I thought.  “With that small a wound, perhaps he just has tamponade, and then when that’s relieved, we will get him back!” I proceeded with the well-versed physical steps of a procedure that I had probably done ten or so times previously.  Soon, I was in his left chest.  A moment later, the descending aorta was clamped.  And then I opened the pericardium which was bulging.  “Don’t hit the phrenic!” I thought.  But it wouldn’t have mattered.  So much blood!! The hole in his skin was so small.  How could there be so much bleeding!  We had good intravenous access, and the blood was running in.  But the blood was coming out so much faster.  I extended the thoracotomy to the right fracturing his sternum.  Suction was there, I had help, but it didn’t matter.  I was too slow, I couldn’t find the bleeding and his life literally raced around my fingers pouring out of his heart as I desperately lifted it praying that I could find the wound.  Almost immediately, his heart had no fill.  The blood darkened and then darkened further yet still and then it even slowed down as my inadequacy became more and more evident.  I could not figure out where the blood was coming from other than from the back of his heart.  After some time, I looked up and saw the ER resident who was still valiantly trying to clear the field with suction, crying.  Her disappointment in our failure was so apparent and so painful.  We desperately continued to search for the bleeding source but by now it became so much less meaningful.  As his blood passed out of his body so did his life.   He was dead.  I finally found the injury, but by the time I did, it was pathetically academic.  In fact, I truly remember today, two decades later, how the blood welled up frustratingly around my hands, as I searched frantically for the wound on his posterior heart, when he still had a chance to live.  But I have no recollection of seeing the actual cardiac wound, even though I know I saw it, in likely a near bloodless field.  I closed him for the coroner, but I don’t remember doing that either.  I know that I did speak to his poor parents with my attending.  But, I do not remember their faces. I am pretty sure that is the result of ingrained defense mechanisms against the incredible pain of loss they experienced. 

Soon, I heard the preamble behind his shooting.  It made me want to puke just like he had.   He had gone to church services with his parents dressed appropriately for the occasion.  Services finished and they went to lunch together at a nearby restaurant.  There, two other young men unknown to our patient, decided to resolve their argument with guns and our patient, an innocent bystander, got hit by a stray bullet.  A bullet that bested the team and me, even though he had come to the ER talking!  He was an honors student and a good athlete.  He had a very promising future which was abruptly cut short on that warm Sunday afternoon.

I can not envision walking in his grieving parents’ shoes.  The moment I truly try to enter their pain, I skirt it, and hide emotionally.  Oh, how unfair, and how wasteful.  How can this be endured?  Today, it is the reality for more than a few parents.  This is not part of the natural order of things. It is unbearable and unjust. We are obligated to do something, anything to lessen the chances of this happening again.   

Third Place 2022

One Lucky Day

Margaret Kreher MD, Department of Family and Community Medicine, Division of Geriatrics and Palliative Care

“Excuse me, do you know what time it is?”  My back stiffened. I knew he didn’t want to know the time.  It had been a long day of office hours and hospital rounding.  I was still adjusting to the pace of work after the birth of my third child.  I was feeling guilty about being late getting home.  It was closing in on 8:00 PM the end of hospital visiting hours. 

I gripped the car keys in my hand.  A large red pickup truck with fat muddy tires was parked next to my car and blocked the full view of me from the sidewalk and street.  I turned around to see a young man with baggy shirt and shorts standing between the back of the truck and the back of my car.  He pulled a gun from his belt and pointed it at my abdomen.  My throat became instantly dry, I opened my mouth, but I could make no sound. 

I was at once both participant and observer.  All surroundings were in hyper focus.  He was talking to me, I was meeting his gaze.  He had a soft hairless face and doe-like eyes.   I was struck by how young he was.  I opened my bag.  It contained billing cards, a diaper, wipes, a lollipop and no money.  I meekly offered my credit cards.  He didn’t want them.  He was talking with anger.  I tried to listen to what he was saying but I was seeing and hearing everything around me with intense, loud clarity.  I could see over the truck bed. Visitors were leaving the hospital and going to their cars across the street.  I could not speak and no one looked my way.  I watched as an elderly woman folded a walker and put it in the trunk of her car.  She got in her car and drove away.  It was a normal evening at the hospital. 

He looked into my car.  I thought maybe he can’t drive a stick shift. I kept trying to look into his eyes still unable to speak.  If he shot me it would be messy I thought because I would be injured in my abdomen.  How long would I lie there between the parked vehicles before someone found me?  I would surely die there unnoticed.  I heard a voice saying, ‘let him get out of this’.  I sensed his hesitation.  He tucked the gun back into his belt.  He turned, walked away, picked up a bicycle that was leaning on a fence nearby and rode off.  Stunned, I took a breath unlocked my car and got in.  I put the keys in the ignition, but then I saw him.  He was on his bike and had pulled up to the driver’s side.  The truck was still blocking the view to the street.  Now I was fully out of view.  I thought I am to be killed in the driver’s seat!   I could not pull forward because a light pole was in front of me.  I would have to start the car and put it in gear to back up.  Too much time I thought to escape safely without being shot.  I heard myself say in a high pitched unrecognizable whisper, “God help me!”   He held out his right hand, there was no gun in it.  He said, “open the window.”   He pulled the gun with his right hand I thought, if he used his left hand to shoot maybe he’d miss.  I opened the window.  “I want to shake your hand,” he said.   I shook his hand.  He pedaled off. 

The city police visited my office the next day. By that time, I had decided my gunman was a boy, an adolescent.  I concluded that he had not been angry enough and chose not to harm.  Still, I wonder to this day why he did not shoot. Why was I so lucky to escape injury or death?  Was it because the car was a stick shift and he couldn’t drive it?  Was it because he saw my sheer terror, felt empathy and thought twice?  I thought for a long time that it was the latter. 

I am anxious. 

The Uvalde and South Street shootings have brought my memory of that long ago parking lot encounter back to my mind.    I tell my adult children to avoid crowds when going out.  The shootings were too casual and easy.  A teenager killed children.  He chose the school randomly and chose the most defenseless.  Teenagers may have randomly inflicted the most harm on South Street.  On South Street the lack of humanity and empathy can be seen on security cameras.  The shooters randomly shot into the running crowd.  They didn’t hesitate. They looked no one in the eye.   

I am angry.   

Why are there rules for driving a car and rules about who can legally buy and imbibe alcohol?  Usually we drive a car and drink alcohol without the intent to cause harm.  The only reason a gun exists is for harm whether it’s self-defense, putting meat on the table or sport.  Why are they so easily available, why are they designed to make it easy to kill so many at once? Why are there no rules to mitigate harm in any meaningful way?  Why are we hostage to the thinking and needs of the 18th century?  They were using flintlock weapons.  Is it the price we pay for our freedom to bear arms?  Yet, we are terrorized by the proliferation of random mass casualty events.  The people out enjoying an early summer evening, the children going to school all thought they had the freedom to do so safely.  Whose freedom are we talking about? Is it kill or be killed?  More guns do not make our lives safer.  

While families grieve we should commit to getting back the freedom to enjoy the normal things adults and children do to socialize, to learn, to participate in the community and to be good productive citizens.  We need to look deeply into the myriad of social, psychological, political and ideological problems that have put weapons of mass destruction in the hands of humans who lack the capacity demonstrate the maturity, empathy and humanity to responsibly bear arms.   

We can’t depend upon luck like mine.  The luck that a boy will make eye contact, hesitate, think twice and put his gun away before causing harm.