You Gotta Get Outta Here Now

It’s the end of my internship in medic school and I get a call for a gunshot victim. Sheriff’s officers are on scene. We get there at the same time as fire and find the victim in a field behind a trailer park. It’s a self-inflicted gunshot wound to the head. He’s awake and alert, but he can’t speak or see. He missed, and tore up the front of his face. We see an exit wound above his eye. Fire gets him on a stretcher and carries him up a little hill to the gurney. He’s bleeding profusely from his mouth. I want him sitting straight up, leaning slightly forward to allow the blood to drain out, so he’s not swallowing it. 

He sits on the gurney and I try to raise the back but the stretcher is in the way. The patient, who is a big guy, grabs my arm and shoulder and starts shaking me.

I say, “My name is Tiffany. I’m going to be in the back of the ambulance with you on the way to the hospital. I know you’re scared. There is a good team here and we’re going to take good care of you. I need you to let go of me.” He lets go.

I ask fire to help me get the stretcher out from under him and the Captain looks at me and says, “You need to get out of here now.”  

I listen, because I don't have the confidence I'd ought to at this point, and he said it with such convincing authority.  

We get him loaded into the ambulance and he’s starting to fade in and out of consciousness. I push his body against the cabinets to hold him upright while I pin his arm to start an IV. My preceptor grabs the suction. We take a rider, who starts an IV on the other arm, while both my preceptor and I hold him up. There is a 22-minute drive to the trauma center. I make that call 10x harder than it needs to be by not standing my ground about getting help removing the stretcher. Everyone has to do everything one-handed, and now the patient has to use his own muscles to hold himself up too, making him work harder than he should need to, and if possible given the circumstances, less comfortable. 

I assess him and at moments he is coherent.  He nods and shakes his head to questions appropriately. His tongue is largely missing. He starts opening the non-damaged eye. He makes eye contact. I reassure him.

We bring him into the trauma center and it is exactly like the movies. Staff and surgeons everywhere, gowned up and ready to go. I give my report. I do a good job because I had transport time to rehearse in my head, but I talk too fast. I notice as I’m talking my voice is higher than I want it to be, but I don’t know how to correct it without it coming off very strange. So, I keep it high intentionally, which feels even weirder.

I ask the charge nurse about him four days later, but I never actually got his name, he was a John Doe. It doesn’t look like anyone died from a trauma in the last four days while in the ER, she says. She wasn’t on shift that day, but there was someone transferred out to a plastic surgery center. That’s not a common transfer. That’s probably him. They transferred him as John Doe. 

I think about him and wonder what he thinks about life now. Is he one of the lucky ones who miraculously sees his survival as a blessing in disguise? Did he manage, like so few, to get a lot of support and therapy after, and reframe the experience? Or is he still depressed and also mute now.  Maybe he can talk with an articulation disorder (I looked up that term, I didn’t learn it in school). 

Maybe he’s still alive but life is much harder. Relationships are much harder. School, getting a job, caring for himself, and going out in public are much harder. Maybe there wasn’t a lot of therapy and support and reframing because therapists are overworked and hard to come by.

I know what is more likely. I saw the trailer he lived in. I have a sense of what resources are at the public’s disposal after working at the psych hospital and the jail. There are so few.  Where would the funding come from for the support he needs? But I think about this guy, and to be perfectly honest, I hope he is either dead and at peace, or one of the lucky ones.  And if he is one of the lucky ones, I would love to meet him again someday. 

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Review

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This piece is haunting, powerful, and deeply thought-provoking. It presents the stark reality of emergency medicine without romanticizing or dramatizing it. The tone is gritty and intense: the rawness of the descriptions, the high-pressure decision-making, and the brutal realities of trauma medicine make this piece feel visceral and immersive.

The narrator doesn’t just recount the event—they analyze their own decisions, question their actions, and acknowledge how inexperience played a role in making things harder than they needed to be. The fact that the narrator followed up on the patient at all is telling—many in trauma medicine are forced to compartmentalize and move on, but some patients stay with you, even when you never see them again.

The final reflection "I hope he is either dead and at peace, or one of the lucky ones," is what makes this piece linger—it forces the reader to confront the uncomfortable question of what survival actually means. The public sees survival as success, but the idea that resources are so scarce that surviving trauma could mean a worse quality of life than death is a painful but honest truth in the world of public healthcare.

The title is also perfect—"You Gotta Get Outta Here Now" applies not just to the moment in the field, but metaphorically to the system itself. There is no real safety net, no real place for people like this patient to land.