I'm A Surgeon Who Operated On A Man Who Had Just Committed A Horrific Murder

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The following is an excerpt from 'Confessions of a Surgeon: The Good, the Bad, and the Complicated ... Life Behind the O.R. Doors' by Paul A. Ruggieri, M.D.:

I wanted him to die. I really did. I was hoping his heart's pumping action would just stop. I was hoping he would never make it to the operating room.

The man had just gone on a shooting rampage in the local courtroom, distraught over an ugly ongoing divorce. He had expressed his festering anger by emptying several rounds from a .38‑caliber handgun into his wife, his wife's divorce lawyer, and other colleagues during legal proceedings in the courtroom. He had only wounded his wife with the first shot to her neck. She was still breathing, gasping for life, when he calmly walked around the table. He slowly squatted next to her and placed the gun to her head. The second shot killed her instantly.

I was the chief resident on the trauma service on duty in the hospital when the shooter arrived with nine bullet wounds, care of the local police. If the man needed to go to surgery, I was the one to take him. Minutes before his arrival, my team and I were alerted to the incoming carnage. I was pacing back and forth. The shooter arrived in the main trauma room. "Shot nine times, twice in the head, and you are still breathing," I whispered under my breath as I approached him. His victims arrived several minutes later. The shooter was the most critically ill of those who were brought to the emergency room that night. The irony: He had to go to the operating room first. He had to be saved first. Blood from his head wounds was beginning to accumulate on the floor. It was a steady drip, drip, drip.

"You son of a b---- ..." I mumbled. He would not meet my gaze. Why don't you save the families of the victims a lot of grief, save the taxpayers a lot of money, and allow me to sleep tonight by just checking out? For a moment, I let my emotions get the best of me. For a moment, I was filled with rage. For a moment, I wanted the shooter to die. He did not deserve the extraordinary efforts the surgical team would soon deploy to keep him alive that night. He did not deserve a trial, given the obvious weight of his guilt. It was all black-and-white to me.

"Dr. Ruggieri." The trauma nurse's voice jolted me back to my reality, the reality of what I was trained to do. "The operating room is ready. Any other orders before we get this guy up there?" Fortunately for him, my profession does not discriminate at death's door. To me, the operating room is considered the great equalizer. All who pass through those doors are one and the same. In the end, there was no moral dilemma; he was gravely injured and I could help him.

"No, Nurse. Just get him upstairs quickly." It was time to save a life.

Once I had his abdomen open in the operating room, nothing beyond repairing the holes in his intestine and repairing damaged blood vessels mattered. "Nurse, clamp now!" A jet of blood rose up and was heading for my right eye. It always does. I turned my head just in time. "Get this guy off me." I needed a wipe.

With each saving stitch, I wasn't saving the life of a murderer. I was doing what I was trained to do. I didn't care about his life before he entered my operating room. He was just a trauma case to me, nothing more. The circumstances surrounding his entrance to my "office" did not matter now. It did not matter how many people he might have killed. I needed to use the powers bestowed by my surgical mentors to get him off the table alive. I did not want him dying on the table, because it would lead to a messy situation. There would be too many questions to answer and too much paperwork to fill out.

Once under anesthesia, with the body part I needed to cut into draped off, he was just like all the others who came before him, despite his heinous crime. At that moment, to me he was several feet of shot‑up intestine, damaged blood vessels, a shot‑up liver, and a half-dollar-sized opening in his stomach. He was no different to any other surgery.

Once a patient is on the operating room table asleep, draped off, and ready to be cut open, I do not consider him or her human. All I see is a diseased appendix, a cancerous thyroid mass, a hernia, or an inflamed gallbladder. Yes, I realize there is a life, a soul, attached to these organs. In order to do my job effectively, however, I cannot allow it to be a distraction. There are no "feelings" inside the operating room, no time for reflection. Here, I do not consider myself human. At that moment, I am devoid of any feelings for the patient. I am a robot, blocking out any outside interferences. I have to be methodical, carrying out precise surgical maneuvers, removing, rearranging, or patching up whatever brought me there. In my work as a surgeon, this is what I am and what I see.

It is only after the shooter is made whole again that the despicable human being who took away a life surfaces. After it was all over, the shooter survived his wounds, was tried and convicted in a court of law, and, ultimately, was sentenced to death.

This violent episode was the first time I had to struggle with conflicting emotions between what my heart desired and what my training directed my hand to do. It would not be the last. There would be more critically ill patients after the shooter who would force me to revisit the conflict between the emotions in my heart and the scalpel in my hand.

During many years of practicing surgery in the community, I have often had to make decisions with life-and-death consequences, in complete cold-blooded isolation from any inner emotions or biases. Often, before I can even begin to process the consequences of these decisions, I am faced with another, and yet another. Some days, my job does not allow me the privilege of being human. Living at a distance from one's emotions can be a comfortable state to settle into.

But despite the unique situations surgeons find themselves in daily, most are indeed very human. We may hide it well, but deep down our emotions percolate. Despite the urge to feel immortal after plucking out a ruptured spleen and saving a life, I am frequently reminded of my imperfections and mortality. My imperfections often arrive in the form of complications, such as accidentally making a hole in an artery or misdiagnosing a problem. My mortality often presents itself disguised as a patient.

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