My home phone rang around midnight. Never a good sign.
“Dr. Krentz, this is the ER. We don’t know the details, but Dr. Henderson is up in the ICU with someone holding a gun on him.”
“They called Phoenix PD. They’ve mobilized the SWAT Team.”
“On my way.”
Eighteen minutes later, I rushed into the ER. It was all over.
Earlier that day, we had resuscitated a young man in his twenties with a massive opioid drug overdose. He had a pulse and blood pressure, but no respirations. The ER team intubated him and got him on a ventilator, but he showed no signs of brain activity. We admitted him to the ICU, where he would remain on the ventilator for twenty-four hours, after which an electroencephalogram would determine presence or absence of brain death.
This drama occurred at a time when advanced directives were not as common as nowadays. In a non-teaching community hospital, our group of emergency physicians also provided critical care coverage in the ICU. Working the night shift, Dr. Jim Henderson (not his actual name) got called to the ICU, STAT. When he arrived, he found another young man standing by the OD patient, holding a gun on a nurse.
“What’s going on?” Jim asked. He stepped between the nurse and the gunman.
The assailant identified himself as the patient’s brother. “We have a pact, not to allow each other to become a vegetable. My brother would not want this.” He moved closer and pointed the gun at Jim’s chest. “Turn off the ventilator, Doctor.”
Jim backed up a step. “I can’t do that. He might live if we keep him ventilated. I am sworn to protect life, not take it.”
“Do it or I’ll kill you.”
Jim held up his hands. “Do what you must, but I’m not turning off the vent.”
The man with the gun became agitated. He advanced on Jim. “Step away. If you won’t turn it off, I will.”
“Okay, but you’re assuming a hell of a responsibility.”
“I’ll live with it.” Still holding the gun on Dr. Henderson, he reached down and unplugged the ventilator from the wall.
To the surprise of both men, the patient breathed on his own. They watched for over a minute. Vital signs remained stable.
“I’m going to plug it back in,” Jim said.
The assailant dropped his gun hand to his side and stepped away, just as police arrived to arrest him.
The patient survived and eventually went home.
When I got to the ER that night, Jim had already returned from the ICU to see other patients. When he told me the story, I offered to work the rest of his shift. He declined.
“Weren’t you frightened?”
“I got a little nervous when he pointed that gun at my chest.”
That’s the person you want in the ER. Rock-calm under pressure.