So Much To Answer For (Rain and Bullets Book 1)

---

Because I thought I knew. She finished her residency in and decided to stay at Temple, and the feeling of wrongness only intensified. There was a teenage boy in August who was shot in the heart. His heart stopped beating. But some weeks later he came in again, with a shooting injury to his brachial artery, in the upper arm. He almost bled out, almost died again, but the surgeons got him back, again. She was just a trauma surgeon, a good one, and getting better.

She had good hands and good judgment and a methodical approach to the craft. And as five years stretched into 10, and 10 into 20, Goldberg built up a deep well of experience in doing the things that are necessary to save the lives of gun victims, the things that are never shown on TV or in movies, the things that stay hidden behind hospital walls and allow Americans to imagine whatever they like about the effects of bullets or not to imagine anything at all.

The main thing people get wrong when they imagine being shot is that they think the bullet itself is the problem. The lump of metal lodged in the body. The action-movie hero is shot in the stomach; he limps to a safe house; he takes off his shirt, removes the bullet with a tweezer, and now he is better.

This is not trauma surgery.

The Neon Rain

Trauma surgery is about fixing the damage the bullet causes as it rips through muscle and vessel and organ and bone. The bullet can stay in the body just fine. But the bleeding has to be contained, even if the patient is awake and screaming because a tube has just been pushed into his chest cavity through a deep incision without the aid of general anesthesia no time; the patient gets an injection of lidocaine. And if the heart has stopped, it must be restarted before the brain dies from a lack of oxygen. It is not a gentle process. In especially serious cases, 70 times at Temple last year, the surgeons will crack a chest right there in the trauma area.

The technical name is a thoracotomy. A patient comes in unconscious, maybe in cardiac arrest, and Goldberg has to get into the cavity to see what is going on. With a scalpel, she makes an incision below the nipple and cuts 6 to 10 inches down the torso, through skin, through the layer of fatty tissue, through the muscles. Into the opening she inserts a rib-spreader, a large metal instrument with a hand crank. It pulls open the ribs and locks them into place so the surgeons can reach the inner organs. This is done with a tool called a Lebsche knife.

Goldberg takes a silver hammer. It looks like—a hammer. She hits the top of the Lebsche knife with the hammer until it cuts through the sternum. You know like when you see on television, when people are working on the railroad, hammering the ties? And everybody—every body —has its own kind of quality. Some of the simple tools surgeons employ in the trauma bay, including the Lebsche knife and silver hammer used to break the sternum while opening chest cavities. Now the chest is open, and Goldberg can work. If the heart has stopped, she can try to get it beating again. This may involve open cardiac massage—literally holding the heart in her hands and massaging it to get blood flowing up to the brain again.

Is it in the chest? Is it in the abdomen? And sometimes it just really hurts as you work your way through. Hurts them and hurts her. There are some gun victims who die quickly, right there in the trauma bay, or soon after being transferred up to the OR. Others develop cascades of life-threatening complications in the following days that surgeons race to manage.

It was a documentary about the 33 Chilean miners who were trapped underground for months in And the miner that had the hardest time down there was the youngest guy. Not the oldest guy. It was the youngest guy. And they said, why? Why did you have such a hard time? And he said, God and the Devil were with me.

God and the Devil are with you. You start a case. They come in talking. They have this devastating injury.

You call yourself a good trauma surgeon. And you just plow ahead and plow ahead and plow ahead. Oh, you are the best. You suck, you suck, you suck. During trauma surgery, tissue in the lower extremities can die, causing gangrene, in which case surgeons might have to amputate the leg at higher and higher points, first at the shin, then at the knee, then at the thigh. One patient a few years ago was shot in the face with a shotgun at close range over some money owed.

She looked at him. He lowered the coat. The nurse thought to herself what you might expect a person to think in such a situation: The price of survival is often lasting disability. Some lose limbs entirely. During trauma surgery, when the blood flow is redirected to the brain and heart by an aortic clamp, blood goes away from other areas, and tissue in the lower extremities can die, causing gangrene, in which case surgeons must amputate the leg at higher and higher points, first at the shin, then at the knee, then at the thigh, to stay ahead of the necrotic tissue as it spreads.

The femur bone may have to be disarticulated—removed entirely from the socket, and discarded. There was a woman several years ago whose boyfriend shot her in the leg. The bullet clipped the femoral artery and she bled. Goldberg was on call that day. Eighty percent of people who are shot in Philadelphia survive their injuries.

This statistic surprises people when they hear it. They tend to think that when people get shot in the belly or the chest or the face, they die. Rafi Colon was shot once in the abdomen with a 9 mm handgun during a home invasion in September The bullet tore through his intestines.

He spent the next 11 months in the hospital, immobilized in bed, with an open wound down the front of him that had the circumference of a basketball. It got to the point where it was a normal thing for him to look down and think, oh, those are my intestines, there they are. Colon learned to sop up the excess acid from his exposed intestines with gauze pads and later with a machine that sucked the acid through a tube. When his friends came to visit, they had a hard time looking at him. He knew what would happen when he ate it. The water ice was red, the Swedish Fish flavor from that summer, and 30 seconds after he swallowed it, the red water ice came oozing out of the hole in his intestine.

Over the course of his long recovery, from the fall of into the spring and summer of , Colon got a feel for the rhythms of the Trauma Service. Lying there in the bed, he occupied himself by counting the number of times each day that trauma codes were announced over the PA system. It seemed like the busiest times were Thursday, Friday and Saturday nights. Rafi Colon in his stairwell at home. Though his neck and stomach scars are still visible years after being shot, he can't terrify friends with his water ice trick anymore. It ultimately took 14 surgeries to repair the damage done by one bullet.

Goldberg was part of the team of doctors who cared for him. They talked about muscle cars and sports. She liked the Eagles; his team was the Giants. She has gotten more sensitive over the years, she said. Her medical training was all about learning to operate, to recognize the kinds of patterns that she now teaches to students and young doctors.

I once saw her give a lecture to 11 medical students who had just completed their surgical rotation. Goldberg diagrammed anatomy and formulae on a whiteboard and asked questions about how the students would diagnose various hypothetical patients. But she also asked the students to share their experiences with patients and their feelings about those cases.

Another student recalled being surprised when a patient asked for his business card even though he was just a lowly medical student. Often when Goldberg meets a shooting victim, it turns out she once treated a sibling, parent, cousin or friend. The letters were surrounded by gold stars.

See a Problem?

Talking to patients seemed to energize Goldberg. She was alternately lighthearted and serious. The patients were uniformly docile and tired. They were on pain medication that slowed their speech. The first patient, shot in the neck, was a young man accompanied by his girlfriend, who sat next to him on the bed with an expression of concern.

The second patient was older. A tube to drain fluids was snaking out of his chest. He held out a trembling left hand and smiled. Goldberg told the man he was scheduled to be released the following Monday. He had been caught in some kind of crossfire. Goldberg descended to the eighth floor to meet with another gun victim.

She knocked on his door and said hello in her friendly voice. There were two large men inside the room in T-shirts and shorts. She assumed they were his family, but when she entered, the men rushed over to her and said that the patient was a suspected shooter himself. They were plainclothes cops, guarding him. Goldberg and she wanted to explain what was happening and help him if he needed anything. There was an open wound in his chest, a vertical incision from below his nipples to his belly button, rising and falling with his breath.

Surgeons had needed to remove one of his kidneys, his spleen and part of his stomach to repair the damage of the bullet and save his life. The edges of the wound were pink and raw. Goldberg said they would try to help with that and rubbed her fingers across his hand in a gesture of tenderness. Gunshot victim Lamont Randell, shot twice during a robbery, begins his long recovery process.

Police statistics show that shootings decrease in the cold winter months and pick up when the weather warms, but any given trauma shift in the winter can be busy and any shift in the summer perfectly quiet. She knew this would involve talking to people in the community, but she also knew she was a flawed messenger. When he was growing up in Sacramento, two of his older brothers were shot and his sister committed suicide with a gun, and at 19 one of his best friends was shot and killed.

He moved to Philadelphia when his sociologist wife got hired by Penn, and two years later, he joined a nonprofit that designed service-learning projects in public schools. Some of his students from North Philly started collecting the stories of families who had lost children to gun violence, which is how Charles made the connection to Goldberg—Temple had treated one of the victims, Lamont Adams, a year-old from North Philly who was shot and killed in after a false rumor was allegedly spread about him.

Goldberg hosted a tour for Charles and his students, inviting them into the trauma unit and explaining what gun patients experience there. She was immediately impressed by the way he dealt with the kids. Charles accepted, joining Temple in August , and since then he and Goldberg have developed a suite of ambitious programs in collaboration with other Temple doctors and staff.

There are three programs aimed at preventing violence before it happens. Cradle to Grave is an expansion of that first tour Charles took at Temple. He brings groups of kids and adults into the trauma area and shows them how surgeons save gun patients. He has his own copies of the various surgical instruments for demonstration purposes, removing them from a travel bag: His thigh and arms. And most disturbing of all, the two bullet wounds on his hand, a sign that Lamont was trying to shield his face from the bullets at close range.

Charles also runs the Fighting Chance program, a series of training sessions for community members, where doctors show people in neighborhoods how to give first aid to gunshot victims, to apply tourniquets and stop blood loss in the seconds immediately following a shooting, before the EMTs or police arrive. Recently, Charles has also become a sort of Johnny Appleseed of gun locks, handing them out to parents who want to keep their children from getting hurt in accidents.

He keeps boxes of them at the hospital and distributes the locks with no questions asked. Sometimes he lugs them to subway stations and offers them to commuters. When Goldberg first saw Scott Charles talk to a group of children, she knew she needed him on her team. Temple asks the patients if they want to talk to a trauma survivor. And they are given an opportunity to view a video of their own trauma-bay resuscitation. The surgeries in the trauma area are videotaped for quality control.

About half say yes. Charles shows them the video. They get psychological counseling for any PTSD symptoms, as well as case management services to help them get high-school diplomas or jobs. All you ever needed was someone to tell you you were right. And all you ever wanted was to put off some of your own light.

There you are, singing Desperado in the car at night. There you are, with everybody looking up at you. I had a baby but the good lord took her. She was an angel but her wings were crooked. I guess he figured he could love her better than me. Some girls marry and some girls wait. Some do better without that ball and chain…singing… Oh me, Oh my tell me it gets easier with time. With the way you drink and the brows you raise. You can bet they wonder how the bills get paid, when you dance all night and you sleep all day.

Girl when you gonna settle down, and make your mama proud? Oh no, not now. They say the good times go too fast. Edge of the Frame. And you make a scene, you get your picture in a magazine. Why you make a beggar out of your best friend. Oh heaven knows, you love to dress me up in ribbons and bows.

I go to get myself a coffee and everybody stares at me. They know you treat me awful mean. When the mailman brings the letters he tries to talk some sense to me. I tell myself over and over I should be getting out of here. So listen Honey and believe me, cause this is all I got to say… Anyone would have to be a fool to love you like I do. He was forty-six with the wife and the kids and the job with the suit and the tie.

Oh but I, I wanna be your child again. I wanna remember when everything was new. And damn this pride that lives inside the hearts of men. I wanna be whole again. I passed a truck filled with old street signs, it seemed like one of them was mine, a long long time ago, before I knew you Caroline. Now the bus is leaving, wish I could stay. Oh Carolina, oh Carolina. You know I love you in my way. We sat out on the front steps and shared a cigarette. We watched the neighbors go to bed.

Get A Copy

They fed the dog and shut the lights, and we were on our own again. But as the sun began to rise. We were running out of shadows to hide ourselves behind. Would you love me one more time, before we raise the blinds and make the bed? My little train wreck. Your eyes are smiling but your cheeks are wet. We fell asleep just like we used to, legs all tangled in the sheets.

I know you dreamed that bus to Houston, heard you talking in your sleep. I would have held you all day long. But when I opened up my eyes you were already gone. The time has come to bring it home. Little bird with a broken wing. So what do you say?

I watch the dust dance across the floor. It used to be so easy to ignore the sun has set, but the sun will rise. What can I do? It was all for you, it was all for you. Another one has already wrung all of the tear drops from your eyes. Still every time you smile I think that everything is gonna be just fine. I know, I got no fight. Never gonna be simple.

The Neon Rain (Dave Robicheaux, #1) by James Lee Burke

When you found me I was broken clear in two. My heart was split wide open, tired of hoping, tired of playing the fool. But you did what I thought nobody could do. Now you ask for nothing more than to be by my side. And when you say it like you say it, Love, your smile makes it easy to oblige. All the hurting and the flirting that I thought would never end. If you were holding my hand. Oh Brother can we please go back? I miss the river and the railroad track. I gotta know if it all still means what I thought it did when I was seventeen. Was born a winner now I live to lose.

And every day is up and down, like the price of gasoline. And go limping home to Caroline, where the rain will fall and the sun will shine. Nobody else can tell you what it takes.

You put your heart on a shelf or you let it break. The rain came down with the thunder and the lightning. I do believe that we will pay for our mistakes. But the songs we sing together are the ones that bring me home.

• Loser Chick: A Girls Guide To Loneliness
• Poetry and Wisdom About Life, Love, and What Really Matters
• Sparrows and Sky
• More Than a Slave: The Life of Katherine Ferguson
• The Forsaken (Vampire Huntress Legend series)
• Die Schlange am Rande der Welt: Roman (German Edition)
• Just Upstairs