It was 5:27pm, on a Friday evening, when the pager went off. “Ugh”, said the intern, “Three minutes before shift change and the ER is paging for another admission!” I could see the dismay on his face as he dreaded the thought of staying late on yet another Friday night. I decided to take care of this patient myself and relieved the intern of his duties. As I went downstairs to the ER, I felt the restiveness in the atmosphere. Walking across the busy hallway of the ER, I saw a bunch of people rushing in and out of a room and my feet impulsively started walking towards there knowing that had to be my patient.

As I entered the room, I saw the nurse bagging the patient to deliver oxygen. Next to her was the emergency medicine resident with an endotracheal tube in his hand but was unable to intubate the patient. The emergency medicine attending attempted next but failed to intubate the patient as well. Minutes later, the anesthesiologist hastily entered the room and tried to intubate the patient but failed as well. The patients husband stood sobbing across the room. His fists were clenched, his skin was flushed, his eyes looked down as he slowly fidgeted holding back his tears. I gently paced towards him and introduced myself. His voice trembled as he said, “We were just having a nice meal when she choked on her hamburger”. His eyes showed deep agony as if life had been unfair to him. He eventually said that the patient had history of multiple back surgeries with rods in her back which caused an inability to extend her neck leading to the multiple failed intubation attempts. We decided to scope the patient’s airway and were finally successful in intubating the patient. I stayed late that night stabilizing the patient and making sure she was stabilized.

Fortunately, in one week, she was not only extubated but was ready to be downgraded from the ICU. She had done well overall but had failed her swallow test and was recommended to have a feeding tube placed for nutritional purposes. However, the patient refused the feeding tube stating that it would reduce her quality of life. Her husband tried to persuade her multiple times to get the feeding tube because he did not want her to have a “near-death” experience again. The argument had been ongoing and there was some “yelling” heard from their room multiple times.

It was 7:45 am the following Friday, when I had just received sign-out from the night team. I was about to start my morning rounds when I heard a “Code Blue,” which indicated a medical emergency. As I put my computer down to run towards the code, I heard another “Code Blue” announced. A few seconds later, I heard “Code Silver” which was the code for a person with a weapon in the hospital. My heart started racing and my feet started running. I sprinted towards the code. As I got close, I saw the nurses gathered outside the room. I could see they were panicking but were trying to keep calm. All their concerned faces simultaneously looked at me as I walked past them to enter the patient’s room.

As soon as I entered the room, I smelled gun powder. I saw a man seated on a chair next to the patient’s bed – his hands were flaccid, hanging off the side of the chair, a gun had fallen underneath the chair. There was a bullet hole on the side of his forehead with blood was gushing down his face. As I walked past him, I saw a lady with 2 gunshot wounds in her abdomen. The white hospital sheets had turned red from the profuse bleeding. I recognized the pale patient’s face–it was the same patient I had downgraded the previous day from the ICU.

I had never seen a gun in my life before. I felt like I was going to freeze but I knew I had to keep going. I had to save this patient, yet again, and I had to save this man. Emotions were flowing … my hands shivered and my voice quivered as the chaos in the room increased. I took a deep breath and quickly got myself together as I loudly announced, “Someone please get the code cart!”

This incident left a deep impact on me. A murder-suicide incident on the grounds of a facility, in a hospital, is not just disturbing but also heart-breaking.

Gun violence has been increasing in this country and is now not just a public health crisis but also an epidemic. It has been inadequately researched and inadequately treated. How is it that diseases like measles, mumps, Zika and Ebola receive so much research funding but firearm related death and disability does not? Contrary to popular opinion, most gun violence is not caused by individuals with mental health conditions according to the American Academy of Psychiatry. As of today, there is no solid research showing whether people are safer in a society with more or less firearms.

As health care professionals, we all need to speak up to remove the legislative barriers and implore that the Center of Disease Control and Prevention, working with professional medical societies, generate more evidence-based solutions to prevent gun violence. It is, now, time for a change.