Two are Dying, and Only One Can Live: Hard Choices

“Leaving a teenager to bleed to death is hard.”

A Day in the Life of a Paramedic

There we stood, standing over two teenage boys bleeding to death on the sidewalk.

Both looked about sixteen.

One was shot in the head, just under the chin.

The other was shot in the chest, with an open fracture to the skull.

As the only ambulance on scene, we had to choose which bleeding teen to focus on. And, sadly, the other boy would have to lie there unattended until the next unit arrived on scene.

It’s called triage, and it is easily one of the hardest things a medic can do. Typically, triage is a simple algorithm used when your patients exceed your resources, but this call did not meet the normal parameters; both boys were still breathing and had palpable pulses.

Oh, and regardless of your experience, leaving a teenager to bleed to death is F#%cking hard.

After a quick verbal exchange, my partner and I determined to focus our efforts on the boy with the chest wounds, leaving the other to bleed out on the sidewalk waiting for the next emergency unit.


I immediately regretted my decision after inspecting the second boy’s chest wounds. He had been shot point-blank in the center of the chest, with powder burns around each hole.

Surprisingly, it’s not uncommon for people to survive a single gunshot under the chin. In fact, I have actually seen it twice.

But it is very unlikely to survive a point-blank triple-tap to the chest.

During the Code 3 transport, my partner and I worked frantically to intubate the boy, start two IVs, decompress his chest, and give fluids. The boy never regained consciousness and continued to degrade despite our best efforts.

We delivered the boy to the trauma center with no blood pressure, weak pulses, and no respirations.

I continued to agonize over my decision to leave the other boy behind, feeling as if I traded his life for one that was lost anyway.


Six months later, I responded to a sixteen year old complaining of abdominal pain. After a lengthy assessment, the young man told me there was a bullet lodged in his lower abdomen that surgeons hadn’t previously removed. This young man was incredibly respectful, calling me “sir” and answering all of my questions with remarkable enthusiasm.

Once in the back of the ambulance, the patient looked at me with a sudden sense of recognition, smiled, and said, “I always hoped I would get to thank you one day.

Thank me for what?” I asked with the trepidation you feel when someone you don’t know recognizes you.

Choosing Me,” he replied. “You saved my life.”

As you might have guessed, this was the boy we found on the sidewalk with three bullet holes in his chest and a cracked skull only months before.

And although he never saw me during the incident, he somehow recognized and remembered my voice. Even though he was at the brink of death, the young man had heard everything my partner and I said, following our every word quite literally with bated breath.

He survived surgery with both of his lungs and his right ventricle (heart) punctured. A plate was put in his head to repair the skull fracture. That left just one bullet, which had bounced off his rib and lodged into his abdomen.

As it turned out, it was the first boy bleeding on the ground who had shot him in the chest. They had gotten into a fight, and the first boy pulled a gun, pressed it into my patient’s chest, and pulled the trigger three times.

As he fell to the ground, my patient then grabbed the gun buried in his chest, turned it upward, and heard it go off again, this time shooting the first boy in the head.

He openly admitted he was a gang member prior to the incident, but his life perspective changed that day. He no longer had any interest in his old circle of friends or his previous lifestyle.

My self doubt and agony subsided. Here I was, actually talking to the boy I was sure had died.

And what happened to the first boy? He suffered a massive brain injury from the shot under the chin, and his organs were harvested to extend the lives of others before he passed.

I had chosen wisely … or, more likely, I just got lucky.

Either way I’ll take it.

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