Gun Rights
KATSUMI BOOKED HIMSELF a flight to a large southern city in the United States, with a hotel room for 3 nights. He ate breakfast on arrival at his hotel, then took a cab to a local gun club. He'd never fired a handgun before as they're strictly prohibited in Japan, but the shop owner was cheerful and friendly and helped him choose a '45 from the display cabinet. Katsumi paid the fee to rent the gun and a firing range for half an hour. He shot 50 rounds into a target, and then took a cab back to his hotel. Later that afternoon he took another cab back to the gun shop, fired off another 50 rounds, then returned to his hotel room. A few hours later Katsumi went to the gun shop once again, rented the '45, and put a bullet through his head.
The medics were there within minutes. Oh, creatures that once were men. Brain and blood all over the ceiling, but not dead yet. Gasping for air through foaming blood and tissue leeching from holes in his skull and his throat.
Katsumi had put the gun under his chin and aimed at his brain. The bullet had passed through his tongue, then ricocheted off the bone at the base of his skull and torn through his optic nerves, his frontal lobes, and out the top of his head. Frontal lobes are where you do your thinking. That's where you know future and past, right and wrong, the difference between trees and dogs.
THE GUN CLUB was conveniently close to a hospital, and the medics dropped Katsumi off in the ER spraying blood with each pitiful attempt to breath, his oxygen saturation already down to 80% and dropping. His passport said he was in his mid 20's, though to the hospital staff he looked like a child laying there on the gurney, so small and helpless. Without a breathing tube into his lungs he was going to drown in his own blood within minutes, at most.
The trauma room was packed with nurses, orderlies, X-ray and respiratory and lab techs – at least 10 professionals jammed into that intense little box, ready to help. But help with what?
It was all too clear that any coherent contact with the planet for this poor man was in the past. The brain damage was massive.
But not dead yet. His heart was still beating. And he was still feeling pain. The trauma team had gone into other people's disasters together countless times. They'd saved their share and felt great about it. They’d lost enough too, and felt lousy together. Now they slipped into professional routines, inserting IV tubes, applying monitoring leads, checking vital signs, inspecting the body for other wounds, for evidence of retained neurological function.
What happened next was up to the doctor on duty, but he – a young man, not long out of training – was unsure what was the right thing to do here.
Clearly the patient had planned this out well in advance and seriously intended to die. And now the front third of his brain was mush. If he was left alone, or given pain medicine, it'd be over within seconds. And if they intervened – but what would he want them to do? He'd wanted to die when his brain was intact; would he want to live now that a big piece of it had been wiped out?
A man has the right to kill himself, the doctor pondered – the Supreme Court had said so. But did he also have the right to just go ahead and do it in a public hospital? And did that mean the medical staff had a duty to help him do so less uncomfortably, or was their duty, using the best technology though almost certainly against the patient’s will, to try and force what was left of him to remain alive?
The trauma team was pretty tight. They’d pumped on chests together and inserted tubes through mouths and necks and ribs, poured in buckets of chemicals and blood and applied jolt after jolt to jump-start dying bodies in that room. You can be a virgin in horror just as in sex, but there were no virgins here.
And when a fast decision had to be made on declaring medical futility or on complying with a patient’s unspoken wishes – in a case like this there are perhaps twenty or thirty seconds to think it through, about the dilemma of applying technology to the warehouse of the soul where it's all too likely that this soul is either ready to leave, or perhaps already has – this doctor liked to make a group decision. Legally the responsibility was all his, but in matters of ethics, of ultimate belief, of pure empathy, he preferred to resort to democracy. Katsumi was jerking, bleeding, gasping, dying horrifically before their eyes.
The doctor looked up towards his team – they were close together, leaning over the mangled, tormented body – and muttered, "For me I'd push morphine and leave him alone. He's about to go. His brain is done. It's rotten like this, but he wanted out and it's too late to go back now."
All those professional eyes faced the doctor, serious, worried, caring. Heads nodded – silently. Not a word. Not a murmur, no agreement nor disagreement, the way they'd made such decisions many times before. Even for hardened pros, it's not easy to generate a word when confronted with such horror in a young patient. Never mind a coherent decision. Not a yes, not a no, not even an I don't know.
If I push them just a little, the doctor thought, they'd go with me either way – and yet, and yet he was loathe to impose his feelings about life and death onto others. And he was not paid to be indecisive: in the trauma room that instant of ambiguity was intolerable –
"All right,” he muttered, “then we’ll tube him –"
– and as he moved towards the patient's head the room surged back into action. The best way to avoid moral doubt, of course, is always to stay busy, to keep thinking of something else. Eager hands positioned the shoulders and head, machinery shuffled into place, suction catheters and lighted blades materialized ready for the doctor’s grasp. The team was on auto-pilot.
A second doctor had come into the trauma room to see if the team needed help. He was an old friend of the doctor on duty, a kind and tolerant man, a devoted father and grandfather whose opinions were widely respected. Squatting behind Katsumi’s devastated head, the doctor on duty murmured,
"I don't feel right about doing this at all –"
"I know," the senior doctor agreed sympathetically, "but you have no choice."
The doctor on duty signaled to inject a sedative to ease Katsumi’s tortured spasms – which promptly terminated his breathing: if they'd stopped then it was all over. And then skillfully suctioning out the blood while pushing a curved steel blade with a bright light on its tip into the patient’s throat he manipulated a breathing tube down into Katsumi’s lungs so that they might mechanically pump oxygen directly in.
Death diverted for a moment, the team stepped back and gazed in dismay at their work.
"Well," the doctor on duty said, trying to offer some consolation to the stunned faces around him, "he's probably going to die anyway from the bleeding into his brain –"
– and now the responses, full of relief, were immediate and heartfelt –
"Yeah, yeah he will doc, he'll be dead soon anyway!"
"Oh yeah, it'll be over in no time now!"
“At least he’s not suffering any more –“
It's OK to die from bleeding into your brain, the doctor asked himself, but not from lack of air? High emotion and sympathy reach peculiar conclusions.
He left the trauma room and retreated to the physicians' lounge, where he found his older friend and colleague. Very gently the senior physician said,
"Don't beat yourself up over this, you did the right thing. And anyway, you had no choice."
"Really?” the doctor on duty replied, “we have no choice in doing this?"
"Well, the nurses would have been pretty startled if you'd just let him go – he's a suicide –"
It was a sincere observation: the elderly physician was Roman Catholic, for whom suicide is a sin. But then the patient was Japanese, who don't hold such monotheistic qualms against applying emotion or reason to the timing of one's last breath.
It's fine for me to have no choice, the doctor on duty thought, but what about Katsumi? Everyone checking into the hospital awake has to sign an advance directive, to tell us what they'd want us to do in such a situation. Katsumi had flown to our country simply on the appeal of our civil right to bear arms, but had neglected to fill out a health care proxy first. Could we pretend that his wishes were not painfully clear?
Seeing the younger man struggle, the senior doctor tried to comfort him.
"Well," he reminded the doctor on duty, almost apologetically, "you know they could have sued you if you hadn't done it."
Ah, the lawyers. And now perhaps they'll sue us for assaulting the patient against his will.
Having reviewed the CAT scan and seen the full extent of the brain damage, the doctor on duty was thinking bitterly to himself: what have I done? The man has wiped out his frontal lobes, where time exists, knowledge of past and future, of right and wrong. He can’t even hope for a guilty mind. And if his body survives he'll be blind, he'll be mentally retarded and, as the bullet demolished his tongue, he’ll be unable to speak. Not even to say if he’s hungry, or depressed, or in pain.
The horror is overwhelming. To proceed under such conditions requires denial, or gallows humor, and they had it at once –
"Well, perhaps you fixed him," the senior doctor observed, trying to lighten his colleague’s mood, "now he's had his lobotomy he probably won't want to kill himself anymore."
And soon the patient, on artificial life support, was moved off to the intensive care unit. The trauma room was quickly inhabited by others who demanded and deserved – and got – the trauma team’s total attention. They’re professional optimists: they have to move on. They'll be ready if you need them.
But in the intensive care unit Katsumi’s body was still alive from about one third from the front of his brain on back. His parents were identified in Japan. They were informed that the hospital had saved their son’s life: now blind, mentally retarded, speechless, a failed suicide, on mechanical life support. He was also septic from the dirt the bullet had dragged through his brain, and so still fighting, either for life, or to die – who could say?
SEVERAL DAYS LATER Katsumi’s parents arrived from Japan to observe the remains of their son.
Still confused and tormented by the events, the doctor on duty walked through his hospital to the intensive care unit, hoping to offer his sympathies to Katsumi’s family.
He found them standing at the foot of Katsumi’s bed. Two frail and tragic figures amidst the busy beeping and humming of machinery and tubes inserted into their son. They stood close together, heads bowed, hands clasped together before them at their waists. They lifted their heads slightly, but would not look at the doctor’s face.
The translator quietly apologized, and explained what he could. Buddhists, Japanese, elderly, Katsumi’s parents felt immense grief but no moral anger at their son's decision to end his time on earth. Living on a modest retirement pension themselves, the massive bill the hospital had attached to their son – like a ransom, so it seemed to them – was terrifying. At the prospect of taking a catastrophically brain damaged suicide back to Japan to perpetuate an inexplicable medico-technological intervention, they were shocked beyond words.
To the translator they had whispered – although of course dignity made such revelation to outsiders unthinkable – what on earth had we done over here? What kind of nightmare world was this? We had rented him the gun: can't a man even shoot himself in peace?
Ebiz has traveled and worked as a physician in Manhattan, Texas, Indonesia, and Afghanistan, and has now practiced for some years on small islands in the western Pacific ocean. He is currently writing a novel titled “Whose Blood and Judgment?” exploring the inherent conflict of interest between peacetime armies and the civilians they are paid to watch over.
KATSUMI BOOKED HIMSELF a flight to a large southern city in the United States, with a hotel room for 3 nights. He ate breakfast on arrival at his hotel, then took a cab to a local gun club. He'd never fired a handgun before as they're strictly prohibited in Japan, but the shop owner was cheerful and friendly and helped him choose a '45 from the display cabinet. Katsumi paid the fee to rent the gun and a firing range for half an hour. He shot 50 rounds into a target, and then took a cab back to his hotel. Later that afternoon he took another cab back to the gun shop, fired off another 50 rounds, then returned to his hotel room. A few hours later Katsumi went to the gun shop once again, rented the '45, and put a bullet through his head.
The medics were there within minutes. Oh, creatures that once were men. Brain and blood all over the ceiling, but not dead yet. Gasping for air through foaming blood and tissue leeching from holes in his skull and his throat.
Katsumi had put the gun under his chin and aimed at his brain. The bullet had passed through his tongue, then ricocheted off the bone at the base of his skull and torn through his optic nerves, his frontal lobes, and out the top of his head. Frontal lobes are where you do your thinking. That's where you know future and past, right and wrong, the difference between trees and dogs.
THE GUN CLUB was conveniently close to a hospital, and the medics dropped Katsumi off in the ER spraying blood with each pitiful attempt to breath, his oxygen saturation already down to 80% and dropping. His passport said he was in his mid 20's, though to the hospital staff he looked like a child laying there on the gurney, so small and helpless. Without a breathing tube into his lungs he was going to drown in his own blood within minutes, at most.
The trauma room was packed with nurses, orderlies, X-ray and respiratory and lab techs – at least 10 professionals jammed into that intense little box, ready to help. But help with what?
It was all too clear that any coherent contact with the planet for this poor man was in the past. The brain damage was massive.
But not dead yet. His heart was still beating. And he was still feeling pain. The trauma team had gone into other people's disasters together countless times. They'd saved their share and felt great about it. They’d lost enough too, and felt lousy together. Now they slipped into professional routines, inserting IV tubes, applying monitoring leads, checking vital signs, inspecting the body for other wounds, for evidence of retained neurological function.
What happened next was up to the doctor on duty, but he – a young man, not long out of training – was unsure what was the right thing to do here.
Clearly the patient had planned this out well in advance and seriously intended to die. And now the front third of his brain was mush. If he was left alone, or given pain medicine, it'd be over within seconds. And if they intervened – but what would he want them to do? He'd wanted to die when his brain was intact; would he want to live now that a big piece of it had been wiped out?
A man has the right to kill himself, the doctor pondered – the Supreme Court had said so. But did he also have the right to just go ahead and do it in a public hospital? And did that mean the medical staff had a duty to help him do so less uncomfortably, or was their duty, using the best technology though almost certainly against the patient’s will, to try and force what was left of him to remain alive?
The trauma team was pretty tight. They’d pumped on chests together and inserted tubes through mouths and necks and ribs, poured in buckets of chemicals and blood and applied jolt after jolt to jump-start dying bodies in that room. You can be a virgin in horror just as in sex, but there were no virgins here.
And when a fast decision had to be made on declaring medical futility or on complying with a patient’s unspoken wishes – in a case like this there are perhaps twenty or thirty seconds to think it through, about the dilemma of applying technology to the warehouse of the soul where it's all too likely that this soul is either ready to leave, or perhaps already has – this doctor liked to make a group decision. Legally the responsibility was all his, but in matters of ethics, of ultimate belief, of pure empathy, he preferred to resort to democracy. Katsumi was jerking, bleeding, gasping, dying horrifically before their eyes.
The doctor looked up towards his team – they were close together, leaning over the mangled, tormented body – and muttered, "For me I'd push morphine and leave him alone. He's about to go. His brain is done. It's rotten like this, but he wanted out and it's too late to go back now."
All those professional eyes faced the doctor, serious, worried, caring. Heads nodded – silently. Not a word. Not a murmur, no agreement nor disagreement, the way they'd made such decisions many times before. Even for hardened pros, it's not easy to generate a word when confronted with such horror in a young patient. Never mind a coherent decision. Not a yes, not a no, not even an I don't know.
If I push them just a little, the doctor thought, they'd go with me either way – and yet, and yet he was loathe to impose his feelings about life and death onto others. And he was not paid to be indecisive: in the trauma room that instant of ambiguity was intolerable –
"All right,” he muttered, “then we’ll tube him –"
– and as he moved towards the patient's head the room surged back into action. The best way to avoid moral doubt, of course, is always to stay busy, to keep thinking of something else. Eager hands positioned the shoulders and head, machinery shuffled into place, suction catheters and lighted blades materialized ready for the doctor’s grasp. The team was on auto-pilot.
A second doctor had come into the trauma room to see if the team needed help. He was an old friend of the doctor on duty, a kind and tolerant man, a devoted father and grandfather whose opinions were widely respected. Squatting behind Katsumi’s devastated head, the doctor on duty murmured,
"I don't feel right about doing this at all –"
"I know," the senior doctor agreed sympathetically, "but you have no choice."
The doctor on duty signaled to inject a sedative to ease Katsumi’s tortured spasms – which promptly terminated his breathing: if they'd stopped then it was all over. And then skillfully suctioning out the blood while pushing a curved steel blade with a bright light on its tip into the patient’s throat he manipulated a breathing tube down into Katsumi’s lungs so that they might mechanically pump oxygen directly in.
Death diverted for a moment, the team stepped back and gazed in dismay at their work.
"Well," the doctor on duty said, trying to offer some consolation to the stunned faces around him, "he's probably going to die anyway from the bleeding into his brain –"
– and now the responses, full of relief, were immediate and heartfelt –
"Yeah, yeah he will doc, he'll be dead soon anyway!"
"Oh yeah, it'll be over in no time now!"
“At least he’s not suffering any more –“
It's OK to die from bleeding into your brain, the doctor asked himself, but not from lack of air? High emotion and sympathy reach peculiar conclusions.
He left the trauma room and retreated to the physicians' lounge, where he found his older friend and colleague. Very gently the senior physician said,
"Don't beat yourself up over this, you did the right thing. And anyway, you had no choice."
"Really?” the doctor on duty replied, “we have no choice in doing this?"
"Well, the nurses would have been pretty startled if you'd just let him go – he's a suicide –"
It was a sincere observation: the elderly physician was Roman Catholic, for whom suicide is a sin. But then the patient was Japanese, who don't hold such monotheistic qualms against applying emotion or reason to the timing of one's last breath.
It's fine for me to have no choice, the doctor on duty thought, but what about Katsumi? Everyone checking into the hospital awake has to sign an advance directive, to tell us what they'd want us to do in such a situation. Katsumi had flown to our country simply on the appeal of our civil right to bear arms, but had neglected to fill out a health care proxy first. Could we pretend that his wishes were not painfully clear?
Seeing the younger man struggle, the senior doctor tried to comfort him.
"Well," he reminded the doctor on duty, almost apologetically, "you know they could have sued you if you hadn't done it."
Ah, the lawyers. And now perhaps they'll sue us for assaulting the patient against his will.
Having reviewed the CAT scan and seen the full extent of the brain damage, the doctor on duty was thinking bitterly to himself: what have I done? The man has wiped out his frontal lobes, where time exists, knowledge of past and future, of right and wrong. He can’t even hope for a guilty mind. And if his body survives he'll be blind, he'll be mentally retarded and, as the bullet demolished his tongue, he’ll be unable to speak. Not even to say if he’s hungry, or depressed, or in pain.
The horror is overwhelming. To proceed under such conditions requires denial, or gallows humor, and they had it at once –
"Well, perhaps you fixed him," the senior doctor observed, trying to lighten his colleague’s mood, "now he's had his lobotomy he probably won't want to kill himself anymore."
And soon the patient, on artificial life support, was moved off to the intensive care unit. The trauma room was quickly inhabited by others who demanded and deserved – and got – the trauma team’s total attention. They’re professional optimists: they have to move on. They'll be ready if you need them.
But in the intensive care unit Katsumi’s body was still alive from about one third from the front of his brain on back. His parents were identified in Japan. They were informed that the hospital had saved their son’s life: now blind, mentally retarded, speechless, a failed suicide, on mechanical life support. He was also septic from the dirt the bullet had dragged through his brain, and so still fighting, either for life, or to die – who could say?
SEVERAL DAYS LATER Katsumi’s parents arrived from Japan to observe the remains of their son.
Still confused and tormented by the events, the doctor on duty walked through his hospital to the intensive care unit, hoping to offer his sympathies to Katsumi’s family.
He found them standing at the foot of Katsumi’s bed. Two frail and tragic figures amidst the busy beeping and humming of machinery and tubes inserted into their son. They stood close together, heads bowed, hands clasped together before them at their waists. They lifted their heads slightly, but would not look at the doctor’s face.
The translator quietly apologized, and explained what he could. Buddhists, Japanese, elderly, Katsumi’s parents felt immense grief but no moral anger at their son's decision to end his time on earth. Living on a modest retirement pension themselves, the massive bill the hospital had attached to their son – like a ransom, so it seemed to them – was terrifying. At the prospect of taking a catastrophically brain damaged suicide back to Japan to perpetuate an inexplicable medico-technological intervention, they were shocked beyond words.
To the translator they had whispered – although of course dignity made such revelation to outsiders unthinkable – what on earth had we done over here? What kind of nightmare world was this? We had rented him the gun: can't a man even shoot himself in peace?
Ebiz has traveled and worked as a physician in Manhattan, Texas, Indonesia, and Afghanistan, and has now practiced for some years on small islands in the western Pacific ocean. He is currently writing a novel titled “Whose Blood and Judgment?” exploring the inherent conflict of interest between peacetime armies and the civilians they are paid to watch over.
