@GregAbbott_TX since you eliminated a suicide hotline for LGBTQ folks just want you to have a clear understanding of what that means... so when a suicide with a pulse comes in, from a gunshot to the head, it usually draws a crowd. The surgeons are there, the neurosurgeons, the ED
staff. I'm at the head of the bed, usually with a resident physician as well. EMS is usually panicked and transfer the patient over to the hospital stretcher fast. Many times, the patient is posturing, arms out stiffly, the result of a massive neurological injury. My first
concern is the airway, which if they shot themself in the temple is usually not too bad. If they shoot themselves in the mouth the airway is a nightmare. Blood, pieces of teeth and skull and tongue... If we can we give them a paralytic which allows us to get a tube into their
trachea through the mouth or, if necessary, by cutting a hole in their throat. Now it's time to look at the wound. Very difficult to tell in real life which one is entry and which is exit. They both swell so much the skull feels like a deflated football. It's not really important
which is which in the moment. If it crosses midline, it's bad. Likely, we have checked for neuro status ahead of the paralytic, often by checking a corneal reflex which is just touching their eyeball to see if they blink. If they blink, there's some brain function left...
If they're stable we might get them to the CT scanner. We usually try to bandage the head before the scan, so I pick up the brain pieces on the gurney and throw them in the trash. One time a kid had vomited scrambled eggs and I couldn't tell what was brain and what was egg. The
bandage is all for cosmesis. In case the mom comes in. If they make it to the scanner, and the bullet transected the Circle of Willis (brain blood vessels), its basically over. Sometimes we can keep them alive long enough to be an organ donor, if we can get the parents to agree.
Which brings me to the parents. They all react differently. Some scream. Some are mad at us. Some shriek. Some I tell in the waiting room and the look on their face is one of utter pain but they get in their car and drive home. They can't bring themselves to see their child like
this. For the parents they're always the little two year old who sprinted to the front door to see mom after work, or the 6 year old with the wiggly tooth, or the teenager proud of making the JV team. It's life ending, to be sure, for all of them. Suicide touches everyone. The
mom, dad, grandparents, siblings, friends, nurses, fits responders, and the whomever it was who heard the bang and the thud and went upstairs to find their loved one had blown out their brains. It's impulsive and stupid and unforgettable.
And Greg here's the thing for you to ponder: if it happens because someone loved differently then you do, and loved someone of the same gender, and you deliberately went out of your way to take away their lifeline, it says a lot more about you then it does to them.

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More from @DBarkhuff

24 Sep
I went to Harvard Medical School, trained at University of New Mexico in Emergency Medicine, am an attending physician and Associate Professor at a Level 1 Trauma Center, have multiple research publications, personally treated countless COVID's, teach a college class on clinical
research...and all of that background and training allows me to know, beyond the shadow of a doubt, I am 100% completely incapable of doing my own 3 phase clinical trial establishing safety, efficacy, and effectiveness after IRB approval having appropriate statistical power
to produce a .05 alpha with multiple primary endpoints including death and hospitalization. I don't "do my own research." I listen to experts about COVID, because I'm not one, and neither are you.
Read 4 tweets
22 Aug
SEAL teams truth: one guy crawled under fire twice into a prison overrun by Taliban to save an American, one guy got shot 19 times and woke up after being knocked unconscious and killed three insurgents with his pistol, one guy ran out of ammo on a hillside in the Korengal and
Found with an empty 9 mm by his side, one guy took fire from a talib on top of a hill thirty feet away and dialed his SR-25 down to zero and smoked him in half a second to save the 2 other SEALS he was with, 8 guys hopped on a bird that took an rpg on final trying to save their
Boys, one guy hopped on a frag, one guy hopped on a hostage so they would live, an entire assault troop of 17 guys died on a hilltop reenforcing another sof unit, one guy died in a rooftop breaking up an ISIS assault, one guy lost both his legs in an IED and waiting for evac
Read 5 tweets
13 Aug
So first of all I'm not an "Afghanistan guy," my combat was Iraq and Africa. I spent 90 days in Kabul, that's it. But here's the thing. Wars never end perfectly. Never. Civil War led to the failures of Reconstruction, WW1 led to WW2, WW2 to the Cold War and Iron Curtain, Korea is
still a thing, Vietnam was the fall of Saigon. My point is, it's never the best case scenario. A lot of my fellow veterans spent a lot of their youth in the Hindu Kush, and I get it. But for us, we ought not to forget our job was to follow lawful orders, watch one
another's backs, and kick the Taliban's ass when we met them in battle. We did that. We denied a safe haven to AQ and kept the homeland safe for decades. The mission creep of nation building was, in all probability, undoable. But you all served with honor and courage. And that's
Read 4 tweets
5 Aug
If you don’t want to get vaccinated and you can’t breath then I have to “intubate” you. This starts by about 6-8 people all in masks so you can’t see their faces standing over you and starting multiple IVs in your arm, foot, and etc. Then we give you medicine to make you loopy
And another medicine to paralyze you. Next I use a piece of metal that looks like a duck beak to open your mouth and push your tongue out of the way so I can see your vocal cords where I then insert a rigid plastic tube. We admit you to the ICU, after the nurses put a Foley
Catheter up your urethra (hopefully you don’t have a big prostate). You’ll spend a couple of weeks facedown in bed, sometimes paralyzed the whole time, with drugs like precedex coursing through your veins. Every 4 hours the nurse will draw blood, every day you get a chest X-ray
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8 Jun
The problem with @EricGreitens.

First of all I've peripherally known Greitens for 20 years. He was a BUDs class ahead, and as a 22 yr old ensign, we looked up to him. He was a Rhodes scholar and I dunno, maybe 25-27. And that's enough when you're 22.
9/11 happened. I remember standing in line in front of the chow hall, with Greitens there, holding court to a bunch of 18 yr olds, telling us there would be some Tomohawks, but no ground combat. We believed him. This wasn't even October 2001.
We all went through BUDS and got assigned to Teams. Back then (maybe its true now, the officers who wanted to stay West Coast and surf and be cool guy navy seal said they wanted to stay in SD, and all ended up getting assigned to SBU teams. So not with SEALs. Just RHIBS, which
Read 10 tweets
31 May
Hey guys, a happy Memorial Day to you all. It feels odd to write those words in a way, as happiness isn’t necessarily the first emotion that springs to mind when we think of our lost friends. For me I always think of 2 people most directly: Nate Hardy and Dan Malcom. Nate was an
absolute lion of a man, killed in Iraq in 2008. He was my closest loss in the wars, but I wasn't there for his death, which happened because he did a room entry on a mission to kill some AQ guys who had been, amongst other things, putting S vests on Iraqi adults who had Downs
Syndrome and walking them into markets. He went into the room as the second guy, first guy got shot and he didn’t hesitate, just went in. He had a 9 month old son, who is almost a teenager now. When he died and they took off his armor he had an American Flag folded underneath.
Read 7 tweets

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