{"id":1551,"date":"2017-06-27T15:00:50","date_gmt":"2017-06-27T15:00:50","guid":{"rendered":"https:\/\/niemanstoryboard.org\/2017\/06\/27\/thomas-curwen-and-surgeon-races-to-save-a-life-during-l-a-s-shooting-season\/"},"modified":"2025-01-15T19:33:21","modified_gmt":"2025-01-15T19:33:21","slug":"thomas-curwen-and-surgeon-races-to-save-a-life-during-l-a-s-shooting-season","status":"publish","type":"post","link":"https:\/\/niemanstoryboard.org\/2017\/06\/27\/thomas-curwen-and-surgeon-races-to-save-a-life-during-l-a-s-shooting-season\/","title":{"rendered":"Thomas Curwen and &#8220;Surgeon races to save a life during L.A.&#8217;s shooting season&#8221;"},"content":{"rendered":"    \n    <div class=\"  core-block\">\n        <div class=\"block block--core block--core-paragraph mb-5   max-w-screen-full mx-auto\">\n            \n<p class=\"has-drop-cap\">Over his career at the Los Angeles Times, Thomas Curwen has written and edited for the Outdoor section, the Book Review, the features desk and the Metro desk. Despite his wide-ranging interests, his enduring passion is for stories that, as he puts it, depict \u201cthe split-second events that change the predictable course of life.\u201d That passion paid off in his Pulitzer-winning contribution as part of the team that reported on the San Bernardino terrorist attack, and his Pulitzer finalist work about a grizzly bear attack in Montana.<\/p>\n\n        <\/div>\n    <\/div>\n    \n    <div class=\"  core-block\">\n        <div class=\"block block--core block--core-classic mb-5   max-w-screen-full mx-auto\">\n            \n\n\n        <\/div>\n    <\/div>\n    \n    <div class=\"  core-block\">\n        <div class=\"block block--core block--core-paragraph mb-5   max-w-screen-full mx-auto\">\n            \n<p>A story on gun violence, then, would fit nicely with Curwen\u2019s interests. But when he set out to report a story on the ratcheting trend in 2013, on the heels the Sandy Hook massacre, Curwen noticed the market was saturated with pieces that focused on gunmen or the victims. So he found a different main subject: the trauma surgeon.<\/p>\n\n        <\/div>\n    <\/div>\n    \n    <div class=\"  core-block\">\n        <div class=\"block block--core block--core-classic mb-5   max-w-screen-full mx-auto\">\n            \n\n\n        <\/div>\n    <\/div>\n    \n    <div class=\"  core-block\">\n        <div class=\"block block--core block--core-paragraph mb-5   max-w-screen-full mx-auto\">\n            \n<p>Five months after securing clearance to Harbor-UCLA Medical Center, Curwen and a photographer witnessed, from inside the operating room, as Dr. Brant Putnam raced to save the life of a teenage boy. The resulting story is a pulsating and spare tick-tock of an all-too-common&nbsp;phenomenon in American hospitals.<\/p>\n\n        <\/div>\n    <\/div>\n    \n    <div class=\"  core-block\">\n        <div class=\"block block--core block--core-classic mb-5   max-w-screen-full mx-auto\">\n            \n\n\n        <\/div>\n    <\/div>\n    \n    <div class=\"  core-block\">\n        <div class=\"block block--core block--core-paragraph mb-5   max-w-screen-full mx-auto\">\n            \n<p>This interview has been edited and condensed.<\/p>\n\n        <\/div>\n    <\/div>\n    \n    <div class=\"  core-block\">\n        <div class=\"block block--core block--core-classic mb-5   max-w-screen-full mx-auto\">\n            \n\n\n        <\/div>\n    <\/div>\n    \n    <div class=\"  core-block\">\n        <div class=\"block block--core block--core-paragraph mb-5   max-w-screen-full mx-auto\">\n            \n<p><strong>You\u2019ve worn a lot of hats at the Times over the years. When you reported this piece, were you on a specific beat? How did you find this story?<\/strong><\/p>\n\n        <\/div>\n    <\/div>\n    \n    <div class=\"  core-block\">\n        <div class=\"block block--core block--core-classic mb-5   max-w-screen-full mx-auto\">\n            \n\n\n        <\/div>\n    <\/div>\n    \n    <div class=\"  core-block\">\n        <div class=\"block block--core block--core-paragraph mb-5   max-w-screen-full mx-auto\">\n            \n<p>Gun violence in America had once again moved to the front page, and most stories, it seemed, focused on the shooters and the dead. I wanted to find a different angle. Two years earlier, I had written about the firefighters and paramedics who arrived on the scene of&nbsp;<a href=\"http:\/\/articles.latimes.com\/2011\/oct\/20\/local\/la-me-adv-sealbeach-firefighters-20111020\">a similar tragedy at a hair salon in Seal Beach<\/a>, and I knew that every time a bullet found its victim, it set off a ripple of effect, concentric rings running throughout our society, changing the lives of families, bystanders, medical professionals, even those reading the news.<\/p>\n\n        <\/div>\n    <\/div>\n    \n    <div class=\"  core-block\">\n        <div class=\"block block--core block--core-classic mb-5   max-w-screen-full mx-auto\">\n            \n\n\n        <\/div>\n    <\/div>\n    \n    <div class=\"  core-block\">\n        <div class=\"block block--core block--core-paragraph mb-5   max-w-screen-full mx-auto\">\n            \n<p>I wanted to see how surgeons and emergency room personnel cope with these senseless, almost daily shootings, and I began calling local hospitals to see if I might be able to report this story from their perspective.<\/p>\n\n        <\/div>\n    <\/div>\n    \n    <div class=\"  core-block\">\n        <div class=\"block block--core block--core-classic mb-5   max-w-screen-full mx-auto\">\n            \n\n\n        <\/div>\n    <\/div>\n    \n    <div class=\"  core-block\">\n        <div class=\"block block--core block--core-paragraph mb-5   max-w-screen-full mx-auto\">\n            \n<p><strong>For you, is this a gun violence story or a trauma surgeon story? Or both? Or neither?<\/strong><\/p>\n\n        <\/div>\n    <\/div>\n    \n    <div class=\"  core-block\">\n        <div class=\"block block--core block--core-classic mb-5   max-w-screen-full mx-auto\">\n            \n\n\n        <\/div>\n    <\/div>\n    \n    <div class=\"  core-block\">\n        <div class=\"block block--core block--core-paragraph mb-5   max-w-screen-full mx-auto\">\n            \n<p>This&nbsp;is the story about a random act of violence that upended the life of the victim and his family, but by focusing on the surgeon who treats gunshot wounds almost every day, I wanted to see if the experience was somehow uneventful. This intrigued me: How can the world collapse at the point of a gun, bringing with it death and tragedy, and leave some unscathed, even undeterred by these events? How do they understand gun violence (and this country\u2019s inability to stop the bloodshed)?<\/p>\n\n        <\/div>\n    <\/div>\n    \n    <div class=\"  core-block\">\n        <div class=\"block block--core block--core-classic mb-5   max-w-screen-full mx-auto\">\n            \n\n\n        <\/div>\n    <\/div>\n    \n    <div class=\"  core-block\">\n        <div class=\"block block--core block--core-paragraph mb-5   max-w-screen-full mx-auto\">\n            \n<p><strong>In terms of your final narrative product, it feels spare, or at least as though it could\u2019ve been much longer, with far more context and backstory. Why did you choose to focus the aperture in this way?<\/strong><\/p>\n\n        <\/div>\n    <\/div>\n    \n    <div class=\"  core-block\">\n        <div class=\"block block--core block--core-classic mb-5   max-w-screen-full mx-auto\">\n            \n\n\n        <\/div>\n    <\/div>\n    \n    <div class=\"  core-block\">\n        <div class=\"block block--core block--core-paragraph mb-5   max-w-screen-full mx-auto\">\n            \n<p>After reporting the story, I realized I had a straightforward chronology. I just needed to get the clock running in the most efficient and economical way, introducing the reader to the emergency room and the two main characters: the surgeon and the boy. Beyond that, I wanted to get out of the way, laying out each detail in the most clear and economic manner, avoiding unnecessary detours and medical jargon. When writing action sequences, I find that short sentences are the most effective, staccato bursts of language, that convey speed, franticness and urgency. Longer sentences would have slowed the rhythm of the prose, and these are no moments to linger over. A life was at stake.<\/p>\n\n        <\/div>\n    <\/div>\n    \n    <div class=\"  core-block\">\n        <div class=\"block block--core block--core-classic mb-5   max-w-screen-full mx-auto\">\n            \n\n\n        <\/div>\n    <\/div>\n    \n    <div class=\"  core-block\">\n        <div class=\"block block--core block--core-paragraph mb-5   max-w-screen-full mx-auto\">\n            \n<p>Similarly, I felt that too much backstory \u2013 those detours \u2013 would have distracted the reader. This account had to be as focused and as sharp as possible.<\/p>\n\n        <\/div>\n    <\/div>\n    \n    <div class=\"  core-block\">\n        <div class=\"block block--core block--core-classic mb-5   max-w-screen-full mx-auto\">\n            \n\n\n        <\/div>\n    <\/div>\n    \n    <div class=\"  core-block\">\n        <div class=\"block block--core block--core-paragraph mb-5   max-w-screen-full mx-auto\">\n            \n<p><strong>In many ways, this story reminded me of Jon Franklin\u2019s famous piece \u201cMrs. Kelly\u2019s Monster,\u201d which won the first Pulitzer Prize for feature writing. Are you familiar with that story? Did you take inspiration from that or any other writing when putting this together?<\/strong><\/p>\n\n        <\/div>\n    <\/div>\n    \n    <div class=\"  core-block\">\n        <div class=\"block block--core block--core-classic mb-5   max-w-screen-full mx-auto\">\n            \n\n\n        <\/div>\n    <\/div>\n    \n    <div class=\"  core-block\">\n        <div class=\"block block--core block--core-paragraph mb-5   max-w-screen-full mx-auto\">\n            \n<p>I am flattered by the association, and yes, I am familiar with Franklin\u2019s masterful story. It certainly has become the hallmark for medical narratives, to which I would add Tom Hallman\u2019s&nbsp;<a href=\"http:\/\/www.oregonlive.com\/editors\/index.ssf\/2013\/04\/the_boy_behind_the_mask.html\">\u201cThe Boy Behind the Mask.\u201d<\/a><\/p>\n\n        <\/div>\n    <\/div>\n    \n    <div class=\"  core-block\">\n        <div class=\"block block--core block--core-classic mb-5   max-w-screen-full mx-auto\">\n            \n\n\n        <\/div>\n    <\/div>\n    \n    <div class=\"  core-block\">\n        <div class=\"block block--core block--core-paragraph mb-5   max-w-screen-full mx-auto\">\n            \n<p>As much as I admire these stories, I don\u2019t know if I can say if they influenced me. I read widely, drawing upon a lot of&nbsp;<a href=\"https:\/\/niemanstoryboard.org\/stories\/whys-this-so-good-no-33-michael-paterniti-long-fall-of-111-heavy-thomas-curwen\/\">different narrative styles<\/a>, and in this case, I credit my sources, namely Dr. Putnam. Once I had completed a draft of the story, I met with him, and we talked about our four hours in the operating room, a conversation that allowed me re-report the story and go deeper in the material.<\/p>\n\n        <\/div>\n    <\/div>\n    \n    <div class=\"  core-block\">\n        <div class=\"block block--core block--core-classic mb-5   max-w-screen-full mx-auto\">\n            \n\n\n        <\/div>\n    <\/div>\n    \n    <div class=\"  core-block\">\n        <div class=\"block block--core block--core-pullquote mb-5   max-w-screen-full mx-auto\">\n            \n<figure class=\"wp-block-pullquote\"><blockquote><p>&#8220;After reporting the story, I realized I had a straightforward chronology. I just needed to get the clock running in the most efficient and economical way, introducing the reader to the emergency room and the two main characters: the surgeon and the boy. Beyond that, I wanted to get out of the way.&#8221;<\/p><\/blockquote><\/figure>\n\n        <\/div>\n    <\/div>\n    \n    <div class=\"  core-block\">\n        <div class=\"block block--core block--core-classic mb-5   max-w-screen-full mx-auto\">\n            \n\n\n        <\/div>\n    <\/div>\n    \n    <div class=\"  core-block\">\n        <div class=\"block block--core block--core-paragraph mb-5   max-w-screen-full mx-auto\">\n            \n<p><strong>You mentioned to me that one of the most difficult aspects of reporting was getting access to the surgical operation. How did that process work? Did you feel that being in the room while it was happening was essential?<\/strong><\/p>\n\n        <\/div>\n    <\/div>\n    \n    <div class=\"  core-block\">\n        <div class=\"block block--core block--core-classic mb-5   max-w-screen-full mx-auto\">\n            \n\n\n        <\/div>\n    <\/div>\n    \n    <div class=\"  core-block\">\n        <div class=\"block block--core block--core-paragraph mb-5   max-w-screen-full mx-auto\">\n            \n<p>The challenge of reporting any story in a hospital setting is HIPAA (Health Insurance Portability and Accountability Act), which prohibits medical personnel from disclosing information about their patients.<\/p>\n\n        <\/div>\n    <\/div>\n    \n    <div class=\"  core-block\">\n        <div class=\"block block--core block--core-classic mb-5   max-w-screen-full mx-auto\">\n            \n\n\n        <\/div>\n    <\/div>\n    \n    <div class=\"  core-block\">\n        <div class=\"block block--core block--core-paragraph mb-5   max-w-screen-full mx-auto\">\n            \n<p>In the past, I\u2019ve secured permission from&nbsp;<a href=\"http:\/\/articles.latimes.com\/2010\/dec\/18\/local\/la-me-1219-end-of-life-doctor-20101219\">patients before I began reporting<\/a>. They would sign a waiver allowing me access to their records and histories.<\/p>\n\n        <\/div>\n    <\/div>\n    \n    <div class=\"  core-block\">\n        <div class=\"block block--core block--core-classic mb-5   max-w-screen-full mx-auto\">\n            \n\n\n        <\/div>\n    <\/div>\n    \n    <div class=\"  core-block\">\n        <div class=\"block block--core block--core-paragraph mb-5   max-w-screen-full mx-auto\">\n            \n<p>In this case, however, any individual coming into a hospital with a gunshot wound would not be in any position \u2013 physically or mentally \u2013 to sign any waiver, let alone understand who I was and what I was attempting to do.<\/p>\n\n        <\/div>\n    <\/div>\n    \n    <div class=\"  core-block\">\n        <div class=\"block block--core block--core-classic mb-5   max-w-screen-full mx-auto\">\n            \n\n\n        <\/div>\n    <\/div>\n    \n    <div class=\"  core-block\">\n        <div class=\"block block--core block--core-paragraph mb-5   max-w-screen-full mx-auto\">\n            \n<p>As a result, the photographer on the story \u2013 Barbara Davidson \u2013 and I were able to work out an arrangement with the hospital and their attorneys to report the story under the condition that once the patient was in recovery, we would explain our intentions. If the patient agreed \u2013 and then signed the waiver \u2013 we could proceed. If the patient did not agree, we would destroy my notes and images.<\/p>\n\n        <\/div>\n    <\/div>\n    \n    <div class=\"  core-block\">\n        <div class=\"block block--core block--core-classic mb-5   max-w-screen-full mx-auto\">\n            \n\n\n        <\/div>\n    <\/div>\n    \n    <div class=\"  core-block\">\n        <div class=\"block block--core block--core-paragraph mb-5   max-w-screen-full mx-auto\">\n            \n<p>It was a gamble, and we were fortunate that Harbor-UCLA Medical Center agreed to these terms. In the end, the hospital staff \u2013 and the patient and his family \u2013 understood the importance of our work.<\/p>\n\n        <\/div>\n    <\/div>\n    \n    <div class=\"  core-block\">\n        <div class=\"block block--core block--core-classic mb-5   max-w-screen-full mx-auto\">\n            \n\n\n        <\/div>\n    <\/div>\n    \n    <div class=\"  core-block\">\n        <div class=\"block block--core block--core-paragraph mb-5   max-w-screen-full mx-auto\">\n            \n<p><strong>The story reads quickly, at times during the surgery almost like an avalanche, an assault on the senses. Was it intentional to create a sweeping energy like that?<\/strong><\/p>\n\n        <\/div>\n    <\/div>\n    \n    <div class=\"  core-block\">\n        <div class=\"block block--core block--core-classic mb-5   max-w-screen-full mx-auto\">\n            \n\n\n        <\/div>\n    <\/div>\n    \n    <div class=\"  core-block\">\n        <div class=\"block block--core block--core-paragraph mb-5   max-w-screen-full mx-auto\">\n            \n<p>It\u2019s a good observation, and yes, that was the intent: to capture the chaos, the uncertainty, the fear and terror of this moment, these seconds that passed as hours on the operating table.<\/p>\n\n        <\/div>\n    <\/div>\n    \n    <div class=\"  core-block\">\n        <div class=\"block block--core block--core-classic mb-5   max-w-screen-full mx-auto\">\n            \n\n\n        <\/div>\n    <\/div>\n    \n    <div class=\"  core-block\">\n        <div class=\"block block--core block--core-image mb-5   max-w-screen-full mx-auto\">\n            \n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"683\" src=\"https:\/\/niemanstoryboard.org\/app\/uploads\/2024\/03\/curwen-gunshot-victim-1024x683.jpg\" alt=\"\" class=\"wp-image-6536\" srcset=\"https:\/\/niemanstoryboard.org\/app\/uploads\/2024\/03\/curwen-gunshot-victim-1024x683.jpg 1024w, https:\/\/niemanstoryboard.org\/app\/uploads\/2024\/03\/curwen-gunshot-victim-300x200.jpg 300w, https:\/\/niemanstoryboard.org\/app\/uploads\/2024\/03\/curwen-gunshot-victim-768x512.jpg 768w, https:\/\/niemanstoryboard.org\/app\/uploads\/2024\/03\/curwen-gunshot-victim-1536x1024.jpg 1536w, https:\/\/niemanstoryboard.org\/app\/uploads\/2024\/03\/curwen-gunshot-victim-2048x1365.jpg 2048w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n        <\/div>\n    <\/div>\n    \n    <div class=\"  core-block\">\n        <div class=\"block block--core block--core-classic mb-5   max-w-screen-full mx-auto\">\n            \n\n\n        <\/div>\n    <\/div>\n    \n    <div class=\"  core-block\">\n        <div class=\"block block--core block--core-html mb-5   max-w-screen-full mx-auto\">\n            \n<h2><a href=\"http:\/\/www.latimes.com\/local\/la-me-gunshot-surgeon-20130818-dto-htmlstory.html\"><strong>Surgeon races to save a life during L.A.\u2019s shooting season<\/strong><\/a><\/h2>\n<em>By Thomas Curwen<\/em><br \/>\n<br \/>\n<em>Originally published August 18, 2013<\/em><br \/>\n<br \/>\nFrom the entry wound \u2014 the size of a nickel \u2014 Dr. Brant Putnam guesses that the bullet is a .45, but it&#8217;s what he can&#8217;t see that worries him most. <span class='article-annotation-mod article-annotation-active'><a class='article-annotation-control'><\/a><span class='annotation annotation-red'>What went into your decision to start in the hospital, almost inside the head of the surgeon we haven\u2019t met?<\/span><span class='annotation annotation-blue'>I am great advocate for telling a story as close to the point of view of the protagonist as possible. This story is Dr. Putnam\u2019s story, and I wanted to establish from the very beginning. All that we\u2019re seeing and experiencing comes from his perspective. Technically, this makes attributions more invisible and creates a more immediate, less intrusive reading experience.<\/span><\/span><br \/>\n<br \/>\nThe boy, a teenager most likely, lies naked on Bed 2 in a trauma bay at Harbor-UCLA Medical Center. His brown skin, slick with sweat, is ashen.<br \/>\n<br \/>\n&#8220;What&#8217;s your name?&#8221; a resident asks as half a dozen doctors and nurses circle him.<br \/>\n<br \/>\nThe boy can&#8217;t answer.<br \/>\n<br \/>\n&#8220;Ohhh,&#8221; he moans.<br \/>\n<br \/>\n&#8220;How old are you, sir?&#8221;<br \/>\n<br \/>\n&#8220;Awww.&#8221;<br \/>\n<br \/>\nThe boy&#8217;s hipbones delicately protrude from his narrow waist. He has a woman&#8217;s name tattooed down his right arm from elbow to wrist and the bullet hole is to the right of his navel. <span class='article-annotation-mod article-annotation-active'><a class='article-annotation-control'><\/a><span class='annotation annotation-red'>These details are incredibly intimate. What purpose was served by including them here?<\/span><span class='annotation annotation-blue'>I wanted to capture the vulnerability of the human body, most obvious when it is stripped naked. The boy\u2019s skinny frame and his tattoo were the canvas of his youth, possibly his innocence, and the bullet hole, the stunning interruption. I also believe that the more intimate the detail, the more universal the appreciation. I didn\u2019t want the reader to be distracted by questions of race which often figure in stories about gun violence. I wanted these hipbones, that right arm, that naval help connect us immediately to this stranger, this boy, just like all of us.<\/span><\/span><br \/>\n<br \/>\nPutnam, chief of trauma, stands back and watches and listens. He is puzzled that the wound is hardly bleeding.<br \/>\n<br \/>\n&#8220;Sit up for me.&#8221;<br \/>\n<br \/>\n&#8220;Ohhh.&#8221;<br \/>\n<br \/>\nThere is no sign of an exit wound.<br \/>\n<br \/>\n&#8220;Hey. Wake up.&#8221;<br \/>\n<br \/>\nA resident slaps the boy. They need him conscious.<br \/>\n<br \/>\nPutnam knows the surge of adrenaline that brought the boy this far is nearly spent. If his <a href=\"http:\/\/www.latimes.com\/local\/la-me-gunshot-surgeon-20130818-dto-htmlstory.html\">blood pressure<\/a> crashes, his heart will stop. Putnam wonders if it is too late.<br \/>\n<br \/>\n&#8220;Let&#8217;s go to the OR,&#8221; he says, loud enough to get everyone&#8217;s attention.<br \/>\n<br \/>\nThe season of shootings has begun on time. <span class='article-annotation-mod article-annotation-active'><a class='article-annotation-control'><\/a><span class='annotation annotation-red'>Were you not worried that this \u201cseason of shootings\u201d may need some explaining?<\/span><span class='annotation annotation-blue'>It is always a challenge to weave statistics into a narrative, but in this case, they are critical. They explain the urgency of this story and lay out why we are here in the first place. So rather than present the numbers like a news story (107 GSWs in three months), I wanted to set them up with a quick lead-in \u2013 alliterative, perhaps disarmingly poetic \u2013 with the hope that any confusion would quickly be answered by the consecutive sentences.<\/span><\/span><br \/>\n<br \/>\nLast year, from July through September, this Torrance hospital treated 107 gunshot victims, the highest number in the county.<br \/>\n<br \/>\nThis year, four GSWs \u2014 medical shorthand for gunshot wounds \u2014 arrived on the first day of summer. One was a suicide and three were assaults. Three died and one would probably be discharged in a few days.<br \/>\n<br \/>\nNow, on June 23, two more have come in, both teenagers, both assaults. They walked through the front door at 2:25 a.m., no EMTs, no police. <span class='article-annotation-mod article-annotation-active'><a class='article-annotation-control'><\/a><span class='annotation annotation-red'>Were you spending the night in the hospital, waiting for a shooting victim to come in? What was it like when one did come in? Relief? Fear?<\/span><span class='annotation annotation-blue'>Barbara and I had spent three previous Saturdays at the hospital from 3 p.m. until 1 a.m., just waiting. We picked Saturdays, we picked the summer, we picked late nights because these are prime-time for shootings. On each occasion, nothing happened, and yes, we were surprised. It was our fourth night, around 2:15 a.m., and we were just about to call it quits \u2013 resigned to another night coming up with nothing \u2013 when these two boys walked into the emergency room. The chaos of their sudden arrival caught us off-guard, and suddenly we were off and running. With no time for reflection, for relief or fear, we were running with Dr. Putnam from the ER to the OR, changing into gowns, masks and boots and trying to stay out of the way.<\/span><\/span><br \/>\n<br \/>\nThe hospital staff calls it the homeboy ambulance service: patients brought in with injuries often from gang shootings.<br \/>\n<br \/>\nPutnam can see that one of the boys will be OK. He has a clean wound through the shoulder.<br \/>\n<br \/>\nThe boy with the nickel-sized bullet hole is far worse, and they know nothing about him. No name, no age, no family. For now, they call him Zinc, one of the pseudonyms the hospital uses for its John Does.<br \/>\n<br \/>\nEmergency departments in hospitals throughout America have physicians like Putnam, doctors who specialize in saving the lives of shooting victims.<br \/>\n<br \/>\nOther traumas, like concussions and automobile accidents, can be subtle and require imaging to see what&#8217;s hidden. Gun injuries don&#8217;t hide their tracks, but they are just as much a mystery, a puzzle put together by the surgeon as seconds race by.<br \/>\n<br \/>\nNo matter the clarity of the injury, the damage can extend like concentric rings beyond the trajectory of the bullet. There is the blast effect, the sometimes fatal bruising that can occur to organs in the vicinity of a wound. There is the so-called triad of death, the interplay between body temperature, blood acidity and coagulation.<br \/>\n<br \/>\nThere is ancillary debris \u2014 shards of glass, pieces of clothing, even upholstery if the bullet has passed through furniture \u2014 and there are always infections from bacteria carried into the wound. <span class='article-annotation-mod article-annotation-active'><a class='article-annotation-control'><\/a><span class='annotation annotation-red'>Did your original drafts include more detail about this process? I\u2019m sure books have been written about what bullets do to bodies, but you managed to tease out the essentials. How difficult was that?<\/span><span class='annotation annotation-blue'>I wanted to keep it simple. I could have named the types of bacteria, even described various infections, but that would have cluttered, even interrupted the narrative. This boy was close to death, and I wanted to stay focused on this detail.<\/span><\/span><br \/>\n<br \/>\nPutnam, 44, estimates that he has treated about 5,000 GSWs and consulted on nearly 2,000 more over the last 20 years, 10 of them at Harbor-UCLA. The victims he remembers the most are the children and women, the bystanders hit by stray fire, the wounded who spoke to him in the ER but died in the operating room.<br \/>\n<br \/>\nWhenever he loses a patient, he hears his mother asking him what he could have done differently. And whenever he saves a life, he knows that success is often just a matter of luck.<br \/>\n<br \/>\nMedicine and technology have come far in recent years in balancing the odds, but when it comes to gun violence, the numbers are overwhelming.<br \/>\n<br \/>\n&#8220;Why guns?&#8221; Putnam asks. &#8220;Why so many guns? It once was fistfights. It once was stabbings. Now it&#8217;s a whole new world out there, and with guns, it&#8217;s just too much.&#8221; <span class='article-annotation-mod article-annotation-active'><a class='article-annotation-control'><\/a><span class='annotation annotation-red'>In today\u2019s world where guns and gun violence are such a serious and debated issue, this quote feels almost of a different, simpler time, before every news network had dissected congressional gun laws. Why did you include it?<\/span><span class='annotation annotation-blue'>I was grateful that Dr. Putnam was as insightful as he was, and I liked this quote because it accomplished exactly what you describe. It reminds us of Dr. Putnam\u2019s long experience with GSWs, and it takes us back to a more simple time, conveying in brief measure how quickly gun violence in America has grown out of hand.<\/span><\/span><br \/>\n<br \/>\nThe emergency room team washes the boy with an antiseptic. He has been intubated and anesthetized. Blood transfusions have begun.<br \/>\n<br \/>\n&#8220;Sticky blues,&#8221; Putnam calls out. No time to wait for the antiseptic to dry. Nurses drape blue cloths around the boy until he disappears, with only a torso remaining.<br \/>\n<br \/>\nPutnam, dressed in surgical scrubs, gloves, cap and headlamp, makes the initial incision from sternum to pubic bone, bowing around the navel.<br \/>\n<br \/>\nChief resident Carrie Luu follows the scalpel with a &#8220;Bovie,&#8221; a pen-shaped tool that cauterizes the open blood vessels with electrical current. <span class='article-annotation-mod article-annotation-active'><a class='article-annotation-control'><\/a><span class='annotation annotation-red'>Were these specifics of the operation confirmed after, or are you familiar with surgery and the tools needed?<\/span><span class='annotation annotation-blue'>The surgery was chaotic, bloody and disorienting. In taking my notes, I tried to capture as best as I could what I was seeing. But there was a lot that I didn\u2019t know: the materials, the procedures, the anatomy. I was lucky, however, to be standing beside an intern who answered my questions. When I got home later that morning, I typed my notes, capturing the fresh impressions as imprecise as they were. Then when I had a draft, I met with Dr. Putnam, and he and I talked through the particular moments of the surgery, filling in the details, capturing his impressions and fact-checking everything that I saw.<\/span><\/span><br \/>\n<br \/>\nThe air smells of singed flesh; tendrils of smoke rise into the lights. <span class='article-annotation-mod article-annotation-active'><a class='article-annotation-control'><\/a><span class='annotation annotation-red'>This is such a sickening and yet somehow beautiful combination of the senses. Can you talk about how you come up with such language?<\/span><span class='annotation annotation-blue'>There is no forgetting the smell of singed flesh; it\u2019s a memory that goes back to the first time we had a mishap with a burner on the stove or barbecue. But here it was at such an industrial scale, given the amount of cutting and cauterizing. And the lighting in the operating room was so cinematic, almost too bright, that the smoke was brilliantly illuminated as it moved and curled upward. As for \u201ctendril,\u201d it\u2019s comes from \u2013 of all places \u2013 an art history class in college where the professor was describing cigarette posters from the Art Nouveau era. The artists loved to represent those languid strings of smoke, the tendrils, that patterned the air.<\/span><\/span><br \/>\n<br \/>\nPutnam sets a clock running in his mind. Two hours is optimum. Three is the limit. Anything longer compounds the trauma with a phenomena known as physiologic exhaustion, when the body has worn itself out trying to compensate for the injury.<br \/>\n<br \/>\nPutnam and Luu begin by separating the small intestine and colon from their ligaments. They notice a few holes in the bowel, but those repairs can come later.<br \/>\n<br \/>\nLifting the intestine out of the torso, they find a pool of blood the size of a football flooding the back of the abdomen. This explains why the entry wound was dry. The boy is losing more blood than they can give him. Putnam wonders again if they are too late. <span class='article-annotation-mod article-annotation-active'><a class='article-annotation-control'><\/a><span class='annotation annotation-red'>I feel now we are almost inside the mind of Putnam, with this level of detail and intimacy. Was he wondering this aloud? Did he tell you this after?<\/span><span class='annotation annotation-blue'>Yes, this was the advantage of working with Dr. Putnam after the first draft was written. I was able to ask him about his feelings and thoughts during the surgery.<\/span><\/span><br \/>\n<br \/>\nHe orders more transfusions. A resident begins suctioning the abdomen.<br \/>\n<br \/>\n&#8220;Minus 8,&#8221; a nurse calls out. It&#8217;s a measure of the blood&#8217;s acidity, a reminder of the triad of death. A normal reading \u2014 zero \u2014 means blood clots can form naturally.<br \/>\n<br \/>\nAs patients lose blood, lactic acid accumulates in the cells, and the enzyme that helps coagulation doesn&#8217;t function. The more acid, the more bleeding, and patients&#8217; temperatures drop until there&#8217;s no stopping the loss.<br \/>\n<br \/>\nTrauma teams try to interrupt this cycle. Transfusions and warming blankets help. The OR&#8217;s thermostat is set as high as it will go: 85 degrees. The boy lies on a pad that&#8217;s heated to 100 degrees, but still his temperature has fallen to 93.<br \/>\n<br \/>\nUnable to see beyond the blood collecting in the abdomen, Putnam reaches in, and his fingers find the inferior vena cava \u2014 a vein nearly an inch in diameter \u2014 that channels blood from the lower half of the body back into the heart.<br \/>\n<br \/>\nHe pushes down on it, and the bleeding slows. When he eases up, he can hear a whoosh. The vena cava has been punctured.<br \/>\n<br \/>\nFired from a handgun, a .45-caliber bullet averages 900 feet per second, and unless it hits a bone, it usually follows a straight line.<br \/>\n<br \/>\nThis bullet&#8217;s journey passed through the skin and the colon, the intestine and then the vena cava. It stopped just behind the pancreas, with its point boring nearly two inches into the spine at an angle, just missing the spinal cord.<br \/>\n<br \/>\nPutnam probes the vertebra. He feels sharp fragments of bone and a hole in the L-3 vertebra no larger than his little finger. If the bullet posed a risk for pain or infection, he would remove it, but experience tells him it is safe to leave behind.<br \/>\n<br \/>\nWith the blood drained, he can see the damage to the vena cava: two holes in the vein, most of the tissue shredded. There will be no repairing it. Each end will have to be tied off permanently, and the other veins will have to adjust by carrying blood back to the heart.<br \/>\n<br \/>\nBut ligating the vena cava is tricky. Unlike arteries with their thick muscular walls, veins are as fragile as tissue paper.<br \/>\n<br \/>\nPutnam puts a clamp with long pincers on the vein, which swells like a garden hose. <span class='article-annotation-mod article-annotation-active'><a class='article-annotation-control'><\/a><span class='annotation annotation-red'>In this graf and the one above, you\u2019ve used everyday, relatable things to such great effect: tissue paper, a garden hose. Is that why you chose them, so people could really connect to what\u2019s going on?<\/span><span class='annotation annotation-blue'>That\u2019s a nice observation, and yes, it\u2019s true. When a story comes close to being technical (L-3 vertebra, vena cava, etc), I think it\u2019s important for us to step away from the textbook and find an explanation, a picture, an analogy that renders the detail in the most ordinary terms possible. Not only does it make the reading experience effortless (critical for narratives, in my opinion), but it also represents my effort to help demystify the world, which \u2013 especially in the fields of science and medicine \u2013 has become so specialized as to be almost alienating. I think it\u2019s incumbent on writers, narrative writers, to help break down those walls.<\/span><\/span> Even in the best of circumstances, fewer than half of patients with similar injuries survive.<br \/>\n<br \/>\nThe boy jerks, a sudden reflex.<br \/>\n<br \/>\n&#8220;Can you paralyze him so he&#8217;ll stop bucking?&#8221; Putnam asks. <span class='article-annotation-mod article-annotation-active'><a class='article-annotation-control'><\/a><span class='annotation annotation-red'>This quote seems removed, almost inhumane. Do you think Putnam still sees all of the people he operates on as people?<\/span><span class='annotation annotation-blue'>I believe that all surgeons understand that our bodies have minds of their own, and in this instance, like a broken machine, are subject to involuntary reflexes that can interfere with the business of living. In moments of such profound trauma, the body and soul become strangers to one another, which is natural and does not take away from our humanity.<\/span><\/span><br \/>\n<br \/>\nMore paralytics are added to the cocktail of intravenous drugs.<br \/>\n<br \/>\nPutnam guides Luu, the chief resident, as she starts to tie off the vein. The stitch reverses direction with each pass and looks like the threads on a baseball.<br \/>\n<br \/>\n&#8220;Minus 11,&#8221; a nurse calls out. They have been working for almost 90 minutes.<br \/>\n<br \/>\n&#8220;Come on,&#8221; Putnam says, encouraging Luu. &#8220;This is where all these things really matter.&#8221;<br \/>\n<br \/>\nShe is having trouble. Sideways torque in the needle tears out the suture. Luu is still learning \u2014 and Harbor-UCLA is a teaching hospital \u2014 but now Putnam has to take over.<br \/>\n<br \/>\n&#8220;Big pledgets,&#8221; he calls out, asking for the felt-like material, nearly an inch in diameter, that will act like gaskets to support each suture against the tissue. &#8220;Hurry, please.&#8221;<br \/>\n<br \/>\nHis hands rise and fall quickly, deftly, with the grace of a pianist. His stitches, though, aren&#8217;t perfect. He learned long ago that there was no call for elegance in surgeries like this. A perfect stitch could mean a dead patient.<br \/>\n<br \/>\nWith a little more than 12 passes, the lower portion of the vein is closed. They are almost two hours in. Putnam is sweating and splattered with blood. The room is stifling.<br \/>\n<br \/>\n&#8220;Watch your eyes,&#8221; Putnam announces as he removes the clamps and tests the sutures. Given the pressure in the vein, blood could spray across the room if the sutures don&#8217;t hold. <span class='article-annotation-mod article-annotation-active'><a class='article-annotation-control'><\/a><span class='annotation annotation-red'>I love the commonsense yet ghoulish instructions. You convey information here in a simple yet dramatic way. How do you choose these moments?<\/span><span class='annotation annotation-blue'>With every narrative, there is an inherent \u2013 and critical \u2013 tension between the action sequences (\u201cWatch your eyes\u2026\u201d) and the exposition that explains why and helps orient the reader. I love playing with this rhythm, pushing the story ahead and then backing off, trying to gauge the reader\u2019s capacity for each. Generally speaking, the stronger the action sequences, the easier it is to interrupt the flow with some explanation, which in my mind should always be \u2013 whenever possible \u2013 as brief as a haiku.<\/span><\/span><br \/>\n<br \/>\nThey hold.<br \/>\n<br \/>\n&#8220;Still very oozy,&#8221; he says. The body&#8217;s normal coagulants haven&#8217;t begun to stop the other sources of bleeding.<br \/>\n<br \/>\nHe and Luu staple the top portion of the vena cava and turn to the intestine. They draw the long, serpentine tube through their hands inch by inch, stapling and stitching any tear.<br \/>\n<br \/>\nA cloth is tossed on the floor to mop the blood at Putnam&#8217;s feet. By now, almost 80% of the boy&#8217;s blood has been replaced.<br \/>\n<br \/>\nLoosely positioning the intestine inside the abdomen, Putnam begins bandaging. He won&#8217;t close the incision because he plans to open the boy again in two days to reassess the work and to see how the body is healing.<br \/>\n<br \/>\n&#8220;OK, we&#8217;re moving,&#8221; the scrub tech announces as soon as Putnam steps back and begins to strip out of his surgical gown.<br \/>\n<br \/>\nPutnam remembers all the bad news he&#8217;s ever delivered. He won&#8217;t have to remember this one. <span class='article-annotation-mod article-annotation-active'><a class='article-annotation-control'><\/a><span class='annotation annotation-red'>It strikes me that, for anybody other than a shooting-trauma surgeon, experiencing any part of this would be an unforgettable experience. What does it say about Putnam that he only remembers the ones that go wrong?<\/span><span class='annotation annotation-blue'>It is  common in emergency room setting that the doctors and nurses only remember the lives they were unable to save. These are the lives that are shrouded in the tears, in the wailing, the sudden outpouring of grief that comes when the family members learn the outcome in the waiting room. For Dr. Putnam, these memories are tied up with his own sorrow \u2013 and second-guessing \u2013 as he relives the surgeries that didn\u2019t end favorably.<\/span><\/span><br \/>\n<br \/>\nAt 5:25 a.m., three hours after arrival, he pronounces the boy in critical condition, expected to live.<br \/>\n<br \/>\nA little before 6 a.m., Putnam goes looking for the family. He still doesn&#8217;t have any information about the boy.<br \/>\n<br \/>\nSleeping families fill the waiting rooms, and in the ER, Putnam speaks with the other victim, who says he doesn&#8217;t know his friend&#8217;s name.<br \/>\n<br \/>\nThen a call comes in. A woman is asking if the hospital has seen a young man with the name Connie tattooed on the underside of his right arm.<br \/>\n<br \/>\nWithin an hour, Connie Greene and her husband meet Putnam in the ICU. She is the boy&#8217;s mother, and his name is Leandrus Benton. He is 16.<br \/>\n<br \/>\n&#8220;He&#8217;s OK,&#8221; Putnam tells the parents. &#8220;He lost a lot of blood, and we almost lost him.&#8221;<br \/>\n<br \/>\nConnie starts to cry. In the last five years, two of her nephews have been killed in street shootings.<br \/>\n<br \/>\nLeandrus \u2014 or Lee, as he&#8217;s known to his family and friends \u2014 had been walking home from a party in Wilmington that night. As he would later explain, he and his friend thought it would be safer to take the alley than the street. Lee had heard the gun but didn&#8217;t see the shooter. The bullet, he said, burned through his gut. <span class='article-annotation-mod article-annotation-active'><a class='article-annotation-control'><\/a><span class='annotation annotation-red'>Did you want to speak to Leandrus more, or his family? Or was the idea not to individualize the victim too much, since this is more a story about all shooting trauma victims and those who help them?<\/span><span class='annotation annotation-blue'>That\u2019s a good question, and you\u2019re right. Of course I was tempted to tell more of Leandrus\u2019 story, but when Barbara and I visited him at his home just a few days after he had been released from the hospital, he was weak and still in shock. And it didn\u2019t feel right to do anything more than to introduce ourselves and explain what I wanted to do with this story. And, as I have noted, we have read about the gunshot victims before, and this is a story about Dr. Putnam, his skill, his training and his familiarity with the terrible things that guns can do. By association, I hope his story can help readers understand that gun violence isn\u2019t just between the shooter and the shot, but that it touches dozens, if not hundreds, of other individuals who live in a world conscribed by reluctant politicians, the Second Amendment and the pain and suffering of neighborhoods where poverty and violence are so tragically interrelated.<\/span><\/span><br \/>\n<br \/>\nPutnam walks the couple into the ICU, and as they wash their hands, he pulls out gowns, gloves and masks for them. He then takes them to Lee, waits a minute and draws the curtain around them so they can be alone with their son. <span class='article-annotation-mod article-annotation-active'><a class='article-annotation-control'><\/a><span class='annotation annotation-red'>The rhythm of the last words is lovely. I also like the image of the curtain, because the surgery was like theater, and the doctor is playing a role for a brief yet vital moment in the boy\u2019s life, then steps away from it. Talk about choosing this ending.<\/span><span class='annotation annotation-blue'>Writing is a collaborative art: Every writer needs an editor. I had two excellent editors on this piece, Drex Heikes, and Kari Howard, now editor of Storyboard, but both proposed a rewrite on my original. The first ending that I had written shifted the attention from the scene in the ICU to Putnam\u2019s reflections on the night. I had wanted to use his words to channel my thoughts about the terrible relentlessness of these shootings. Clearly I was too close to the material. Drex and Kari felt that his quotes broke from the narrative and wanted me to try a subtler approach. So we decided instead to highlight this moment of tenderness and privacy, letting readers ask their own questions and walk away with their own sense of futility and perhaps sorrow. <\/span><\/span><br \/>\n<br \/>\n<strong>Writer&#8217;s note: Here is the original ending:<\/strong><br \/>\n<br \/>\nWithin an hour, Connie Green and her husband meet Putnam in the ICU. The boy is 16 and his name is Leandrus Benton.<br \/>\n<br \/>\n\u201cHe\u2019s OK,\u201d Putnam tells the parents. \u201cHe lost a lot of blood, and we almost lost him.\u201d<br \/>\n<br \/>\nConnie starts to cry. Two of her nephews had been killed in shootings in Long Beach.<br \/>\n<br \/>\nPutnam walks the couple into the ICU and to their son\u2019s bed. He draws a curtain around them.<br \/>\n<br \/>\nThey will learn later that Leandrus had been walking home from a party in Wilmington. He and his friend decided they would be safer to take the alley than the street.\u00a0 Leandrus heard a gun but didn\u2019t see a shooter. A bullet suddenly burned like fire in his gut.<br \/>\n<br \/>\nAfter being on duty nearly 24 hours, Putnam relaxes and reflects on the day.<br \/>\n<br \/>\n\u201cTraumas are random,\u201d he says. \u201cThey leave you asking not just why did this happen, but \u2013 when things looked so bad \u2013 how did they turn around?<br \/>\n<br \/>\n\u201cIt takes a lot of luck and the sense that someone is watching over us.\u201d<br \/>\n<br \/>\nPutnam is weary. \u201cI just need to get through the shift,\u201d he says.<br \/>\n<br \/>\nBut he knows that once he gets home, he will start wondering.<br \/>\n<br \/>\n\u201cWhy guns? Why so many guns? Why do young people get status through guns? It once was fist fights. It once was stabbings. Now it\u2019s a whole new world out there, and with guns, it\u2019s just too much.\u201d\n\n        <\/div>\n    <\/div>\n","protected":false},"excerpt":{"rendered":"<p>The Los Angeles Times writer, who watched a doctor operate on a teen gunshot victim, talks about his enduring passion for stories that depict \u201cthe split-second events that change the predictable course of life&#8221;<\/p>\n","protected":false},"author":1,"featured_media":11085,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[10],"tags":[],"topics":[],"authors":[197],"issue":[],"class_list":["post-1551","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-annotation-tuesday","authors-davis-harper"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Thomas Curwen and &quot;Surgeon races to save a life during L.A.&#039;s shooting season&quot; - 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