​The Manikin

by Donald Firesmith 

Three other medical students and I were waiting in a meeting room just down the hall from the
operating room, where we would take our fifth and final exam to determine whether we were ready
to graduate and start our residency working on actual patients. Emberly was our budding
anesthesiologist, while Ellie and Dominic would be our two surgical nurses. And then there was
me, Milo Mackensie. I would be the surgeon.
We had each passed the preceding four exams: broken arm, mystery infection, laparoscopic
appendectomy, and bowel resection. This exam would test our skills working on a patient with
some kind of life-threatening injury. As before, our professors would only give us basic
information about the test scenario before the exam began.
“So, what do you think it will be?” Dominic asked. “My bet is it involves a terrible traffic
accident. They’re common and certainly something we’ll have to deal with in real life.”
“My guess is someone with multiple gunshot wounds,” Emberly replied. “If the ER is supposed
to be at a big city trauma center, shootings would be a daily occurrence. How about you, Milo?
What do you think it might be?”
“I have no idea,” I replied. “Given that this is the final exam, it’s bound to be something deadly
serious. Something bad enough that we could lose our patient if we’re not careful. What about you,
Ellie?”
The door opened before she could answer, and our three professors, who would oversee our
exam, walked in. Dr. Reinholt was a highly experienced general surgeon and would grade my
performance. Dr. Isaacson taught anesthesiology and would give Emberly her score. Finally,
Professor Lemont would grade our two surgical nurses.
Professor Reinholt laid out the exam’s scenario. “During today’s exam, we will simulate
working in a major trauma center. A mass shooting at a local middle school has resulted in several
deaths, and dozens of adults and children with one or more gunshot wounds have arrived in the
ER. The shooter used an assault-style rifle. As we’ve covered in your first-year class, the
high-velocity, low-mass bullets from such weapons tumble on impact, rapidly depositing their
kinetic energy into the surrounding flesh and bones. Expect your patient to present with small entry
wounds, large exit wounds, and massive internal tissue damage and destruction.”
I couldn’t help remembering the videos and images of the horrible injuries we had seen in
class. Worse was the memory of observing an autopsy of a young man killed by such a weapon of
war. It was no wonder the vast majority of the medical community hated assault weapons and
wanted them banned.
“Your goal today is to save your patient’s life,” Professor Reinholt continued. “Because of the
scenario’s large number of casualties, assume other patients will need you and your trauma bay as
soon as you’re finished with this one. Prioritize your work, concentrate on the most critical injuries,
and stabilize the patient for transfer to a regular OR for further surgery. We will grade you not only
on the quality of the medical care you provide but also on how rapidly you work.” 

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