In his book "Confessions of a Surgeon: The Good, the Bad, and the Complicated ... Life Behind the O.R. Doors," Paul Ruggieri, a trauma surgeon, reckons with the moral crucibles that doctors face, including sharing his experience operating on a patient who had just killed his wife. 

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'I wanted him to die'

The patient who presented at Ruggieri's hospital had just appeared in court for a divorce proceeding. In anger, he fatally shot his wife, and he fired at his wife's attorney and others in the courtroom before the police shot him nine times and sent him to the hospital.

At first, Ruggieri writes, "I let my emotions get the best of me." Upon hearing the shooter's story, Ruggieri, says, "I wanted him to die."

Ruggieri recalls, "I was hoping his heart's pumping action would just stop. I was hoping he would never make it to the operating room."

'Here, I do not consider myself human'

Before long, though, a "trauma nurse's voice jolted me back to my reality, the reality of what I was trained to do," Ruggieri writes. "The [OR] is considered the great equalizer. All who pass through those doors are one and the same."

He adds, "Fortunately for [the shooter], my profession does not discriminate at death's door."

Once in the OR, Ruggieri writes, he was no longer "saving the life of a murderer," but rather doing what he was supposed to do as a surgeon. "I didn't care about his life before he entered my [OR]," he writes. "He was just a trauma case to me, nothing more. ... It did not matter how many people he might have killed."

In fact, Ruggieri writes that, when a patient is in the OR, he has a hard time conceiving of the person as a human being. Rather, what he sees "is a diseased appendix, a cancerous thyroid mass, a hernia, or an inflamed gallbladder." He acknowledges that "there is a life, a soul, attached to these organs," but for him to do his job properly, that can't become "a distraction." He writes, "There are no 'feelings' inside the [OR], no time for reflection," adding, "Here, I do not consider myself human … I am a robot, blocking out any outside interferences."

The shooter whom Ruggieri treated "survived his wounds, was tried and convicted in a court of law, and, ultimately, was sentenced to death."

Ruggieri writes that this incident "was the first time I had to struggle with conflicting emotions between what my heart desired and what my training directed my hand to do." But, he adds, "It would not be the last."

It's common, Ruggieri writes, for him "to make decisions with life-and-death consequences, in complete cold-blooded isolation from any inner emotions or biases." He continues, "Often, before I can even begin to process the consequences of these decisions, I am faced with another, and yet another." He adds, "Some days, my job does not allow me the privilege of being human."

One the one hand, "Living at a distance from one's emotions can be a comfortable state to settle into," Ruggieri writes. However, "despite the unique situations surgeons find themselves in daily, most are indeed very human," he notes.

He concludes, "Despite the urge to feel immortal after plucking out a ruptured spleen and saving a life, I am frequently reminded of my imperfections and mortality," which "often arrive in the form of complications" during surgery. He writes, "My mortality often presents itself disguised as a patient" (Ruggieri, Business Insider, 5/27).

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