I made a choice. I was left in charge and I made a choice. On the surface that does not sound like anything unusual. Adults make choices every day. Some matter more than others.

This choice had a profound impact on me. It impacted how I feel about my work and other around me. More importantly it has impacted the way I feel about those I have worked well over eight years of my life to serve.

From the beginning of medical training, we are taught not to let our own morals or judgements impact how we treat our patients. We are to treat all patients the same even if we find them or thier illnesses offensive.

When you are a 22 year old kid being told that on the first day of med school you roll your eyes because it sounds so obvious and stupid. I remember thinking, "NO SHIT! Of course I'm not going to expect my future patients to have my values."

The more you practice the more you realize it is NOT simple and it becomes a constant battle. You often have to remind yourself of that very first lesson before is too late.

In Chicago, we had been dealing with heinous crime of a rapist on the loose. He only targeted elderly frail women. He not only raped them which is heinous onto itself. He beat them to the point that one of then died shortly after coming to the ER.

As if that does not sound awful enough, this monster actually wrote the word "whore" on each of the victims stomach in a black indelible magic marker. So, first he brutally attacks them and then shames them as if it their "fault." Yes, shame on them for being old, vulnerable and walking the streets trying slowly get by in life.

We kept waiting for the police to catch him but they always claimed to be close. That became extremely frustrating to hear when we are constantly trying to treat the medical and psychological impacts of the constant flow of victims.

What made it worse it even at home, it has been all over the news. So, we had to deal with the stress all day and all night.

The day started with at least a foot of snow. That may sound shocking to some but for someone who has spent the majority of their life in Chicago, it was an average winter day. I followed in the trail of a snow plow and made it to work.

Much to my surprise and delight there were no patients. Usually on a snowy day, we have at least a few homeless people thawing out.

The snow slowed down the patients which was good at the moment. Unfortunately, it also slowed down the supply of blood to the blood bank. Everything was slow coming out of O'Hare. From what I heard we were precariously short.

My day got even better When I saw that Anna was on. Unfortunately, I let my emotions get the better of me when I exclaimed, "Anna's On?" I hate when that happens. Lydia gave me that all knowing look. Shit! It's awful but I really can't help myself sometimes.

I decided to bring her a donut. I tried to casually play it off as a neutral gesture for a tired coworker. The looks told me it wasn't working so I decided to just get the hell out of there.

I went into the on call room. She was sound asleep and actually seemed at peace. It is rare to see someone look at peace in this job.

I really wanted to relax and talk to her but I did not have the heart to wake her. I tried to leave the donut in her hand. However, she kept moving. It was a lost cause.

It's annoying that we always make the most noise when we are making a conscious effort to be quiet. I tried to leave her to get more sleep but of course I made too much of a raquet and woke her up.

I apologized. It then becme one of those awkaward moments when two people just stare at each other not knowing what the fuck to say. She finally gave me a questioning, "What?" I intelligently responded, "Nothing."

I offered to get her a "little breakfast." She has other ideas. She seemed to have the breakfast menu at Doc Magoos memorized and rattled several items she wanted me to bring her for breakfast Ok. Our breakfast plans were thwarted by the horibble chain of events that defined the day

We were informed we had GSW coming in, a security guard was shot in a parking garage. When we were told that he got shot stopping an elderly victim from being raped, it made our routinely chaotic world that much more frightening.

Apparently the elderly rape victim was on her way as well. Despite the fact that he stopped her from being raped, I was reported she was in rough shape. It felt wrong being relieved that a victim was "only" in rough shape but not raped.

Obviously our goal is always to save the patient. However, when a patient is harmed trying to save a vulnerable person the stakes are higher. Maybe in an ideal world they should not be but they are. At the same time, it always hurts to lose a patient. However, it does hurt more in the presence of heroism. Maybe it is not supposed to but we are human too. Even though we were dangerously short of blood we thankfully had enough to spare for this man. Barely enough but enough nonetheless.

It pains me to even express this but the guard did not make it. Towards the end, I had an uncontrollable urge to flip off Dr. Greene. We realized his left ventricle was shredded. I ordered vicral sutures to TRY and sew it up. He insisted that there was not enough to sew.

I begged him to let me try. I firmly reiterated that he stopped an elderly woman form being raped. He fired back, "No bad deed goes unnoticed."

What the fuck does that mean? The man is dead. If I wanted to get deep I could consider a beautiful afterlife with God as a reward. However, at that moment I was too angry. My only thought was this guy died and that IS not justice it's bullshit.

I refrained from directly cursing out an attending. However, I am human and was angry. So, I did cry out "son of a bitch" and quickly exit while removing my gloves.

When the victim arrived, she was in appallingly bad shape. We were not even sure we could save her. When they were giving us the bullet, they said they were unable to intubate on the scene because he tried to strangle her and her cords were too swollen.

She had a direct orbital floor fracture In order to have fractures of this magnitude she had to have been struck very hard in the face. I guess he figured why stop at strangulation. Why not destroy her face.

In cases of orbital fractures caused by violent assaults patients almost always need painful surgery to repair the damage. In extreme cases, brain damage is possible. Due to the severity of this attack we all feared a brain injury. However it was too early to tell.

As if the direct orbital fracture was not shocking enough, we noticed that the abhorrent monster decided to this time carve the word whore in the victim's stomach. He gave up on the magic marker and most likely used a large butcher knife.

I'm not a perfect choir boy by any means. However, I just don't understand that level of evil. I mean what goes into a person's head as they carve the word whore into an elderly woman's stomach? It is beyond all comprehension.

The good news is we did save her life. The sad part is she will never get over the emotional trauma. However, we were all grateful to have saved her life.

sI thought that at the very least my day could not get any worse. I was minding my own business catching up on charts, when a call came over the paramedic radio saying the rapist had been shot and he was on his way to OUR ER.

Connie and Malik both said at the same time "Tell them we don't want him. Why can't Mercy take him or Rush?" Dr. Green ignored them and firmly said like an attending in charge, "Come on people you know what to do!"

At this point I had the urge to flip him off or even directly say "fuck you" to him. Malik angrily shouted, "Let's the bastard die!" He pretty much echoed what the rest of us were thinking. Dr. Greene responded, "He's a patient and like any other patient he gets our best effort." I could hear the voice of my old med school teacher agreeing with Dr. Greene and telling me I'm wrong.

I was put in charge of the trauma. I truly wanted to stand there and let the fucker slowly die. However, at the same time, I did not want to end up selling pretzels outside the hospital for the rest of my life.

At one point, he really started gushing blood. The blood was turning into a massive puddle on the floor. I knew I had to act. Connie said she had two pints of Oneg and started to hand them to me. I realized they were our LAST two pints. FUCK!

I could hear all the voices blending together saying, "What do you want to do Carter?" Anna's voice was the loudest begging me to make a decision.

I know what I have been taught but right or wrong I was not going to give the last pint of blood to a monster that craved a knife into an elderly woman's stomach. I thought about all the innocent patients that might need it such as a little kid hit by a car chasing his ball into the street.

FUCK it! He was not getting the blood while I was in the trauma. Dr Green has left to help with another trauma so he was not there to tell me what to do.

Suddenly the answer came to me. The miserable fucker was going to get blood but not the coveted fresh o neg. I decided to pick up his own blood that has run into the containers on the floor. I made the announcement that I was going to auto-transfuse him. Anna shrieked "You are gonna use his own blood?" I remember thinking, "Are you deaf? That is what I said."

I picked up the container and attached the rapid transfuser. I swear Anna was relentless. I really did not need the extra bullshit. As I was hooking it up she yelled, "HE NEEDS BLOOD CARTER!" My answer was accurately, "AND HE IS GOING TO GET IT!"

Unfortunately, we were able to save him and NOT the poor guard that save the old woman from being raped. It's a hell of a world we live in.

My problems were not yet over. Yes, it is no secret that I'm very attracted to Anna. I'm sure all of the ER staff and some other departments know about it by now.

She was very distant towards me for the rest of the day. At the time, I did not want to admit that I knew fucking well why she was mad at me.

Finally I could not take it anymore. When she left I ran out after her and tracked her down at the el station. I caught up to her and asked her what the hell her problem was. In the heat of the moment I ran out without a coat. I secretly hoped we would resolve this soon. I was freezing my ass off!

She kept telling me I knew what her attitude was about. Deep down, I did know. However, I looked her right in the eye and lied. She asked me if I withheld treatment because I did care if he lived or died. It's true but I firmly denied it.

This argument was going nowhere and I was fucking freezing. We had no choice but to eventually angrily part ways. It was gnawing at me all day. She was right. I did not care if he lived or died.

I have admitted it to myself but that does not mean that I am sorry. It may be wrong but I'm not sorry. I do know now nor will I ever regret my decision.

I knew I had to talk to Anna. I was not going to let some vile piece of shit ruin our "friendship" or whatever we actually have.

Thankfully, we worked things out. I told her that she was right. I told her that I did not think he deserved it. I admitted to her that I could not have lived with myself if some little kid died because we wasted the blood on him. I told her that I am not sorry. I think I finally got her to see my point of view.

If I got a similar case like that again, I would not change the way I feel. I realize that may be wrong too. However, despite what my teachers always said Drs are human and putting aside moral judgements is not always possible. It's the right thing to do but not always an attainable goal. I'm never gonna stop believing that an innocent child deserves fresh blood more than a cold blooded rapist.