During my nursing career, I have worked in several specialties. I worked Medical / Surgical, Step Down, Intensive Care (ICU) and Emergency Room (ER). The ER is where I feel most at home. I like the action, the varying degrees of acuity, and just simply not knowing what is going to come through those doors next. In the ER, I see things that have went horribly wrong. From broken necks, impaling injuries, abuse, motor vehicle accidents, burns, boating accidents, failed suicide attempts, stabbings, gun shot wounds, rape victims, drunks and bar fights, and the list goes on. What has having seen these worst case scenarios done to my mind? One case has been plaguing me since it happened. I am going to give you the scenario and I am reaching out to other allieds for their comments. Here goes: I was working the 3:00p.m. to 3:30a.m shift in a level I trauma center. It was about 1:00a.m. and I get notified that the “choppers” are bringing in a young man with a self inflicted gun shot wound (GSW). He apparently had a dispute with his girlfriend, got drunk and then got a gun. He was going to be my patient when he arrived. He would occupy my time until my shift ended. At approximately 1:27a.m. my patient arrived and came in via stretcher right off of the chopper. We moved him to an ER gurney. The hospital trauma team was there with me. We began our assessment. The patient, in his attempt to end his life, placed a loaded shotgun under his chin aiming up. He pulled the trigger. The result was an incredibly disfigured and bloody face. The eyes…gone. What was once his face, resembled raw hamburger with pieces of flesh and blood mixed in. Mouth…unidentifiable. Nose…gone. Once the vital signs were checked, the patient was hooked up to the monitors, and the IV’s established by the flight allieds checked, we began our head to toe assessment. The command was given while holding his hands. “If you can hear me, squeeze your right hand.” He did. “Squeeze your left hand.” He did. Oh my lord, this poor soul. In his attempt to end his life, just managed to remove his face, mouth, nose and eyes. His brain was fully intact. My thoughts went to this young man’s future. This one event, in a moment of sadness, rage and drunkenness has altered this person for the rest of his life. I stayed focused, doing my job. I couldn’t allow this to “rattle me”. It didn’t. I did my job to my full ability, trying to keep my patient alive and comfortable. Once stabilized, I took him off to the operating room. My shift was over. My drive home was about 45 minutes and it allowed me to “decompress.” Once home, my wife was in bed, but a nice note was written on the kitchen counter. “Dinner is in the fridge, I love you.” Dinner was spaghetti. I heated it up and was eating it. Then it hit me. “What is wrong with you?” I said to myself. “How can you go from seeing what you just seen to eating spaghetti”. I rationalize it like this: As allieds, we have to stay focused. If emotion enters our job, it may impact our ability to function in the best interest of the patient. I believe, as allieds, we create defense mechanisms to allow us to deal with these types of scenarios. We are not insensitive or “warped”. We have emotions just like everyone else, we just have to control ours. What do you think…?