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It happened almost 18 years ago, yet those of us who were involved will never forget the events of that afternoon.

The routine weekday surgical schedule was just finishing, when we were notified of an incoming patient with a serious stab wound which had just occurred in the parking lot of the local high school. As the chief of anesthesia, I responded to the Emergency Department along with the on-call surgeon and other medical personnel. Ours was a small rural hospital with no nearby freeways, and cases like this were very uncommon. We were fortunate to have had a very good medical staff, most of whom had been trained at major metropolitan hospitals.

The high school was less than three blocks away, and the hospital-based paramedics responded immediately. Two very experienced medics arrived on the scene less than four minutes after the call came in.

The patient was a student at the high school. He had been stabbed in the left lower abdomen during a fight with another student. The medics later reported that the victim was awake and talking when they arrived, and that a small amount of blood was seen at the site of the knife wound. His blood pressure and pulse were stable, but he appeared to be going into shock.

Two large IV lines were inserted and he was immediately transported back to the hospital. On arrival, he was still awake, but he showed signs of internal bleeding. My impression at that point was that he would probably survive.

More IVs were inserted and he was taken directly to surgery. After he was placed under anesthesia, the surgeons made their incision and a large amount of blood immediately came out of his abdomen. His blood pressure quickly dropped. We had already started giving him blood, and pressure bags were used to pump additional blood and fluids into his IVs.

The small external wound from the knife had been deceptive. Two major blood vessels had been severed, and after the surgeons controlled this bleeding, additional bleeding continued from a very deep area close to the spine. The knife had obviously been a long one. It was not possible to get access to the source of this deep bleeding because of its location, and although efforts continued to stop the bleeding, it was not possible.

Despite large amounts of blood and IV fluids, we were not able to keep the patient鈥檚 blood pressure stable. His condition quickly deteriorated. The decision was made by the surgeons to pack the abdomen with sterile gauze and to transfer him by air to the nearest major trauma center, which was 130 miles away.

We all knew that this young man鈥檚 chances of survival were very small, but this was his only hope. He later died at that hospital.

This patient and the young man who stabbed him were both only 16 years old, and both had very large extended families. I don鈥�t believe that the attacking student intended to kill his classmate, but in one brief moment, a bad decision was made that resulted in the death of the victim and 12 years in prison for his assailant. Both families have been forever damaged.

We later discovered that the fight had occurred because of a disagreement over a parking space.

I have since spoken many times with others about this case, trying to think of anything that we could have done differently to save this patient鈥檚 life, but there really weren鈥�t any other options. This young man鈥檚 fate was sealed from the moment that the knife entered his abdomen.

Over the years I have often thought of a quote from the TV show 鈥淢*A*S*H,鈥� modified here for this situation. A senior doctor told another doctor who had just lost a patient, that in medicine, Rule No. 1 is that some young people will die. Rule No. 2 is that doctors can鈥�t change Rule No. 1.

Very sad, but so true.

Mark Donnell, M.D., is a physician in Silver City.