A twenty-one-year-old known gang member presented to the emergency room late on a Friday night with multiple gunshot wounds, including one to his hand, with multiple open fractures and extensive soft-tissue injury. After evaluation by the on-call resident, the orthopaedic attending physician was notified and the decision was made to bring the patient to the operating room for surgical treatment.

Due to the extensive nature of the trauma, the surgical reconstruction took several hours. In the middle of the operation, one member of the operating-room staff began to complain about the late hour and commented that the surgeon need not be so meticulous as the patient was not going to use the hand to play piano; he would likely be using it to shoot a gun. The attending physician replied that we could not know whether or not the patient played piano, nor whether he might take it up after surgery. The surgery was completed, and the patient was brought to the intensive care unit for postoperative monitoring of his other injuries.