The following manuscript was published as part of the February 2018 Social Medicine theme issue.
It seems that each week we learn of a new mass shooting. Gunfire from a legally-purchased AR-15 assault rifle hits innocent high school students, nightclub patrons, and mall-goers. Mothers, fathers, friends, spouses, teachers, colleagues — and yes, children — hide in closets or under seats, terrified that they won’t make it out alive. Of course, many do not. The public watch as the police arrive, a suspect is detained, friends and families embrace in sorrow, and a politician reassures the nation that our brave first responders are bringing the victims to a nearby hospital. The media’s report to the public generally ends, but when I hear “trauma team to ED STAT,” my work only just begins.
As a surgical resident, it’s my job to respond to these calls. The approach to a gunshot victim has a standardized protocol. From the right, nurses place IVs and draw labs. From the head, an anesthesiologist inserts a breathing tube. And from the left, surgeons stand at the ready in case we need to emergently open the chest. The most experienced surgeon manages the case from the foot of the bed. In a matter of seconds, we must find every wound, decide the level of patient stability, attempt to stabilize them, determine if and when an operation is needed, and, in the worst cases, if the patient can be saved. Ideally, it’s controlled chaos. We run through our trauma routine as if it were a computer algorithm. And sadly, it has become routine.
At some point during this madness, the family arrives.
I wish the gun lobby had been there three months ago, the day I heard a mother’s screams when she found out her 18-year-old son had just been shot. Thinking about it still sends chills down my spine. Actually, it was less screaming than it was shrieking. It’s like what you see in the movies — except the blood on my scrubs was very real and belonged to this mother’s teenage boy. I wish our lawmakers had been there when a grown man collapsed in tears after finding out his wife, 24 weeks pregnant with their first child, died after being shot in the chest and that our attempts to save the fetus failed. God, I wish they were there. I was.
Physicians are taught to break news to families in a quiet room without distractions; how to phrase it, when to pause, and what words to avoid. They tell us that these conversations get easier with time and experience. We offer thoughts and prayers, rinse and repeat. We become numb.
I haven’t had enough of these conversations to just rinse and repeat. And I guess I don’t have enough experience telling families that their child is laying lifeless in a room behind me, because I’m not numb. What I am is sad. And I’m furious. I’ve seen five gunshot victims roll into the emergency room during my training. Just one made it out. I’ve put permanent breathing and feeding tubes in patients whose families refuse to let go of their 30-year-old child shot in the head with no chance at meaningful recovery. I’ve fought for these victims. I’ve cried for these victims. I’ve thought and prayed for these victims. Yet somehow that hasn’t helped reduce gun violence in America.
Surgeons are told that trauma is a great specialty because when we can save a dying patient, we can take the credit. But when we can’t, we can tell ourselves their wounds were too severe and there was nothing we could do. It’s a coping mechanism to relieve guilt and allow us to sleep at night. But there are things that we can do. We can march, we can donate, we can make calls, and we can vote. We can push for sensible gun control.
Doctors all over the country are taught the best strategies to treat gunshot victims and how to have these difficult conversations afterwards. These incidents and resulting conversations, however, don’t start in the emergency room. They start with lawmakers writing and passing policies that legalize the sale of assault weapons. Politicians who have never heard that trauma call or delivered news to a distraught mother whose son has died in vain. It’s up to us to demand change because I don’t want to become an expert in gunshot trauma. I don’t want to become numb to the shrieking mothers or the grieving fathers or the newly adrift orphans. Call your representatives today and demand they take action toward common-sense gun control, including a ban on assault weapons.
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