The critical care team making rounds — my team for today — stops abruptly in front of the next patient room, and I hear my co-resident present the story: The 18-year-old patient suffered a gunshot wound to the face. The circumstances of the shooting aren’t clear, but we heard it had something to do with “gang violence.” And we continue listening to the presentation: an update on any changes in the patient’s status that happened overnight, his vital signs over the past 24 hours, the input of different specialists, and, finally, the treatment plan for the day.
We shuffle into the room — an army of white coats — with hopeful, patient smiles. We stand in a halo around the bed as we look at the young man, wearing a cervical collar and not able to fully open his mouth. This is what gun violence leaves in its wake. Though we’re trained, as doctors and nurses, not to let emotion cloud our clinical judgment as we treat devastating wounds and illnesses, it’s still jarring to see the damage that can be done by a weapon so readily available in our society.
Our patient’s head is turned to the left and his eyes flicker open. He’s missing several teeth. There’s a bullet wound in his throat, which is slowly healing. Saliva collects in the front of his mouth and the back of his throat, and he says he needs to cough. Each day, there’s a risk that he’ll bleed into his airway. He’s connected to several intravenous drips. In a completely unfamiliar environment, surrounded by snaking tubes and lines, surely, he’s scared; and the mental fight is as important as the physical one if he is to survive and heal.
His mother and sister have pulled the shades down in the room. They sit at the window and watch us with guarded, expectant looks as we file in. The attending physician walks over and sits beside them. He leans back and crosses his legs, then starts to talk. The young man is stable, he says. His throat is healing, slowly. When can he eat? Well, see that yellow bag? That’s his nutrition right now. He can’t eat. The bullet tore a hole in his throat.
We can triage the victims, resuscitate their organs and monitor their bodies. Sometimes we can even offer encouragement or comfort to patients and their families. The need for care of this kind never stops. But even though my job is treating gunshot victims after the fact — not dealing with the issues that lead to their shootings — sometimes I find myself wondering about the events that lead to the moment, beyond my control, that sends an 18-year-old to a team of medical professionals because of a bullet through his face. I ask myself: Will he recover? What will the family do? How will he function when we release him? What’s the cost — socially and economically — to the community?
As physicians, we’re in a unique role. Like everyone else, we hear the public’s outrage about gun violence, read the social-media posts, talk about it at work, home and even happy hour when we take our scrubs off for a minute and try to unwind. But then we go right back to work and see the victims. We browse through their lab values to find out if their electrolytes are in balance or if there’s an infection brewing. We stare at them through MRIs and CT scans, tracing the path of the bullet, or bullets, paying close attention to the nearby structures and tissue, examining the damage. We use critical-care resources and personnel to provide the best care possible to the victims of gun violence.
In other words, we do our job. But we can’t stop gun violence.
The estimated annual cost of gun violence in this country is reported to be $229 billion. But the numbers are just that, estimates, given the limited research and federal resources dedicated to understanding the overall toll gun violence takes on Americans. Individual states are taking action to address this ongoing catastrophe — California’s legislators just approved $5 million for a gun violence research center — but what’s needed is a nationwide effort. Tuesday, the American Medical Association declared gun violence a “public health crisis” and the organization will lobby Congress to overturn the legislation that for the past 20 years has blocked funding designated for the Centers for Disease Control and Prevention to study gun violence. Legislation largely supported by the National Rifle Association.
What members of Congress who’ve blocked this funding don’t seem to understand is that every day the CDC is limited in its ability to address the causes of gun violence is a day I may see another 18-year-old on my rounds. They don’t seem to understand that all I can do as a physician is patch up broken bodies — I can’t prevent them from being broken in the first place. They fund cancer research and studies on obesity, but because of political pressure, they continue to deny research on this particular public health crisis. Which is exactly what it is.
There are more guns than people in the United States. We need more robust research at the federal level into the full costs of gun violence, and the burden it places on our already strained physical and mental health systems. This research will provide facts; the ammunition — risk factors, potential solutions — that will illustrate to legislators the need to enact changes to gun laws throughout the United States. In the meantime, we’ll put on our white coats, treat our patients’ wounds and pray for recovery.