Physicians and Guns

Health Tips / Physicians and Guns

I guess it should come as no surprise to anyone, the increasing number of articles in conventional medical journals about the health consequences of gun ownership. After all, each year more than 30,000 people are killed by a gun and another 70,000 are wounded. Add up the past decade and you get nearly one million gunshot victims. Picture Chicago’s Soldier Field, filled and refilled with people–17 times–to give you a visual on one million human beings.

While you’re visualizing, fill two of these stadiums with children. Anybody who denies we have a major health crisis on our hands is simply bonkers.

The medical abbreviation for a gunshot wound is GSW, something I wrote myself dozens of times during rotations at Cook County (now Stroger) Hospital. “18 y/o BM GSW L chest DOA.” I doesn’t take much imagination to figure it out. And given that the current US population is roughly 313 million, if we project based on one million GSW victims over the past decade it means that at least one in every 313 of us will be shot over the next decade.

Of the roughly 30,000 to die this year by a GSW, the majority will be suicides (57%), followed by homicides (35%), with the remaining 5% “accident,” “police intervention,” or “undetermined.” The vast majority of that gun-homicide number is made up of young men, but as Chicagoans we know this too well, living as we do in the murder capital of the US.

Many of those listed as homicides start out wounded and can’t be saved

I got a taste of this during my first night on surgical call at Cook County when I was a medical student, lowest man on the surgical team. A 20-something kid had been shot during a gang fight, the bullet entering the right side of his abdomen and travelling through his intestines, liver, and spleen before exiting on the left. My job in the operating room was to keep a tight grip on the retractor, a curved metal device that does just that, retracting abdominal muscles so the surgeon gets a large visual field in which to make his repairs.

Holding a retractor is both tedious and exhausting. You can’t see anything interesting because the surgeons are standing in front of you. It’s exhausting because you have to pull constantly, keeping the tension on, and within minutes you feel your biceps throbbing. If you ease up on the tension, the surgeon loses his field and lets you know fast by whacking your knuckles with whatever metal object is nearby. So you stand perfectly still and pull. It’s hot as hell under the bright OR lights and everybody’s pouring sweat. It’s only in the movies that a nurse dabs perspiration from the surgeon’s forehead. At County, he wiped his sweaty forehead on the shoulder of the medical student next to him, which was me.

We started at 1 am and closed the poor guy up, still alive, at 8 am. Seven straight hours of surgery and I still had the whole workday ahead. About a third of the way through the operation, at 3 am or so, I abandoned any thought of being a surgeon, knowing then that I’d be an internist. Our patient actually survived for a couple of weeks before dying of surgical complications. The entire time he was in the hospital a policeman sat in front of his door, ready to take him to Cook County Jail if he survived.

The medical costs of guns are staggering

In addition to the agonizing grief of losing a family member to gun violence, the raw costs are currently tagged at $33,000 for a fatality and $300,000+ for a GSW. These numbers reflect a combo package of medical, police, legal, transport, and the like, and adds up to about $12 billion a year.

Since the vast majority of victims have no health insurance, taxpayers pick up the tab. Also, the GSW price tag doesn’t include any of the multitude of person-hours spent caring for the GSW victim, both by family and medical professionals.

A recent article in The American Journal of Medicine dispels the NRA-promulgated myth that guns make our nation safer, whether by protecting our homes or our borders from marauding and rapacious Canucks. To remind you, the majority of gun fatalities are suicides (57%), followed by homicides (38%). The remaining 5% are a combination of police intervention, accident, and “undetermined.” In other words, if you wake up one morning, buy yourself a gun, and at some point actually pull the trigger, the odds are you’ll use it to blow your own brains out.

But what about the “safety and protection” issue?

Here’s a quick personal gun story. I write these health tips from a small cabin located at the dead end of dirt road in rural Illinois. I rarely see my neighbors, but when we do get together guns are a frequent discussion topic (small-town and rural dwellers own more guns per capita than city dwellers). My neighbors are all nice guys, and all utterly astonished that I’ve never owned a gun, aside from my childhood Daisy Red Ryder air rifle, which mysteriously disappeared from my room during its first week of ownership, my parents never confessing to anything.

“How are you going to protect your home?” my neighbors ask.

“Against what?” I ask. “Wild turkeys? Deer?

They remind me there’s a state prison down the road. It’s a maximum security prison and looks every inch of it. No one has been known to escape.

I pipe up cheerily, “I’ve got it! The gun will protect me against the skeet you guys are always shooting. Must be hundreds of them. Dangerous (clay) birds, those skeet.”

Sadly, earlier this year one of these neighbors had a psychotic break, which I fortunately missed. He suddenly became paranoid and was walking through the area threatening his friends with his very loaded gun. He was talked into dropping the gun (“the state troopers were set to blow him away,” I was told) and was promptly hospitalized. But you can imagine how this story could have ended tragically.

Guns do not make nations safer

The medical article I linked to above neatly brings to an end the cliche that guns make nations safer. First, researchers listed 27 developed countries according to the number of guns per person. This ranged from a high of 88 guns per 100 people (the US, of course) to a low in Japan, with 0.6 guns per 100 people. The European countries were all mid-range, averaging 30 guns per 100 people.

Then the researchers compared the gun ownership rate with the firearm-related homicide rate per 100,000, and again, the US was highest (10.2 people per 100,000, totaling  30,000+ deaths annually) and Japan the lowest, with just 0.6 people killed per 100,000.

Europeans seem to handle their guns better than we do here, with just one gun death per 100,000

The conclusion could not be more obvious: a country’s high gun ownership rate makes it a dangerous place to live. That seems so rational, but it’s exactly the opposite of what the NRA endlessly tells its huge membership and our elected officials.

What’s interesting is how the crime rate figures into this. Although you might assume that citizens are prompted to buy guns by a nation’s high crime rate, overall the US crime rate is average, pretty much on a par with low gun-ownership countries like Switzerland and Portugal.  Like my rural neighbors, people in the US apparently think that because our crime rate is much higher than it actually is, it’s worth arming ourselves to deal with our baseless fear of  “them…out there.”

And we’re killing ourselves in the process.

Be well,
David Edelberg, MD