My personal contact with guns is limited, pretty much confined to a furtive glance at the firearm peeking reassuringly or menacingly (depending on your point of view) from a cop’s holster. Except for a brief childhood encounter with a Daisy Red Ryder BB gun, I’ve never held or fired a handgun or a rifle. In fact the Red Ryder was in my possession for less than a day before it mysteriously and permanently disappeared from my room.
Out of curiosity, I did go to a gun show once with my wife. It seemed as though there were more guns for sale than people who lived in the county, but everyone was very nice, one dealer listening patiently as my wife explained her views on animal rights.
“Then why did you come to a gun show?” he sensibly asked. What could she say to that? “Oh, just to look, I guess.” And we left.
Unless you’re an emergency department doc or a surgeon, physicians don’t get too involved with gun-related incidents. I once had a temporary job in northern Minnesota taking over GP’s practice for a few months that involved also acting as the county coroner. During my stint, there was one suicide (shotgun to mouth), one murder-suicide (tourist fisherman from Chicago shot a state trooper before killing himself), and one gun-related injury. A hunter, mistaken by his companion for a deer, had his spine severed by his friend’s bullet. My participation was minimal. I did the appropriate paperwork on the deaths and sent the now-paraplegic to Duluth for surgery and rehab.
Gun deaths vs. gun injuries
I mention that spine-severing incident because there’s a tendency to think about gun deaths more than gun injuries. Every one of them–58 dead in Las Vegas, 543 dead in Chicago so far this year, and the 12,176 dead in the US (this number changes so quickly you’ll need to click here to view the current daily total)–is its own tragedy for family, friends, co-workers, and society itself.
Physicians, emergency medical technicians (EMTs), and nurses are on the front lines saving the lives of the wounded. The US killed-to-wounded ratio is 1:2. For every person who dies by gun violence, two are wounded (check this link again to see the numbers). This ratio was skewed Las Vegas, with 58 dead and more than 500 wounded according to this report, likely because of the type of guns used by the terrorist.
Let’s review that one more time. To date in the US, 12,176 people have been killed and 24,766 wounded by firearms.
What guns do to human bodies
It was during my surgical rotation in medical school at Cook County Hospital that I first saw what a gun was capable of doing to a human body.
An 18-year-old had been caught stealing a cheap portable TV from someone’s bungalow. The owner shot the kid as he was crawling out through a window. Right now, place your forefinger on your right side just below your bottom rib. That’s where the bullet went in. It exited on the left side, smashing through the bottom rib and on its route through the body tearing through the liver, gallbladder, spleen, and several inches of intestine.
Positioned around the operating table in County’s poorly air-conditioned OR were the head attending surgeon, his first assistant (a resident), me and a second medical student, a scrub nurse, and an anesthesiologist. We students were there to hold the retractors, curved metal instruments needed to keep open the patient’s abdomen so the surgeon has an open operating field. You pull the retractor with the full strength of your upper arm muscles. Releasing the tension reduces the field and puts the surgeon in the position of operating blindly.
My partner and I pulled at our retractors for the entire six-hour procedure. If we weakened, the surgeon gave a verbal warning first, then a rap on the knuckles with the handle of whatever instrument he was holding at the time. It’s only in the movies that a nurse wipes the perspiring brow of the surgeon. At County, the surgeon and his first assistant wiped their brows on the shoulders of medical students. After six hours, I was drenched in sweat and my arms were throbbing, but that was nothing compared to the kid who took the bullet.
During the entire operation, a policeman sat outside the operating room, I guess believing the kid might leap up and make an escape attempt. Another policeman accompanied the gunshot victim to the surgical intensive care unit, sitting at the foot of his hospital bed for a week until the young man who had been shot developed an infection. The cop guarded him in the medical intensive care unit too, where the boy died ten days later.
Never the same
After my surgical rotations, I moonlighted in different emergency rooms. There I’d see so-called “minor” gunshot wounds (GSWs for short), helping extract small-caliber bullets from arms and legs. Those with GSWs to the head, neck, chest, and trunk would be immediately whisked to the OR. If you yourself are ever shot (and the chances are not unreasonable—we’re the third most dangerous country, after El Salvador and Mexico), chances are you’ll be operated on by a trauma surgeon and these guys really know what they’re doing.
But it’s not just the immediate treatment of a GSW that should concern us. No one is ever the same after being shot, physically or emotionally. My father-in-law, a WW2 Ranger who landed at Normandy, had severe back pain every day of his life for his remaining 55 years and struggled with post-traumatic stress disorder for decades.
Not a single one of the survivors of the Las Vegas massacre will ever be the same.
Guns are a major public health issue
Every physician–even the gun collectors, even the NRA members–knows that gun violence is one of our greatest public health issues. The number of people who will experience some form of gun violence (fatal or not) is about the same as the number of people who will be diagnosed with cancer of the pancreas. We spend serious dollars on cancer research. Why not something on the health risks of guns?
Just as the tobacco industry blocked any medical research that might link cigarettes to lung cancer, gun interests pushed the infamous Dickey Amendment through Congress. You haven’t heard of it?
This notorious amendment (introduced by former Rep. Jay Dickey, Republican from Arkansas who now regrets his action) was a provision inserted into the 1996 federal government spending bill when Congress was determining how much money should be allocated to the Centers for Disease Control (CDC).
There had been some reasonable discussion about doing research on gun safety. In fact, in 1993, one study showed that the mere presence of a gun in the home increased the chances of a homicide occurring there. But because researching and reporting on gun deaths could be interpreted as CDC advocating gun control, the provisions of the amendment would be violated and CDC’s funding cut off.
It’s like saying “Do all the research you want on cigarettes, but if you find a link between tobacco and lung cancer you’re forbidden by law to say anything that might get people to smoke less.”
In October, 2015, 110 members of Congress (all Democrats, by the way) signed a letter asking Congress to reject the amendment and remove it from the spending bill, but since Congress is Republican-controlled and members are major recipients of NRA money, the Dickey Amendment remains solidly in place.
Automatic repeating (ARs) rifles, like one ones used by Stephen Paddock in Las Vegas, are capable of shooting nine rounds per second and killing from a distance of five football fields. They are seriously dangerous. The photo that accompanies today’s Health Tip email shows the type of bullets used in Paddock’s guns.
While the CDC might be forbidden by law to tell you that being shot can be fatal or, if not fatal, extremely painful and life-altering, I am not under any such ridiculous restriction. If you are shot and killed, your sudden death will adversely affect more lives than you can imagine. If you are shot and survive, you will be physically and emotionally scarred for the rest of your life. That there are members of Congress who don’t want you to know this is simply criminal . And in a horrifying stroke of serendipity, between the time I wrote this Health Tip on Sunday and its publication, a loving, capable teacher at the school my sons attended as children was murdered by gunfire in her own neighborhood.
Be well and be safe,
David Edelberg, MD
PS: If you’ve been uncertain about what the internet term “troll” actually means, check back to read the comments on this Health Tip in a few days. The most unpleasant diatribes aren’t from our health-conscious WholeHealth Chicago patients or even regular Health Tip readers, but rather from people paid to post inflammatory remarks and sow discord.