Christmas Eve, for Dr. Mary Brandt, will forever be associated with saving the life of a little girl who nearly died from a gunshot more than 25 years ago.
Teams were in the middle of changing shifts when a 6-year-old came to a Texas county hospital ER with massive gunshot wounds to her shoulder and chest. Her mother had been fatally shot by her boyfriend. When the girl tried to call 911, the man turned his shotgun on her.
After hours of surgery, Brandt saved the child. Since then, Brandt, now a pediatric surgeon at Texas Children’s Hospital in Houston, has operated on many more child shooting victims. “All of us have some patients who we can’t forget,” Brandt said of the young girl. “In terms of being able to not be sad about it, it took months and months. I’m still probably a little sad about it.”
Few people in the world are more familiar with gun violence than emergency room doctors and surgeons like Brandt. But until recently they’ve largely kept quiet about their experiences on the front line of this public health crisis.
That changed in November after the American College of Physicians issued new guidelines on how doctors can help protect patients from gun violence ― and the National Rifle Association responded by telling physicians to “stay in your lane.”
In effect, the NRA wanted these doctors to shut up about an issue that touches their lives daily, leading to a record high of nearly 40,000 deaths in 2017, according to recent data from the Centers for Disease Control and Prevention, and around twice as many injuries each year.
The NRA retort was enough to lead many physicians to break their silence. Under the banner of “This is our lane,” surgeons and other doctors thrust themselves into the gun debate, sharing photos from inside operating rooms and telling stories about the agony of treating an unending flow of shooting victims.
Medical organizations also doubled down, calling for additional gun violence research and further pushing measures like universal background checks, waiting periods to buy guns, safe storage initiatives and so-called red flag laws designed to keep firearms away from people who may be a danger to themselves or others.
Now, in a series of interviews with HuffPost, doctors are shedding additional light on the topic, painting a diverse portrait of a problem that afflicts communities in a variety of forms, including mass shootings, assaults, accidents, intimate partner violence and suicide.
Their accounts describe exhausting work that doctors have traditionally shouldered in private. Many doctors told HuffPost they feel it’s their moral duty to show the public the truth: Gun violence is ubiquitous in emergency rooms all over the country.
Exposing people to that reality could resonate in a way that general facts and figures about gun violence haven’t and show Americans that it’s necessary to begin taking steps to address the crisis, Brandt said.
“Human beings don’t just change their minds because of data.”
It’s something I wish I could do something about, but I feel helpless.
Dr. Adam Schechner, University of Maryland Prince George’s Hospital Center
When doctors see patients with gunshot wounds on a daily basis, it’s hard to keep track of how many they’ve treated.
“I wish I knew. Too many,” said Dr. Adam Schechner, a trauma surgeon at the University of Maryland Prince George’s Hospital Center in Cheverly.
Schechner estimates he’s tended to hundreds of shooting victims, the majority of them young men from Washington and the Maryland suburb of Prince George’s County. Schechner recalled a case in which a young man died of his injuries. When Schechner informed the patient’s mother, she broke down. The woman gathered herself long enough to explain that the son she’d lost was the only family she had left. Her other son had been shot and killed a few years prior. She was alone.
“That one really, really got to me,” Schechner said.
Even when his patients survive, it can feel as if he’s working against a tide that will ultimately erase his work, Schechner said. Many of the gunshot victims that come into the hospital have been shot before.
“It’s disheartening because most of the time it seems like they just don’t care, [like] they don’t seem to appreciate the second chance they’ve been given,” Schechner said. “That’s really the hardest part of my job: working to save somebody’s life and then having them not appreciate that life.”
Last year, the hospital Schechner works at launched a program to help survivors who’ve been shot or stabbed multiple times, providing wraparound care and social services designed to target the root causes of violence. The evidence so far suggests it’s working.
The program is a critical step toward prevention, but it’s hardly a catchall solution to gun violence, Schechner said. The more shooting victims he treats, the more he realizes this issue affects him not just as a doctor but also as the father of young children, who he fears he could someday find on an operating table with a gunshot wound.
“It makes my life outside the hospital that much sadder, because it’s something I wish I could do something about, but I feel helpless,” Schechner said.
It was like a scene from hell.
Dr. John Fildes, University Medical Center of Southern Nevada
Even two decades as a trauma surgeon couldn’t truly prepare Dr. John Fildes for the terror he encountered on Oct. 1, 2017.
Fildes began his shift at the University Medical Center in Las Vegas just minutes after the gunfire stopped at the Route 91 music festival, the scene of the deadliest mass shooting in modern U.S. history. There were already 35 people with gunshot wounds waiting in the trauma area, he said.
“There was blood all over the floors and the gurneys, and there were patients that were holding pressure on their own wounds telling me to take care of the sicker patients,” Fildes said. “It was like a scene from hell.”
Fildes and his colleagues scrambled to get the most severely injured patients into the operating room and worked to stabilize the others. Most of the team managed to work through the paralyzing horror of the moment, though a handful of staffers were so emotionally jarred that they had to be briefly pulled away to compose themselves, Fildes said.
Despite the circumstances, Fildes and the surgery department he chairs saved every one of the 104 patients connected to the shooting who arrived at the hospital alive.
Any sense of triumph was short-lived, Fildes said. He still struggles to find words to describe what transpired that night.
“This was 1,100 rounds of military-grade ammunition showered on 22,000 people,” he said. “There isn’t another one of these cases.”
Although the medical center began interventions for post-traumatic stress disorder the next day, in the year since the shooting, staffers have reported sleeplessness and repeated nightmares, Fildes said. A handful have required more serious care.
The Route 91 Harvest festival shooting was a horrific outlier, and Fildes said he hopes no surgeon will have to witness another massacre of this scale. But even doctors lucky enough to avoid mass shootings can’t escape the constant drumbeat of more ordinary firearm injuries and deaths, he said. For many, that bloodshed is reason enough to speak out on gun violence.
“Doctors don’t have a gun problem; they have a bullet hole problem,” Fildes said, adding that a renewed focus on firearm safety, prevention and enforcing existing gun laws would go a long way toward saving lives.
There’s only one degree of separation between you and everybody else.
Dr. Christopher Barsotti, Berkshire Medical Center and Southwestern Vermont Medical Center
When Dr. Christopher Barsotti, an emergency physician, moved to southern Vermont from a busy Chicago hospital known for treating shooting victims, he hoped he’d be leaving gun violence behind. Instead, it became more personal.
Barsotti sometimes recognizes patients he treats in the emergency room, or has at least met their family members or neighbors, he said. That can make cases even harder as he learns about the often tragic circumstances that precede shootings.
Beyond self-inflicted gunshot wounds and instances of people “settling scores,” rural hospitals see plenty of hunting accidents, domestic violence or shootings involving children who’ve accessed unsecured firearms, said Barsotti, who is a gun owner himself. In the worst cases, it may fall to Barsotti to deliver bad news to a person he knows.
“When you live out here, there’s like 2 degrees separation between you and everybody else,” Barsotti said. “When you are actually working and taking care of people, there’s only 1 degree of separation.”
Sometimes the unthinkable happens. Dr. Richard Miskimins, a trauma surgeon at the University of New Mexico Hospital in Albuquerque, recalled operating on a patient who’d been shot in the face. Hours later, he found out he knew the man.
“He was so horribly disfigured that I didn’t realize,” Miskimins said.
Albuquerque is hardly a rural town, but as home to the state’s only Level I trauma center, Miskimins and his colleagues treat a number of patients transferred from smaller counties in the state. Self-inflicted gunshot wounds are particularly common, Miskimins said. Although the vast majority of people who attempt to kill themselves with a firearm will die, those who don’t are typically left with debilitating neurological or physical injuries that require intensive care.
A few years ago, Miskimins treated a patient who’d intentionally shot himself. After completing a lengthy recovery, including a facial reconstruction, the young man began visiting the ICU regularly to thank the staff, said Miskimins. The patient has since gotten involved in national suicide prevention efforts.
“Suicide is so often just an impulsive thing, where, in the depths of despair, they act,” he said, citing studies showing that many people who survive suicide attempts don’t go on to try again. When a gun is available, those impulses are far more likely to end in death.
It’s not just the person who sustains the injury.
Dr. Richard Miskimins, University of New Mexico Hospital
Gun violence isn’t just a story of victims and perpetrators, Miskimins said. Whether fatal or not, every shooting ripples outward, touching not only the individuals directly involved but also their families, friends and loved ones, as well as the medical professionals who serve as intermediaries during these painful ordeals.
“It’s not just the person who sustains the injury that has a significant psychological impact on them; it’s also on their family that comes and sees them,” Miskimins said.
As challenging as it can be for everyone to recover after a shooting, it pales in comparison to the alternative. Telling a parent that their child has been fatally shot never gets easier, said Dr. Mark Seamon, a trauma surgeon at the University of Pennsylvania’s Perelman School of Medicine. He said he changes into clean scrubs and takes a few deep breaths before giving the news.
“You never know what their reaction will be,” Seamon said. “I’ve had reactions where the mother would say, ‘Well, we knew this was coming,’ and just walk out.”
So, a lot of folks have asked me about this photo: the chair. Why? Well, I have a chair for all the things I ROUTINELY do: my dinner chair, my reading chair, the chair where I rock my kids to sleep. And the chair where I tell parents their kids are dead. #ThisisOurLane pic.twitter.com/MNDutybXwC
— Stephanie Bonne (@scrubbedin) November 17, 2018
Even when a family fears the worst, they’re never really prepared for it.
“There’s a certain tenor, there’s a certain pitch to their voices or the cry that they give when you tell them that their loved one has died,” Barsotti said. “It’s a sound that hits you in the pit of your stomach.”
The day you don’t cry is the day you should quit.
Dr. Mary Brandt, Texas Children’s Hospital
The emotional burden of gun violence weighed heavily on the mind of every doctor HuffPost spoke with. When asked how they deal with it, there was less agreement.
Some emergency rooms do their best to address grief in real time. When someone dies in the trauma bay at the University of New Mexico Hospital, they’ll hold a brief moment of silence to reflect on the loss and acknowledge the staff, said Dr. Stephen Lu, a trauma surgeon.
“It takes like 30 seconds, then we go on with the rest of the night,” Lu said.
To handle the stress of a life-or-death job in the operating room, many doctors said they must be able to compartmentalize. For some, that may mean simply trying to bury the brutal reality of what they’ve witnessed.
Schechner, the doctor from Maryland, rarely talks about how his job affects him personally, he said, noting that surgeons are generally wary of showing any sign of weakness related to their work.
“Every person that I pronounce dead from a gunshot wound takes a little piece of me,” Schechner said. “The fact of the matter is we’re human, too, and we’re not supposed to act like it.”
Despite perceptions of physicians as being unshakable, or even stolid, those qualities are just one part of the job, said Brandt, the pediatric surgeon from Texas. The other half involves being human. In the operating room, surgeons must focus on saving lives. “Afterwards, we allow it to hit us,” Brandt explained. “One of the things I’ve always felt, and I have taught, is the day you don’t cry is the day you should quit.”
To the @NRA, this is what it looks like to stay in #mylane. We will not be silent about the toll of #gunviolence. I speak out for this patient, for their parents who will never be the same, for every person who came after this one and didn’t have to #thisiseveryoneslane pic.twitter.com/B5mo6pC4dV
— Kristin Gee, MD (@kmgee9) November 10, 2018
Doctors manage these emotions with varying degrees of success. Traditionally, the medical profession has viewed self-care as selfish, maintaining that a physician’s own needs are secondary to the patient’s, said Dr. Jo Shapiro, director of the Center for Professionalism and Peer Support at Brigham and Women’s Hospital in Massachusetts.
After three decades of practicing surgery, Shapiro was struck by the lack of attention paid to the people doing the work. It eventually became clear that physicians couldn’t continue putting themselves last. Studies have shown that burnout, depression and other mental health problems plague the health care profession. And the doctors HuffPost spoke to were quick to note that the cascading effects of gun violence don’t stop at physicians. They can touch everyone from nurses, to hospital support staff, to the custodians who clean blood off the floor of the ER.
Shapiro now directs a program that trains physicians how to support each other when they experience trauma on the job, whether it’s an acute response to a particular case or the cumulative weight of unceasing gun violence.
“Somebody has to be there to help patients who have been shot, but it’s very frustrating, saddening [and] hard to do over and over again,” Shapiro said. “It can be demoralizing.”
Unless you’ve had someone die in your hands, that’s easy to say.
Dr. Stephen Lu, University of New Mexico Hospital
Some doctors see the “This is our lane” movement as an outlet not only to begin processing their grief but also to channel it toward solutions.
“There’s such joy in thinking I’m not just treating the end result, I’m helping prevent this,” Shapiro said. ”[It’s] letting us bring our humanity back into our work.”
This focus on prevention is also well-trod in the field of medicine, with doctors using similar methods to tackle past public health crises, such as HIV, smoking, motor vehicle deaths or environmental hazards and pollution. First, they study a problem to identify its patterns and root causes. Then they work to design policies in an effort to reduce those negative effects, rather than just treat them as they arise.
When it comes to the issue of firearm deaths and injuries, the political polarization has made many doctors hesitant to speak up, said Lu, the New Mexico trauma surgeon. By not speaking out, he said, doctors may have unintentionally sanitized the shootings that rip through American streets, homes, schools and ultimately hospitals tens of thousands of times each year.
“Americans are shielded from death in general,” Lu said, adding that it’s one reason for the lack of compassion and empathy in the gun debate.
Yet it’s people who lack this exposure, who likely have never seen a gunshot up close and hopefully never will, who are now telling doctors that gun violence is none of their business.
“Unless you’ve had someone die in your hands, that’s easy to say,” Lu said.