It was just after midnight when the call came in. “Fifteen-year-old male, single, G.S.W.” – gunshot wound – “to the abdomen,” I heard over the loudspeaker. “Stable vitals.”
Earlier that night, we had treated another young man who had been shot in the abdomen. He’d been hit just outside the hospital and walked in, clutching his belly and yelling in pain. The bullet went straight through the left side of his abdomen, puncturing his spleen, before it exited through a small wound in his upper back. In the operating room, surgeons removed his spleen and tied off the bleeding vessels. He went to the I.C.U. in stable condition.
This new patient was also screaming and yelling. He also had a single gunshot wound to his left upper belly. When the paramedics wheeled him in, his heart rate, blood pressure and oxygen levels were normal.
“It’s going to be OK,” a nurse said to him. “You’re going to be fine.” But things were not OK. Two minutes later, he was gasping for breath. His oxygen level was dropping, as was his blood pressure. When we turned him over, we found an exit wound the size of a small grapefruit.
Early in my medical training, I learned that it is not the bullet that kills you, but the damage from the bullet. A handgun bullet enters the body in a straight line. Like a knife, it damages the organs and tissues directly in its path, and then it either exits the body or is stopped by bone, tissue or skin.
This is in contrast to bullets from an assault rifle. They travel three times the speed of handgun bullets. Once they enter the body, they fragment and explode, pulverizing bones, tearing blood vessels and liquefying organs. This is what was happening to my patient, whose heart quickly stopped beating. We performed an emergency thoracotomy – splitting open his chest in an attempt to clamp off bleeding and restart his heart, but the damage was far too extensive. He died in our emergency room.
He was 15.
On Wednesday, four people were shot in northern Virginia, including Rep. Steve Scalise of Louisiana, who remains in critical condition from a gunshot wound to the hip. A bullet to the hip from a handgun is far less likely to be deadly than a shot to the chest or head. Unfortunately, the shooter in Virginia reportedly used a semiautomatic assault rifle. I once treated a patient shot in the pelvis with a similar weapon. The bullet shattered the hipbone into hundreds of pieces. It shredded the femoral artery, causing life-threatening bleeding and destroyed whole portions of the bowel and bladder.
This was the kind of damage inflicted upon victims of the Pulse nightclub shooting in Orlando and other mass shootings, including Newtown, San Bernardino and Aurora. Trauma doctors and nurses who treated patients in these tragedies and medical examiners who investigated the aftermath all commented on the unbelievable devastation resulting from the bullet wounds. Indeed, this is the intended consequence of assault rifles. They are designed to be weapons of war.
There are estimates that the annual societal cost of gun violence exceeds $229 billion. What I see are the human costs, not only of death but also of survival. Because of spinal damage, my patients become paralyzed, unable to walk and sometimes unable to move anything from the neck down. Because of blood loss and infections, they have their leg bones removed and undergo limb amputations. Because of intestinal perforations, they wear colostomy bags. Many require multiple surgeries, followed by a lifetime of hospitalizations from antibiotic-resistant infections and chronic, unremitting pain. Some become addicted to painkillers; they face a downward spiral of unemployment and poverty, homelessness and hopelessness.
Medical professionals are trained to stanch bleeding, stitch wounds and patch up broken bodies. We are good at our jobs; most gunshot victims survive their wounds. But every day, we are plagued by the question of how to prevent these injuries in the first place, when the damage is so extensive from weapons so readily available.
Two years ago, a group of doctors wrote in the Annals of Internal Medicine: “It does not matter whether we believe that guns kill people or that people kill people with guns – the result is the same: a public health crisis.” In the war zone of the emergency room, we don’t see partisanship or politics. We see the devastation that happens when our society normalizes tools of total bodily destruction.
Dr. Leana S. Wen (@DrLeanaWen) is an emergency physician and the Health Commissioner of Baltimore City.
The New York Times