As an ER physician, I wait to hear the name of a receiving hospital whenever news of a shooting breaks, as with the Uvalde, Texas, school shooting Tuesday or the shooting in a Buffalo, New York, grocery store last week. Please let there be a receiving hospital.
I have paused at the door to give mothers another minute, knowing that their lives will be forever split into all the time before I opened that door and all the time after.
Some people think we need to talk more about, or even show, the devastation wrought on a human body by these weapons. Here’s all I think you need to know: Someone used a gun against another person. Guns are designed to release bullets with high energy for the purpose of tearing, transecting, piercing and shattering live tissue, vessels and bones. And the product functions as intended. That’s why so many people never make it to see us in the hospital and why in every scenario it’s infinitely better to prevent or minimize the severity of the initial injuries.
But if they make it to us, they still have a chance. They have a pulse, a blood pressure. The heart is working and still has some blood to pump around. There are valuable minutes to stabilize while we figure out what’s wrong, how to fix it. Usually, the ambulance calls ahead to the hospital so we know what to prepare for. Shot in the arm, the leg, with stable vitals? OK. We breathe. Shot in the head or the abdomen or the chest, or with dropping blood pressure, it’s: “How many minutes do we have?” We move quickly to set up the trauma bay.
At a Level 1 trauma center, it takes an unfathomably large team to care for a single patient who has been shot (tens of millions of people don’t even have access to these centers, which is why prevention is the far better option). The trauma attending is there before the ambulance pulls up, anesthesiology is on stat page, the O neg blood is rolled up in a cooler (a strangely ordinary one, like the one you have at home). We open up the thoracotomy kits, the large bore intravenous line kits. At a smaller, lower-capacity hospital, they prep with whatever team they have and may call out to staff members at home to come in and help. A mass casualty can quickly overwhelm emergency rooms of any size.
Sometimes the ambulance drivers stop radioing in updates, and in the sickening silence you know — time ran out. The chance we had is lost. Sometimes they make it through the door, but the best of our abilities doesn’t reverse how well that product worked, how efficiently it fulfilled its purpose. Sometimes they survive, but the aftermath changes their lives forever.
The only recent successful bipartisan legislation related to firearm violence is to provide downstream education about how to staunch the hemorrhage from a gunshot wound, rather than measures to prevent it from happening in the first place.
When I was in residency, the room where we received visitors whose loved ones were critically injured or ill was just around the corner from the trauma hallway. That short distance meant that it was easy to dash over and provide an anxious family with an update. It meant that there were only a few seconds to process the gathering dread of the news we had to give and to steel ourselves to do it right. Ask what they know so far, be direct, no euphemisms, no false hope. Give them time to absorb your words. Give them time to ask questions. After a shooting, they have to absorb so much more than a loss. It’s the hate, the senselessness, the parts that will never quite register: They were healthy, vibrant, alive one moment. And then the next moment they were not. There were things that might have prevented this. But they were not done.
I have forgotten so many faces, but it’s the parents I remember, because of how their bodies collapse under the weight of our words, under the burden that is now theirs permanently. I have paused at the door to give mothers another minute, knowing that their lives will be forever split into all the time before I opened that door and all the time after. If I wait, I give them more of the before-time, in a world in which their child is still alive. What is the rush to the other side? To wish that moment of transition away, to yearn for a society that would mobilize to prevent that moment for every child, for every parent, is simply to be human.
When I was just starting my career, I attended a lecture by the renowned emergency physician Dr. John Marx. He said the worst thing we see in the hospital is what one human inflicts on another. Fifteen years later, I can attest that this is without doubt true.
But there are also the matching horrors outside the hospital. Like the greed, cowardice, frustration and inertia that keep our trauma centers as busy with penetrating traumas now as they ever were, even though many safety measures, including background checks and raising the legal age for gun purchases, are enormously popular across political parties and among gun owners. Like the cultivated ignorance, including the deliberate underfunding of research that would build additional knowledge around means of decreasing firearm injuries and deaths, both through prevention and through better trauma care, or the insistent, nonsensical and harmful claims that our gun violence problem is solely one of mental health when psychiatrists themselves highlight the critical role of firearm safety measures. Like the fact that the only recent successful bipartisan legislation related to firearm violence is to provide downstream education about how to staunch the hemorrhage from a gunshot wound, rather than measures to prevent it from happening in the first place. Like the fact that in concert with giving up on upstream interventions, we have eroded downstream care as costly trauma hospitals close in areas already experiencing the gravest health inequities, including rural, poor and disproportionately Black communities. Like the fact that our health care societies advise a wide range of measures to minimize gun violence, then put their dollars into politicians who will never enact them. In the short term, I hope we all can show support for the communities affected. I hope everyone who can will donate blood, as hospitals have been in short supply and need more to care for patients who have been injured. Here in the hospital, we will always be waiting to receive those who make it to us. We’ll do our best, on our end, every time. But our best will always be a worse option than prevention. Please don’t lose sight of the better option.
Dr. Esther Choo
Esther Choo, M.D. M.P.H., is an emergency medicine physician, health policy researcher and founding member of Equity Quotient, a company that advises organizations on building cultures of equity. She has provided commentary on the pandemic and other health care topics through appearances on MSNBC, CNN, the BBC and Yahoo! Finance and editorials published in The Lancet, the British Medical Journal, The Washington Post, NBC Think and USA Today. 
