I am a physician who, every once in a while, works with gunshot victims, though not in the way you see on TV medical dramas. I'm not one of those doctors who gets called in the middle of the night to perform life-saving surgery. I don't belong to one of those teams working the ER, the ones who rush, under extreme pressure and short deadlines, to stabilize shooting victims the moment they arrive by ambulance.
Ranit Mishori, M.D., M.H.S.
My work is different, less dramatic, continuing long after those lives were rescued, when the victims -- really, survivors -- have to deal with the damage done to their bodies and their psyches. As a family physician, I have seen and cared for survivors of gun violence, because of course these individuals continue to require primary care at my outpatient clinic. What they go through -- often for weeks, months, years and even decades after they were first pierced by bullets -- is the part of the story that often gets overlooked when we hear the phrase "casualties of gun violence."
We tally the dead in never-ending grim statistics and bar graphs that are growing higher and higher each year. We memorialize mass shootings and commemorate anniversaries carrying pictures of those who were murdered.
But we need to remember: Bullets do not only kill. They also maim. Too often, we stop talking about those who survived with injuries. Their lives, too, have been upended, sometimes in terrible ways. Their lives, too, should be tallied and studied, and we, as physicians, should act to make sure they are.
After shooting incidents, we are often given initial statistics of the number of injured. Parkland: 17 wounded; Las Vegas: 527 wounded; Orlando: 58 wounded. There's Aurora, Sandy Hook, Charleston, Sutherland Springs and, sadly, many more. According to some studies, more than 67,000 people are injured in shootings each year.(www.ncbi.nlm.nih.gov)
But what kinds of injuries are we talking about? How many of these injuries resulted in lost limbs? How many of the injured have lost their sight? How many have suffered spinal cord injuries and are partially or completely paralyzed? How many have suffered irreversible brain trauma? How many have suffered the often-unseen parts of trauma -- the psychological scars? Post-traumatic stress disorder? Anxiety and depression? Survivors' guilt?
For sure, there are many amazing recoveries, people rebuilding their lives and stories of resilience, but there are also the daily struggles that may include (a partial list): learning how to walk again; battling phantom pain; going in and out of hospitals for surgeries, skin grafts, and urinary and lung infections; battling recurring skin breakdowns; brittle bones that are prone to break; having to use special catheters for simple things like going to the bathroom; getting used to a new normal when you've lost the ability to see, to hear, to speak, to study, to work.
These injuries are not only debilitating and life-altering for patients and their families. They are also expensive. Recently, one of my patients with a spinal cord injury -- a successful lawyer with health insurance -- told me he paid more than $80,000 in out-of-pocket expenses to have a home health aide come in, daily, to help change bandages and ensure his skin breakdowns did not progress to severe infections.
Another patient -- a young man who suffered severe brain trauma and lost his ability to speak -- also lost his home and had to move in with his elderly immigrant parents who are struggling to pay for physical and speech therapy sessions, transport him to doctor appointments, and handle his unpredictable bouts of rage (a result of his brain injury).
In a country that doesn't have universal health coverage, these injuries are often hugely taxing on families and survivors, sometimes pushing them over the brink into bankruptcy.
What are the costs to our society from the ongoing, chronic care of victims of mass shootings? Of gun violence in general? Whose responsibility is it to pay for such care?
I watched recently as one of the brave students who survived the Parkland, Fla., massacre said on TV: "I speak on behalf of my friend who cannot speak for himself anymore." I honor him and his amazing peers for doing just that. We should all do that.
But I think I speak for many of my colleagues -- not only in family medicine, but in pediatrics and psychiatry, trauma surgery and emergency medicine, rehabilitation specialists and neurologists -- when I say we must also not forget to speak on behalf of the countless other victims of gun violence: the injured.
More importantly, we must work together to solve this public health crisis. We can do this by supporting research into gun violence and its consequences,(6 page PDF) counseling our patients about gun safety, exploring economic outcomes, and finding common-sense policy solutions that could prevent deaths and injuries.
The thing that makes this violence so unforgivable is not that we don't know how to address it. We know how to, but we are not getting it done.
Ranit Mishori, M.D., M.H.S., is a professor and director of the Robert L. Phillips Jr. Health Policy Fellowship in the Department of Family Medicine at Georgetown University School of Medicine in Washington, D.C.