By DAVID H. NEWMAN Published: January 1, 2013 (NY Times)
THERE is an unspoken rule in medicine: we do not tell tales out of school.
As an emergency room physician, an Army veteran who was deployed to a combat support hospital in Baghdad in 2005, and a biomedical researcher in the field of cardiac-arrest resuscitation, I have been and am, on a daily basis, a witness to grave misfortune. Ordinarily, though, except for medical purposes, I will not discuss what I have seen.
Last week a colleague asked me to make an exception. The father of two young children, he was moved by the rampage at Sandy Hook Elementary School in Newtown, Conn., to ask his professional circle to reconsider our silence. I am an expectant father, and his words resonated with me. They reminded me that we doctors are at the front lines of the scourge of gun violence, and that to remain silent as this threat to public health continues unabated would be no different than for an oncologist or a cardiologist to stay mum on the dangers of smoking.
The doctor’s balance between discretion and education is complex. But the news from Newtown, and my colleague’s request, convinced me that we have reached the threshold. I can no longer stay silent.
Here is just some of what I have seen over the years. In Baghdad, I saw a 5-year-old girl who was shot in the head while in her car seat. Her father, who knew she was dying before I said it, wept in my arms, as bits of her body clung to his shirt.
Much of the gun violence I have seen, though, I have seen on home soil, here in the United States. There was a 9-year-old girl, shot in the chest by an assault rifle during a “drive-by” gang shooting, in a botched retaliation for a shooting earlier that day. She was baffled, and in pain, with a gaping hole under her collarbone.
I have also seen an 8-year-old who found a shotgun in the closet while playing with a friend. The two boys pointed the weapon at each other a number of times before the gun accidentally discharged. The 8-year-old arrived in my emergency department with most of his face blown off. Miraculously, he survived.
Another child I will never forget was a 13-year-old who was shot twice in the abdomen by an older boy who mistook him for one of a group that had bullied and berated him a week earlier. Slick with sweat and barely conscious, he groaned and turned to look at me. Soon after, he died in the operating room. His mother arrived minutes later, wide-eyed and breathless.
I do not know exactly what measures should be taken to reduce gun violence like this. But I know that most homicides and suicides in America are carried out with guns. Research suggests that homes with a gun are two to three times more likely to experience a firearm death than homes without guns, and that members of the household are 18 times more likely to be the victim than intruders.
I know that in 2009, the most recent year for which data is available, nearly 400 American children (age 14 and under) were killed with a firearm and nearly 1,000 were injured. That means that this week we can expect 26 more children to be injured or killed with a firearm.
Emergency rooms are themselves volatile environments, not immune to violence. Over the last decade, a quarter of gun crimes in American E.R.’s were committed with guns wrested from armed guards.
I have sworn an oath to heal and to protect humans. Guns, invented to maim and destroy, are my natural enemy.
Sally Cox, a school nurse in Newtown, told Scott Pelley of “60 Minutes” that when state troopers led her out of the school after the mass shooting they instructed her to cover her eyes. This was humane, and right. But some of us see every day what no one should, ever. If the carnage remains undiscussed, we risk complacency about an American epidemic — one that is profoundly difficult, but necessary, to watch, and to confront. That is why I bear witness.
David H. Newman is the director of clinical research in the department of emergency medicine at Mount Sinai School of Medicine.