Thursday, January 10, 2013

A Doctor's View of the NRA Call for More Guns in Our Schools

Originally posted at

I will never forget the day I was called to our trauma center ER to intubate “Bobby.” The pager exploded in alarm: 1-01-1. One victim, 1 minute, level 1. 

 I ran. 

 Arriving breathless as medics crashed through the door with a child on a stretcher, I see a puzzlingly clean scene. No gore, no blood-soaked blankets. The boy’s terrified blue eyes search silently for help. His chin is tilted up and mouth open, chest heaving in short gasps, like a stranded fish. It’s ok, it’s ok, I say to him as his story is recited and an intubation tray is set beside me. Eleven years old, home with older brother, found the key to the gun cabinet and shot himself showing off the Glock, which was supposed to be empty. Unlike most kids, he isn’t thrashing, crying, shoving us away. He isn’t moving at all. He isn’t making a sound, every fiber trained on getting that next breath. A laryngoscope is shoved into my hands, a nurse prepares the succinyl choline, a paralyzing drug to make placing a breathing tube easier. But I stay her hand. 

 There is a small trickle of blood from the corner of his mouth and an almost innocuous-looking hole in the side of his neck the size of the tip of my little finger, with a single drop of blood. The bullet has torn through his vertebra and spinal cord, then ricocheted around inside. There is no exit wound. He is paralyzed, barely able to breathe…and God knows what is in his throat. He is losing strength quickly, but with trauma in the airway, I don’t know if there will be a clear track for an endotracheal tube. I make a quick decision, grab the bag and gently apply the smallest mask I have to his face, carefully assisting him in his own fading breaths, and call for an operating room team stat. It will be ok, I tell him, his eyes locked on mine, his pupils dark holes in his terrified face. It will be ok. I will not leave you. I promise, I promise you will get enough air. He nods faintly. The trickle at the corner of his mouth grows slightly. 

 The operating room is silent and tense. Everyone stands ready. At this moment, I may open his mouth and find that all is well—slip a tube in, and assure that he won’t die of suffocation. Or I may find chaos, swelling, bleeding, an airway I can’t access. We will have only seconds. A shake of the head will tell the surgeon to start cutting a hole in his neck, and I will keep trying in the meantime, because emergency tracheostomy in these situations often fails, the neck swollen and distorted by the bullet’s mayhem. It is a roll of the dice…and this time we almost lose. 

 I tell him once more that all is well, and nod to my assistant, who delivers a stun-dose of hypnotic drug. But when I look inside, there is nothing familiar in his torn throat to slip a tube into. Blood wells up obscuring my view. I shake my head, the surgeon cuts, and I suction the kid’s mouth and try again. And again…. And again. The boy’s arterial oxygen saturation starts to fall with each heartbeat, and the pulse begins to slow…I hear the surgeon curse, and I curse, and then, suddenly I’m able to see distorted vocal cords and pass a tube through them. We all take a deep breath. Besides suturing tissue and taking him to the intensive care unit, however, we have done all we can do for this child. This is what his life will be now, on a ventilator, unable to move independently, for the rest of his life. 

 Is this, I remember thinking, what I aspired to? 

Children’s deaths touch us all deeply. The most recent horrific mass killing grabs our attention and rage for a few days, but the problem seems too overwhelming to tackle and so we get discouraged. The NRA would have us believe that we can arm our schools, change the video games, lock up the nuts and all will be well. But we don’t talk seriously about giving up our guns, which is actually what we must do to turn the tide. Because, Dear Readers, Sandy Hook is an aberration. Don’t let the NRA fool you. Mass killings are not how or why our sons and daughters are dying in a hail of bullets—mass killings account for fewer than 1% of all gun-related deaths in the United States. The other 99% of victims are dying because we have too many guns. Over 75,000 people are maimed and permanently disabled in the U.S. every year from gun violence. And the vast majority of the guns involved were easily obtained, most of them legally. Eric Harris and Dylan Liebold used weapons bought for them by their friends. All of the weapons that Adam Lanza used were available to him from his own home. James Holmes obtained his firearms legally over the internet. “Bobby” got his gun out of Daddy’s closet.

 NRA says they don’t oppose gun violence research, so long as it is objective. Well, here’s news for the NRA. The research is in. Guns don’t kill or maim people. People with guns kill and maim people, and they do it in breathtaking numbers.

In 2013 there will be more deaths from guns in the U.S. than from automobile accidents. Over 37,000 people will die from a bullet. That is one life every 12 minutes, 24/7 all year long. That’s another 9/11 every single month, every single year, as far into the future as we can see, until something is done. The annual death toll is almost quadruple the total number of Americans killed in the 9/11 attacks, the Iraq War and the War in Afghanistan combined. Wars usually end, and we can calculate the final numbers. But the death toll from gun violence repeats over and over annually. The leading causes of death in people age 15-34 in the U.S. are homicide and suicide, the majority of which involve a gun. The annual death rate from firearms among children under age 15 is more than 12 times higher than in 25 of the next top industrial countries combined. Putting an armed guard in every school will not save many of those lives.

A significant portion of deaths related to criminal violence involving firearms…in many if not most cases involving guns that were obtained legally under current Federal and state laws. An armed guard in every school will not save many of those lives, either.

In the aftermath of Sandy Hook, many called for increases in mental health expenditures and more programs to keep the mentally ill in confinement. But the fact is that mental health issues play a minor role in homicides in the United States. Most homicides occur in the home, as the result of domestic disputes or emotional crises, combined with poor impulse control and the ready availability of a deadly weapon…in the vast majority of cases, a weapon that was obtained legally under current Federal and state laws. An armed guard in every school will not save any of those lives.

In the U.S. approximately 5 million new guns enter the market every year. The per-capital gun death rate of the US is over 10 times that of the UK. Surely our founding fathers did not intend the for constitution to become a suicide pact with future madmen and criminals, or with gun enthusiasts who appear willing to sacrifice our future generations in an unwavering ideology that, bluntly stated, puts political motives above our children’s and young people’s lives. Nor did our founders likely ascribe to the belief that there is some sort of “God-given” right to manufacture and own assault weapons whose only purpose is to kill human beings, kill quickly, and kill in unprecedented numbers. The founding fathers were fighting a war with a hostile invader on their own soil. “A well-armed militia” might have been necessary then, but that is a far cry from a right to have a recreational assault weapon (or three) in every home.

The NRA argues that “right to carry” laws reduce crime. But well-respected research by the National Research Council and other groups has shown that there is no correlation between right to carry laws and crime reduction. Gun lobbyists argue that other weapons are used to murder people: knives and hammers can kill, too. But not as easily. And not as many. It took under 10 minutes from the first shots that broke down the door to the last trigger pull for 26 people in that elementary school to die. About 18 appear to have died within the first two to three minutes. Two minutes is not enough time for rescue from the bullets of an assault rifle. It is not enough time to retrieve a weapon for self-defense. It might be just time enough to realize what is happening and scream down a hallway. It might be just time enough to turn and try to run...

….but it is not enough time get away.

The NRA says all we need is a good guy with a gun, but as Gabrielle Giffords (a gun owner herself) just pointed out; “a good guy with a gun” came out of a store nearby and nearly shot the very man who was finally able to wrestle down Jared Loughner and put a stop to his wave of killing.  In over 60 mass killings in the last 3 decades not a single one was stopped by a private citizen carrying a gun.

Let’s take the blinders off and admit that liberalization of gun laws--such as allowing the Brady Bill assault weapon ban to expire in 2004--has been associated with unprecedented peacetime civilian death and mayhem. Let’s finally admit the truth: that most people who murder with a gun are not madmen or alienated video game enthusiasts, as the NRA would have us believe, but human beings who reached a breaking point—but who would not have killed, or would have killed far fewer people, if they had not had the ready availability of a gun in their own home. Let’s admit what we actually do know: that gun-locks, gun safes, and personalized guns are useless in the advancing slaughter. We’ve tried them. They are unpopular, and they don’t work. Fewer than one-third of gun owners store their weapons unloaded, or even bother to lock up their guns.

Close to one-half of American households have at least one firearm. The average gun owner has at least 2 firearms. In over 9 million U.S. homes, that number is more than 10. Five years ago we hit a milestone: there was essentially one gun for every man, woman and child in America—more than any other country in the world. At close to 100,000 deaths and injuries annually, gun violence literally constitutes the greatest single public health threat to our young generations.

As a physician, it is my duty to speak up. The time has come to open the second amendment, for the sake of all our children.

What we really need is fewer guns.