Link

Any one who follows this blog on the nuanced lives and careers of two surgeon moms should watch this. In its entirety. 

http://academicsurgicalcongress.org/aas-2017-president-address-caprice-greenberg-md-mph/

It is the Presidential address delivered recently by Dr Caprice Greenberg to end her term as President of the Association of Academic Surgery. She speaks with clarity and conviction on a topic of importance to both men and women across generations of surgeons. She provides data, vivid examples, and eye opening analyses about how and why women are professionally held back, not just in surgery but across specialties and other professional roles. 

What I Really Care About During A Trump Presidency

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The internet is ablaze with images and commentary about our new president. They focus on a baby blue dress with an interesting collar or lack of chivalry or delusional views of a crowd or pithy signs about that which cannot be combed over, but let me tell you what I do and don’t care about when it comes to our new president.

I don’t care what his wife wears; but, I do care about how his trade policies will impact the price of everyone else’s clothes since most Americans cannot afford 4-figure price tag garments made in America.

I don’t care how he treats his wife or the two wives that preceded her; but, I do care about what he is doing to dismantle women’s healthcare and reproductive choice.

I don’t care what size of his crowds were compared to my crowds; but, I do care that  he has no qualms about every person in either of those crowds or in any other public space carrying a loaded weapon.

I don’t care how bad his spray tan is or how awkward his combover looks when the wind gusts; but, I do care that he is going to decimate our environment and exacerbate global warming.

I don’t care about his son’s personality or medical history; but, I do care that he is going to dismantle a public school system and higher education financing mechanism that educates the rest of our children.

I don’t care that he hasn’t released his tax returns; but, I do care that he intends to give the top 1% tax cuts while everyone else pays more and loses necessary services.

I don’t care that he is not as amazingly healthy as his hyperbolic doctor purported him to be; but, I do care that he is going to significantly reduce access to health care for millions of our most vulnerable citizens.

I don’t care that he was obsessed with promulgating the “alternative fact” that our 44th President was not born in the US; but, I do care about him oppressing those among us who were not born here especially if we do not bear a white European ethnicity or do not practice Christianity.

When our new president cares only about stroking his own ego and pandering to those who simply cannot tolerate a progressively diverse society and increasingly global economy, we must have a laser like focus on the values and policies we really care about.

Equity

    I will be joining a woman’s march tomorrow. Whipped up this embroidery project post-call. Fabric was a bit thin and hooping is still very hard, especially with two designs to merge into one line. But it makes the point. Today our nation moved from unconscious bias and micro aggressions to the normalization of racism/xenophobia/homophobia/etc. and oppression. So tomorrow I march for: Gender equity. Pay equity. Marriage equity. Health equity. Education equity. 


    Too tired for a sign but if I made one it would say:

    HUMILITY

    CIVILITY 

    EQUITY 

    Unimaginable Grief: Reflections on the Newtown Film

    I grew up in a home with the subtle lingering sorrow of parents who have lost a child. An older brother I never got to meet. 

    I have dear friends who have lost their children. Mothers and fathers who will never be the same. 

    I am gripped with grief every time I enter a windowless family waiting room to tell a parent that their child is dead. I often wonder how they are doing now, months or years later. How do they move on the way my parents and my friends who have lost children have moved on?

    This is the hardest thing I ever do in my job. I operate on beating hearts. I crossclamp aortas. I whip out spleens 20 minutes skin to skin. But this, this is the hardest thing I have to do as a trauma surgeon, telling parents their child is dead. 

    Last night at a trauma surgery professional meeting we were privileged to watch the Newtown Film documentary with the filmmaker and an ER physician who provided care that day and is a Newtown resident. It was a gut wrenching story about the evolution of grief.  It followed the parents who lost their children in this particularly gruesome and entirely preventable way. The grace and dignity with which they tackled life after 12/14 was remarkable, inspiring, and heartbreaking. It followed the teachers, the students, and the first responders who saw and heard what was simply unimaginable in even our worst nightmares…until then. Until 12/14/12. 

    Carnage: 20 dead first graders. 6 dead educators. 

    We are having myriad civil discussions at this meeting on what we as a profession can do to reduce firearms injuries. To be sure it’s a careful line to walk in our current societal climate. Avid readers of this blog already know where I personally stand on this issue based on my experiences as a trauma surgeon and the fact that I am human. 

    But today, today I just can’t get my mind of those dead children. They were loved and cherished lives filled with infinite potential. A lone gunman whose mother thought it appropriate to have a semi-automatic weapon and multi-round bullets in her home took them all away. 

    They didn’t stand a chance. Not with that weapon. Not with that kind of ammo. All gunned down in <5mi. 

    How many of us wave good bye to our little tykes, back packs all snug on their shoulders, expecting them to return home at the end of the school day? My own child was a sitting in a first grade classroom not too far north of Newtown, CT on that day. Any of us could be these parents experiencing unimaginable grief. 

    I am once again listening to the words of Lin Manuel Miranda from Hamilton to try to buoy me through these emotions as a mother, as a surgeon, as a human with a soul. 

    In ‘It’s Quiet Uptown’ Eliza who has lost her son to gun violence sings:

    There are moments that the words don’t reach.

    There is suffering too terrible to name.

    You hold your child as tight as you can

    and push away the unimaginable.

    The moments when you’re in so deep,

    it feels easier to just swim down.

    There are moments that the words don’t reach.

    There is a grace too powerful to name.

    We push away what we can never understand,

    we push away the unimaginable.”

    Her husband Alexander sings:

    “If I could spare his life,

    If I could trade his life for mine,

    he’d be standing here right now

    and you would smile, and that would be

    enough.

    I don’t pretend to know

    the challenges we’re facing.

    I know there’s no replacing what we’ve lost

    and you need time”

    The chorus repeatedly adds:

    “They are trying to do the unimaginable.”

    The Newtown Film chronicles a community trying to do the unimaginable. While I cried through most of the film watching the grief unfold, the most powerful moment for me was when David Wheeler who lost is son Ben was testifying to a CT legislative task force. He said “The liberty of any person to own a military-style assault weapon and a high-capacity magazine and keep them in their home is second to the right of my son to his life.” That line took my breath away like a sucker punch to my gut.

    The Newtown Film is powerful and difficult to watch but I hope that all of us Americans- parents, teachers, first responders, policy makers, legislators, and professional organizations – all of us  see it.  With this film, I hope that the national dialogue will become less contentious as we realize that no one, no parent, no school, no community, should ever have to suffer such imaginable grief. 

    We don’t need data, we need to ban semi-automatic assault rifles

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    I am on call today. It’s been an average day for this trauma surgeon. 1250 miles away, it has been a day of extraordinary carnage at a trauma center in Orlando, and that was for the 53 people who survived the incident. Another 50 were left dead at the scene, all shot by a single person.

    Yes, a single gunman.

    This tragedy brought up a lot of issues that torment and divide us Americans today.

    Anti-gay bigotry.

    Islamophobia.

    Gun control.

    No doubt the perpetrator was a horrible, soul-less person. While whether he was driven by hatred for gays or misappropriation of Islam or an obsession with ISIL are issues worth considering, the fact of the matter is that, regardless of what drove him to do this, his impact would have been far less severe if he had not been in possession of an AR-15 semi-automatic rifle.

    In the hours since news of the horrific event emerged, several friends shared a clip of President Obama on the PBS Newshour responding to a query on gun control where he discusses how the reduction of automobile-related mortality was data driven and how we are hamstrung by the NRA and those who are backed by the NRA when it comes to finding data-driven solutions to the gun problem. The President assured his audience that no one is going to take away guns from “lawful, responsible gun owners [who use them] for sporting, hunting, protecting yourself.” In fact, it appears that Moms Demand Action (an organization that emerged after the Sandy Hook tragedy) used data to change its focus from a ban on assault weapons to a focus on background checks and common sense use of firearms. Evidently, the data showed that the 1994 assault weapon ban, which existed for a decade before it was allowed to expire in 2004, did not save that many lives, and the organization wants its efforts to save as many lives as possible.

    But let me ask you this:

    Did the lives of the 50 people killed and 52 wounded in the Pulse night club not matter?

    Did the lives of the 26 people killed and the 2 wounded in Sandyhook Elementary School not matter?

    Did the lives of the 12 people killed and 70 wounded inside the Century 16 Theater not matter?

    In his PBS town hall, the President also commented on restrictions on background checks which some believe may have prevented this man in Orlando from becoming a gunman. Many people posted the list of the 45 senators who blocked legislation that would have kept someone on a terror watch list, a person of concern to the FBI, from getting any gun legally. However, when there is not a legal way, someone truly intent on killing will find an illegal way. An so this single person who killed so many instantly in such rapid succession would have found a way.

    He might have built as bomb as we saw in Oklahoma City and at the Boston Marathon. But, fertilizer, diesel fuel, pressure cookers, and ball bearings have other purposes.

    He might have flown a plane into the building as was done in a calculated, multi-person, multi-year scheme set up by a worldwide terror group on 9/11/2001. But planes are intended for transport.

    I could go on and on. And I often hear these myriad ways that others can kill cited when people state “Guns don’t kill; People kill.” Heck, I see them daily in my job: beer bottles, baseball bats, ice picks, kitchen knives, pipes, motorized vehicles…These all can be used to commit murder but are nowhere near as efficient as a semi-automatic rifle.

    And for these reasons, yes it is worth discussing what motivated this man to commit mass murder. It’s worth trying to understand how he became this venomous monster. It’s worth examining our processes of surveillance by law enforcement of those whom we suspect might become venomous monsters. But come on, do we really need to amass any quantity of data on semi-automatic rifles? A single magazine can hold 20 to 100 rounds of military grade bullets and fire up to 60 times a minute. Do we need really need study if this kind of weapon is necessary for decent law-abiding folks to shoot tin cans in their back yards, or take down deer for sport, or protect themselves from home intruders?

    Don’t get me wrong. I am both a surgeon and a health services researcher. I thrive on studying vexing issues through data collection and robust statistical analysis. I believe evidence-based approaches. Like many trauma surgeons and injury prevention researchers, I too want to know if biometric locks would reduce accidental deaths due to handguns. I wonder what psychometric tools might be used to optimize background checks if we ever could effectively implement them. I just don’t think we need data on this particular kind of weapon.

    In case you missed it before, the kind of weapon that was used to kill 50 people nearly instantly and injure 52 more in Orlando overnight, was also used to killed 12 and wound 70 in Aurora, CO and was used to kill 20 children and 6 adults while injuring 2 more in Newtown, CT.

    I was recently attended a talk by Dr. Lenworth Jacobs, a renowned surgeon at Hartford Hospital. He spoke of what steps they took on the day of the Sandy Hook massacre to ready their trauma center. Alas, no one was transported there because the vast majority were dead at the scene. Dr. Jacobs had the difficult task of reviewing every single autopsy while preparing a consensus statement on how to handle active shooter events. The air went cold as he described to a room full of surgeons what the military grade ammunition did to those poor kids’ bodies. They never had a chance.

    The Hartford Consensus statements that would emerge from this review of Sandy Hook and other mass shooting focused on how to prepare civilians, first responders, and trauma centers to save as many lives as possible in the face of such horrific events. Nothing was said about the weapons themselves. When asked about this, the Dr. Jacobs responded that it’s too politically charged; and since active shooter events will presumably continue to happen, our role [as surgeons] was to identify a problem that is addressable (people dying of possibly preventable hemorrhage) and address it (education on hemorrhage control within the context of active shooter events). The logical person in me who understands that the right to bear arms in part of the fabric of US society admired the pragmatism and ingenuity regarding active shooter events described in Dr. Jacob’s talk.

    Less than 3 weeks later there was the deadliest ever active shooter event in Orlando. To be sure, some of the 53 who lived must have benefited from the data reviewed for the Hartford statements. But please don’t tell me that you need data or that data is the reason why you won’t stand up and say “no, not ever” to a type of gun that can rip holes in the aorta, pierce through the brain, pummel through the heart, and break strong bones into bits and pieces in an instant up to 60 fucking shots a minute. There is no need for civilians to ever have this kind of a weapon. Not ever.

    And while it’s true that people will continue to die because those intent on killing will do so with criminally acquired firearms or by weaponizing everyday objects, because law-abiding gun owners will continue to be careless with their hunting rifles and handguns, and because those suffering from depression will commit suicide by firearm, we simply cannot stand behind this veil of data in not calling for a ban on semi-automatic assault rifles.

    The overall number of people killed by the AR-15 and similar military grade firearms might pale in comparison to the aggregate numbers of lives lost through other forms of gun violence but lets not devalue the lives of those killed and injured with these heinously destructive weapons by pretending we need data to ban them.

    We don’t need data. We need to stand up and do the right thing. We need to put an end to the ‘single shooter able to kill multiple victims in just a few minutes’ phenomenon made possible by the deadly combination of soul-less perpetrators and powerful semi-automatic assault rifles.

    _______________________________________

    Since this post was first shared a number of people have posted petitions regarding a ban on assault rifles. I don’t know what if any impact any of these will have but I am sharing them below.

    https://petitions.whitehouse.gov/petition/ban-ar-15-civilian-ownership

    http://csgv.org/action/pass-a-ban-on-assault-weapons/

    http://petitions.moveon.org/sign/ban-assault-weapons?source=s.fb&r_by=15891390

    https://www.change.org/p/tell-congress-the-president-reinstate-the-assault-weapons-ban

    What Brock Turner, his asshole dad, and a biased judge make me want to scream at my daughter (and my son)!

    The internet has been consumed this week with outrage regarding the trial of Brock Turner a varsity swimmer at Stanford University who was convicted of 3 counts felony sexual assault and only sentenced to 6 months in the county jail for a crime punishable by upwards of a decade in the state penitentiary.

    Evidently the trial was a classic blame the victim set up by the well compensated attorney hired by Turner’s family who was painted to be an all-American good guy. The jury didn’t fall for it and he was convicted. The judge, however, himself a former Stanford varsity athlete with seemingly similar racial and socioeconomic background, worried about the impact of a longer sentence on the convicted rapist. And so, the extraordinarily light sentence followed was in sharp contrast to what a young man of a different racial and socioeconomic background might expect from our judicial system.

    Now twice victimized, first when she was raped and second when her behavior on the night she was raped and her character were drawn into question in a court, the young woman who was assaulted by Turner wrote a powerful letter that galvanized social media followers who were soon calling for the judge’s recall. The convicted rapist’s father countered the letter noting how just ‘20 minutes‘ of his son’s life had resulted in such a detriment to his well-being. He went on to suggest that his upstanding progeny take up motivational speaking on the the topic of alcohol and promiscuity on college campuses rather than taking up space in a jail cell. Not surprisingly, this sent the twitterati into an uproar.

    ‘Rape Culture’ and ‘White Privilege’ have been hashtagged repeatedly these last few days and I too am enraged. But, I am not here to talk to you about my rage. There are plenty of others who have expressed my thoughts on this brave victim, the entitled brat who victimized her, his piece of shit father, and a judge (no matter how neutral his prior rulings might be) who clearly was woefully imperceptive of his own unconscious bias in favor of affluent white males in rendering a sentence in this case.

    I am here to express my grave concern about what to say to my children in response to this.

    I don’t want my daughter to have to go through what this young woman went through. I don’t ever want to see her spirit wiped away by the most gruesome of personal violations and to have her reputation destroyed in the process of seeking justice. I want to provide her with wise counsel to protect herself from ever being raped. And by this I don’t mean the scary bogeyman rapist who lurks in the bushes preying on unknown victims; for that she will have a black belt in Krav Maga.  Since the vast majority of rapes are perpetrated by known assailants upon known victims, be they long-term intimate partners or recent encounters on a dance floor, my daughter needs solid advice on how to avoid the Brock Turner types now and in the future.

    Wharton Professor and author Adam Grant’s post on Facebook (pictured below) sums up the causes of rape exceptionally well.

     And if these are it, then what can I say to my daughter to not play into the blame the victim stance that is so common in our society? I want to scream at her:

    “Don’t ever, not ever, drink a single drop of alcohol, ever no matter what! I don’t care how safe the social scene appears to you. I don’t care how solid a crew your girlfriends promise to be. I don’t care if you are the legal age. You have no idea if and when you judgment will be compromised; and, since the Brock Turners of this world can’t be relied upon to exercise any judgment even when you are sloppy drunk to the point of unconsciousness just don’t let yourself to be vulnerable to the likes of him due to intoxication so JUST. DON’T. DRINK!”

    “Ditto for drugs. Don’t expect anyone around you to exercise good judgment on your behalf. They won’t, especially if they are Brock Turner. Got it? NO DRUGS!”

    “Don’t dress provocatively. No cleavage. No short skirts. Nothing that accentuates your femininity, NOT EVER! You can read about how rape is about violence, aggression and power rather than about sexual arousal, pleasure, and sex in the text books but in real life I beg you not to do anything that could possibly make you more attractive to the Brock Turners of this world. They are incapable of exercising control over their sexual urges and they will lash out violently and aggressively to satisfy these urges with bodies that are simply more powerful than yours so NOTHING SEXY on that body!”

    “Ditto for flirty behavior. I wish a coy remark here or a sideways glance there could be just a fun, arm’s length interaction but to someone like Brock Turner it is like an invitation for sex even if it takes violent aggression to get it. So please DO NOT ACT LIKE YOU ARE ASKING FOR IT!”

    “Don’t walk alone. You never know when a stranger is going to assault you. Wait you have Krav Maga for that. What I really mean to scream is DON’T GO ANYWHERE ALONE WITH SOMEONE LIKE BROCK TURNER! Especially if you have not obeyed my prior four rants about drinking, drugs, dressing, and flirting. If you do, you better hope that the non-Brock Turners are randomly riding by on their bikes or their skate boards to save you.”

    And here I am seriously teetering on the edge of an unprovoked screaming fit at my daughter because my first reaction is not to scream at my son:

    “DON’T BE LIKE FUCKING BROCK TURNER!!!!!!!!!!!”

    “Nope. Not ever. I don’t care how she dressed or behaved, or how compromised her judgment may have been for whatever reason, or whatever fantasies have been imprinted in your brain from the media, or how our society tends to treat men and women differently when it comes to matters of power and sex and everything in between. You are better than that. You treat women-all humans for that matter-with respect. You protect those who might be vulnerable, be they male or female, young or old, drunk or sober, black or white, whatever their potential vulnerability may be. You stand up for what’s right and you squash all that is morally reprehensible. You be the guys on the bikes or the boards. You help. And unlike Brock Turner, his asshole dad, and this biased Judge you be the one who sets a good example for all the little boys that follow.”

    The trouble with discourse that drives us apart in response to a death in the line of duty

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    Cross-posting from the heenastat blog.


     

    My heart sank when I heard the news that a local police officer had been killed in the line of duty. I was not on call that day but I knew exactly what the words “he was taken to a local hospital where he was later pronounced dead” meant. As trauma surgeons we provide care for those injured in senseless, often preventable ways daily. But when an officer is stricken it hurts in so deeply because we share a position with them at the forefront of the worst that happens in our society.

    So when I heard the news I mourned for the officer, for his family, for his colleagues, for all of law enforcement, and for the people who tried so valiantly to save his life and would forever be asking themselves “was there something else we could have done?”

    Let me assure you, there was not.

    As with all trauma centers, we have a comprehensive morning report where we discuss all of our new patients: what was the mechanism, how did they present, what was done for the work-up and subsequent treatment? So it was clear that the trauma team did everything they scientifically or physiologically could in this case. In morbidity and mortality* terms, this would be a ‘non-preventable’ death.

    Here’s the thing though, of course it was preventable. And we are all (as members of the community, as his brothers and sisters in law enforcement, as representatives of both sides of the criminal justice system, as providers in the healthcare system) asking this same question “why, why did a good man—a good cop, a good husband, a good father, a good son, a good citizen—die this way?”

    In a statement to the press less soon after losing her son, the officer’s grief-stricken mother was quoted as saying there is “no respect for police anymore” suggesting perhaps that a pervasive devaluing of law enforcement by society might be at the root of her son’s preventable death. She was no doubt alluding to the national discourse evolving in recent years due to some high profile episodes where the actions of responding officers have been questioned. Some actions have been proven to be criminal by our justice system, as in the case of an Oklahoma City Police Officer who serially raped women he had pulled over, in other cases, however, the facts in support of criminal behavior beyond a reasonable doubt are less clear (e.g., Officer Parker of Madison, AL and Mr. Sureshbhai Patel; or Officer Wilson of Ferguson, MO and Mr. Michael Brown; or Officer Pantaleo of New York, NY and Mr. Eric Garner).

    Clarity notwithstanding, there has seemingly been a shift in public rhetoric questioning of infallibility of those on the front lines of law enforcement. Sadly, in some cases the rhetoric has escalated to vitriol, rioting, and even directed acts of violence against law enforcement.  It truly is maddening that a man, fueled by the overarching discourse questioning police intentions and behavior, would then seek an opportunity to kill the police as in the case of Mr. Ismaaiyl Brinsley who gunned down Officers Wenjian Liu and Rafael Ramos of the NYPD, not during the act of apprehension or while committing another crime, but just because.

    However, no matter what the headlines are, the overwhelming majority of our men and women in blue are good men and women who take on their duties with the best of intentions and model professional behavior. And so, when this good man’s mother cites this volatile discourse as a possible cause of his death—as much as my heart breaks for her—it hurts our community by suggesting a local conflict where there was none.

    By all accounts, the cop killer in this case was a sociopath lacking any respect for human life or the laws of our society in general as evident by a lengthy record replete with charges ranging from cocaine trafficking, to assault & battery, to weapons possession. Those of us who are not career criminals might get tachycardic or diaphoretic during traffic stops but our natural instinct is to reach for our license & registration, not for our gun. A man with no moral compass felt cornered and so he fired; but, this was no more because he was cornered by an officer than if I had made some gesture to this armed and dangerous criminal during my nightly dog walk.

    So, while a family, a profession, and a community mourn, I urge each of us to contemplate how the criminal justice system might have functioned differently to prevent this senseless tragedy but to avoid stoking fired up rhetoric that pits people against the police and police against the people. Discourse that drives us apart stands in the way of viable solutions to combat the socioeconomic and psychological factors that may drive one to a lifetime of crime in the first place and to take those who cannot be rehabilitated off the streets before another preventable death, be it of an ordinary citizen or a man/woman in blue.

    ______________________________________________

    *Morbidity & Mortality, or M&M as it is called is a weekly conference held by surgical teams to review all deaths and complications in an effort to learn more about the systems-based and disease-based processes that led to the adverse outcome.

     

     

    Who am I?

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    Long time followers of this blog know that we started it based upon a shared quest to be better to ourselves, our bodies, our families in the midst of very demanding careers as trauma surgeons. As the one who started the blog, I must admit that my initial intention was to focus on what made us whole outside of work. And so, much of the content, especially early on, was about our shared interests in hot heels and all things fashion, our efforts to stay healthy donning our cool kicks or our ballet socks, and our challenges as wives and mothers whose day jobs require a scalpel.

    But as time passed, we wrote more and more about our professional experiences, because it turns out a large part of our whole is what we go through at work. After all, with 4-10 nights per month on in-house call and standard 120 hour weeks on service in addition to research, service and society work to advance our academic careers, we spend many, many more hours on the work part of ourselves than the outside of work part of ourselves.

    Since my hope had been to share the outside of work part of ourselves in this blog, as I found myself writing here more and more about work related issues, I recently created separate blog. I told @surgeoninkicks it would be my “professional blog” where I could share some of the darker stuff that affects us (i.e., someone interested in my Jimmy Choos may not want to be confronted by the sorrow that I feel when I lose a patient). It would be a blog where I would write about the experiences that help me maintain joy in the profession.

    However, the reality is that the two sides of our worlds are not separable. Maintaining joy in the profession in inextricably linked to finding joy outside of work. @surgeoninkicks understood this but it took me longer to confront this reality of who I am.

    I am a surgeon in a specialty with extraordinarily high rates of burnout, with hours that pose significant logistical challenges to self care, family life, and extracurricular activities, and with routine exposure to human pain and suffering. I do feel joy in doing my best to care for patients and their families. I did choose a career path where I would be balancing non-clinical and clinical work. I do have a husband, two children, a dog, many friends, and interests outside of work. I do feel stress in juggling it all and routinely engage in retail therapy as an elixir. I am not nearly as fit and healthy as I want to be. This is who I am. 

    So, this week I will migrate the few posts from my other blog into this venue. I will continue to write about all the facets of who I am in this blog, a blog I am so lucky to have shared with a true soul mate in @surgeoninkicks.  She has seen me through this crisis of online identities and I am ready to share completely. Thank you for the continued readership. Your enthusiastic support of our work is greatly appreciated.

    Today Nearly 300 of Us Will be Killed or Injured with a Gun

    My heart is heavy this week due to gun violence. Today, it is a mass shooting that happened afar. Most days it is something that happened in my own trauma center’s catchment area.

    Some people ask why I only speak up about our nation’s epidemic of gun violence when there is yet another mass shooting. After all, as a trauma surgeon I am all too familiar with the daily toll of gun violence one person at a time.

    Whether it is the young urban dweller who lacking hope for a good future, in the absence of socioeconomic security and educational opportunities, turns to a life in gangs armed with illegal guns and ends up in a crime fueled shootout…

    Or the depressed middle-aged suburbanite who under the oppression of dark feelings related to job loss or divorce or perhaps seemingly no obvious stressor attempts to take their own life with a hand gun…

    Or the believer in concealed carry who, in a state of inebriation, engages in what might have otherwise been a simple fisticuffs that instead turns out to be a deadly bar fight…

    Or the curious child who, due to the momentary carelessness of an adult who would swear they are an educated legal gun owner compliant with best practices for firearms safety, pulls the trigger with a devastating outcome…

    Or the bereaved, yet obviously mentally unstable, individual who acts on his grievances against his mother’s surgeon by gunning him down in the clinic

    Or any of the 297 Americans killed or injured daily due to firearms, as trauma surgeons, my colleagues and I bear witness the death and destruction caused by our nation’s obsession with the right to bear arms first hand each and every day.

    While it’s a thrill for a trauma surgeon to get a great case—it might be the adrenaline surge of doing an ED thoracotomy on a coding patient with a hole in the heart or the exhilaration of the exploratory laparotomy requiring 4 or 5 lacerated organs to be repaired—but as a human, each and every time I am called upon to care for someone who was shot, no matter what the circumstances, I feel sick to my stomach. My soul grieves for those who I can’t save, for those who will be left permanently disabled, and for everyone—patients, families, and caregivers alike—who will share the post-traumatic stress of having gone through the shooting and its aftermath.

    This should not be happening in a civilized society.

    To be sure, there are myriad other issues that contribute to gun violence in our country ranging from economic insecurity to mental illness to extremist beliefs to the ubiquitous violence we see in our LED lit world today. And, let’s not be naive; many objects can be weaponized to intentionally or unintentionally injure, maim, and kill others. As we have come to know from the fertilizer used in Oklahoma City to the ball bearings used in the Boston Marathon to the box cutters and airplanes used on 9-11, to the beer bottles, lead pipes, knives, bats, and automotive vehicles that we surgeons see as causes of trauma every day, it’s not just guns that are the problem. But it is foolish to think that these other issues contributing violence in all of its forms trump that of essentially unfettered access objects that, in any form—shotgun, handgun, semi-automatic—have a singular purpose: to injure, to maim, or to kill. The original purchaser’s intent may have been different—perhaps for target practice or for hunting animals or for self-defense borne out of paranoia of threat to personal property that is seemingly rampant in our society—but it’s just too easy, no matter how the gun was acquired and by whom, for guns to be used to cause harm whether by murder, or suicide, or terrorism, or accident.

    And so, when there is a mass shooting that attracts the social media outcry of those around me—those known to me from near and far and those unknown to me who simply come across my news feed—I do speak up more vociferously than I do in my everyday life as a trauma surgeon because, in the deepest depths of my heart, I am hoping that this increased attention might galvanize WE THE PEOPLE to find it in our collective consciousness to finally take steps to re-envision what the right to bear arms means in a civilized society. No other country accepts this as an inalienable right; and, as a result they don’t see nearly as many deaths and injuries due to firearms as we do. But we hang on to this 18th century notion as a point of American pride. It’s time for 21st century Americans to figure this out because today nearly 300 more of us will be injured or killed by gun violence.