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. 

Hero

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A colleague of mine was recently questioning her capabilities having lost yet another patient who had arrived nearly lifeless after being shot.  She was despondent over the nation’s overall complacency about our gun violence epidemic giving her far too many opportunities to fail or succeed as a trauma surgeon. Truthfully, neither quick decisive action nor expert surgical skill was enough to repair that much damage. Not in the hands of any trauma surgeon.

As trauma surgeons we bring everything we have–every ounce of energy and drive, countless years of specialized training, and an ever expanding armamentarium of medical technology to fix broken bodies–to our work but sometimes we simply feel like failures, both unable to save our patients and unable to move the dial on policies that might ameliorate gun violence.

Here are the words of support that I offered to my friend: a compassionate, highly skilled trauma surgeon who without hesitation took a hemorrhaging gun shot wound victim to the OR to try to save his life:

“The grief is understandable. For your patients. For your community. For our society. You have a skill set that makes you brave enough to even try, my friend. As a trauma surgeon when you hear audible hemorrhage you run toward it, just like the police run into the gunfire or the firefighters run into the flames. Each and every patient is lucky to have you and your strength; their families will be grateful for your efforts and empathy no matter the outcome. Don’t be too hard on your self.”

Having been raised in a culture of morbidity & mortality conferences where we scrutinize every decision and every action preceding a death or complication, having a chosen specialty whose goal is to salvage badly damaged bodies, and living in a world where these patients keep appearing in our trauma bays even when we speak up about gun violence, this self-doubt is common among us.

But sometimes we just needed to be reminded we are heroes who have chosen to run toward the audible bleeding so we can get up and go back to work the next day.

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.

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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

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.