Physicians sound the alarm for treating gun violence as a public health epidemic
By Katie Scarlett Brandt
Especially on warmer nights, the gun victims arrive in waves. Typically, they get to the emergency rooms by ambulance. If they come by car, sometimes the driver or other passengers roll them out at the entrance like a heap of dirty laundry before speeding away.
It makes no difference whether the victim was shot by a stray bullet, shot in a domestic fight or shot by a gang member. Emergency medicine physician Mark Cichon, DO, hears them say the same thing over and over.
“There are two things that everyone pleads for in their terminal moments: One is their mother, and one is God,” he says. “There are no atheists in foxholes.”
Cichon is chair of emergency medicine at Loyola University Medical Center in Maywood, a level 1 trauma center just west of the city. This past March, he partnered with Rev. Michael Hayes, a chaplain at Loyola, to publish a letter in the Chicago Tribune. In it, they make a case for classifying gun violence as a public health epidemic on par with Zika virus, heart disease and obesity.
Another harrowing letter, from Catherine Humikowski, MD, medical director of pediatric critical care at University of Chicago Medicine, published in the Chicago Tribune in October 2015, highlighted the same goal.
The victims are steadily mounting. There were 2,988 people shot in Chicago in 2015, and 4,368 shot in 2016, according to the Tribune. The city of Chicago has become synonymous with gun violence in many eyes, while our society has grown almost immune to the news.
Society isn’t just immune. It’s lost.
In addition to the thousands of people tragically shot, gun violence costs Americans billions of dollars each year in law enforcement, healthcare and lost wages. However, the issue has become so politically charged that people aren’t able to talk about it without invoking the Second Amendment. And that’s when things can get ugly.
Relentless gun violence
Cichon and Hayes are striving to remove politics from the argument by presenting the issue in terms of public health.
“Let’s say we were talking about polio or West Nile or Zika. If a doctor of a major hospital said, ‘Hey, we’re in trouble,’ I’d expect to see city officials stepping forward,” Hayes says. “I’m looking for people to band together to do whatever it takes. There comes a time to say, ‘I’m going to pitch in here.’ Because that’s what it means to be a citizen.”
But that hasn’t happened. Instead, the shootings continue. Hayes tells of a teenage patient who died of gunshot wounds, the bullet tearing apart the teen’s internal organs beyond repair. Hayes recounts the many times a week he has been called on to provide spiritual support for gunshot victims in the emergency room or intensive care unit.
Humikowski says she saw so many gunshot victims in her first week at University of Chicago Medicine Comer Children’s Hospital that she wanted to quit. She cared for more children who had been shot in that one week than she had in two years of training in Boston.
Most kids on the South Side either know someone who has been shot or they’ve been shot themselves, Humikowski says. “They don’t perceive a future without violence because it’s not something they’ve ever had.”
The need for research
Government-funded research into gun violence as a public health problem would be a place to start.
“We need to know what the root causes of this violence are and in an interdisciplinary way. We need to know what economists, sociologists, theologians are saying about it, but we don’t,” Hayes says.
Government-funded research could have a similar impact to what it has had on the tobacco and automobile industries. “It wouldn’t be that hard,” Humikowski adds.
“Look at smoking,” she says. “My daughter won’t ever experience a world where she has to sit in a smoking section because the non-smoking side was filled. That change happened in one generation.”
Little by little, researchers, the medical community and health advocates have chipped away at the tobacco industry. Their combined efforts led to policies that changed where advertisers could promote smoking and where smoking was permitted.
“We exposed data for being faulty. We warned the public, and a lot fewer people smoke now than did in the ’80s,” Humikowski says.
With regard to gun violence, though, bringing about that change has been a battle two decades in the making.
Loss of funding
In 1996, the National Rifle Association (NRA) was waging war against Congress and the Centers for Disease Control and Prevention (CDC).
That war started three years earlier in 1993, when CDC-funded research led to a study published in the New England Journal of Medicine. In “Gun Ownership as a Risk Factor for Homicide in the Home,” researchers made a strong correlation between firearms in the home and an increased risk of homicide.
As a result of subsequent pressure from NRA lobbyists, Congress stripped the CDC of $2.6 million for gun violence research and passed the Dickey amendment, which states that “none of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control.”
The American Psychological Association condemned the amendment at the time. In 2015, Doctors for America, the American Academy of Pediatrics and other medical associations asked Congress to repeal it.
Former President Barack Obama also made that futile request after the Newtown massacre at Sandy Hook Elementary School in 2012. A few years later, a gunman opened fire in a nightclub in Orlando and, again, nothing changed politically.
“At the end of the day, the laws we make have to reflect our cultural values. [These gun lobby efforts] are driven by a very powerful, financially motivated lobby, but with sustained effort, we can do it,” Humikowski says.
Research could help specialists understand what drives people to violence, where they obtain their weapons and who is impacted as a result. Studying gun violence doesn’t have to be polarizing to the hunter who looks forward to fall hunting trips or the office worker who goes to the shooting range twice a week to blow off steam.
It’s not that there’s zero gun violence research happening. However, it is largely funded by individuals or independent groups that focus on different aspects of gun violence, such as Everytown for Gun Safety, which is aimed at motivating voters who feel strongly about curbing gun violence.
Through the public health lens
By framing gun violence as a public health issue, researchers would be able to capture widespread and detailed data on exactly how fatal shootings happen. From there, they would have the knowledge to coordinate actionable steps to change it.
After all, gun violence is a disease that is killing our youth, Humikowski argues. The disease is acute and chronic. It is contagious, and it can be terminal.
Researchers could receive funding that enables them to get out into communities, talk to residents and analyze the relationships between a range of variables that play a role in gun violence. They could study high-risk behaviors and environments, types of weapons used, access to illegal firearms and accidental shootings.
By looking critically at the data, lawmakers could tailor policies to achieve the greatest impact. Manufacturers could design firearms so that kids couldn’t easily use them—similar to the way medication, chemicals and cleaning products come in bottles with childproof lids or automobiles come with safety belts.
“That didn’t grow out of nothing.
It grew out of funded research,” Humikowski says, arguing that society needs to apply the same resources to studying gun violence as it has for other diseases.
Healing the spirit
One day in the ICU, Humikowski treated a gunshot survivor whom she had seen months earlier when he was first shot. The gunshot wound had left the teen paralyzed from the shoulders down. At 15, his body was gaunt, and he had multiple infections. He had to live in a nursing home.
Humikowski says that when she saw him, “It hit me how numb I had become to [gun violence]. His body had fallen apart. It was an analogy to what was happening in my mind.”
Though she may feel like that at times, Humikowski is far from numb. She speaks passionately about gun violence and is fully present for the gunshot victims who flood her pediatric ICU every year.
When she goes home at the end of the day, she hugs her daughter tightly and collapses, wondering how much longer she’ll last in this environment.
Cichon, who originally planned on being a solo practitioner in a rural community, says it takes a special type of personality to treat patients under these extreme circumstances.
“You don’t know what’s coming through the door. It takes resiliency and a balance of not just being a caregiver but also having the opportunity to be cared for in one’s own life,” he says.
Cichon finds that balance in his family, friends and colleagues. Back in the ER, when he faces those victims pleading for their mothers or God, they rattle him to his core. But he powers on—manipulating procedures, equipment and technology to treat the patient’s body while Hayes heals the soul.
To find the strength to meet victims and families at their lowest moments, Hayes says he depends on the resources of his faith.
“I know that the people who are hanging on by their nails in dangerous communities are undergoing such psychological trauma on a daily basis,” he says. “We are diminishing our dignity as a collective by allowing this to continue.”
He’s calling on everyone—including legislators, citizens and philanthropists— to do their part.
“I firmly believe that we are greater than the forces of chaos that are plaguing our city, but we have to stand up. We have to make it our problem. Somehow our feeling is disconnected from action. This is a time that calls for activism and advocacy,” he says.
And then Hayes has to go. There’s been another death. Another family is mourning, and Hayes has to summon the strength to meet them at rock bottom.