Episode 4: This is our Lane
As gun violence continues to be a highly politicized issue, some believe that the experiences of health care providers have no place in the conversation. In 2018, physicians responded to a statement tweeted by the NRA stating the physicians should “stay in their lane,” by asserting their perspectives through the use of the This Is Our Lane hashtag. In the same vein, Episode 4 of (Re)Search for Solutions discusses the experiences of clinicians who deal with the immediate aftermath of a shooting.
Sonali sits down with Dr. Megan Ranney, an emergency physician and faculty at Brown University as well as a co-founder of the AFFIRM Research collective, to discuss how treating gun violence as a public health issue can help us to find solutions to the epidemic. She also speaks with Dr. Ameera Haamid and Dr. Garth Walker, who are also emergency room physicians, about their experiences.
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Additional links, resources, and episode transcript below!
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Episode Transcript
Ameera: And my thoughts were “Wow, something so small, something so tiny, fired from something handheld could literally take someone’s life so easily.” And you don’t really need a lot of them, right, you just need one in the right spot and there are so many “right spots” in the human body. I just remember that that was one of my thoughts when I first saw someone with a gunshot wound. That even though the injury looked so small and insignificant, the internal damage and the psychological damage is so great.
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Sonali (over theme music): (Re)Search for Solutions is a series where we cover research related to pressing issues in our world today. During this season, we're focusing on unexpected and creative ways that researchers are looking at solutions to the persistence of gun violence. I'm Sonali Rajan, a professor in the Department of Health and Behavior Studies at Teachers College, Columbia University, working with the Media and Social Change lab.
[Music fades out under narration]
Sonali: On this episode of Research for Solutions, we’re hearing from emergency medicine physicians who are on the front lines of responding to firearm injuries. As we think about ways to prevent gun violence, it’s important to include the voices of those who are responsible for what happens immediately after a shooting occurs. As both healthcare providers and researchers, the perspectives of physicians are extremely valuable in conversations about solutions to gun violence. One such clinician is Dr. Megan Ranney, an emergency physician and faculty at Brown University and co-founder of the AFFIRM Research collective.
Dr. Megan Ranney: My work spans multiple areas. As an emergency physician, I take care of folks who are at risk of firearm injury or who have suffered gunshot wounds on a very regular basis. I’m also actively engaged in trying to figure out how to stop it through my day job at Brown, where I conduct research projects with students and other faculty and community members, and just — if not more importantly, through my work at AFFIRM. Where we’re working to redefine the way that our country talks about gun violence and thereby create innovative new solutions to the epidemic that we’re stuck in.
Sonali: As gun violence continues to be a highly politicized issue, some believe that the experiences of health care providers have no place in the conversation. One example of physicians asserting their perspectives was the use of the This Is Our Lane hashtag on social media, which we discussed with Megan.
Megan: So in fall — in November of 2018, the NRA sent out a tweet in response to a paper written by the American College of Physicians telling “self-important doctors” to stay in our lane, and to not talk about firearm injury. Saying basically it was none of our business. This tweet set off a firestorm of response from the medical community.
The #ThisIsOurLane was coined within about 12 hours of the NRA’s tweet and then really went viral. It started with a few of us sharing stories and talking about the ways in which both the treatment and the prevention of gun violence is very much our lane as doctors and public health professionals. But it spread into something that was used by thousands and thousands of not just physicians, but also other health care professionals, from across the country and even across the world. People shared personal stories, shared clinical stories, shared emotions and captured the imagination of the American public in a way that we hadn’t done before.
Sonali: Gun violence is not contained or limited geographically, and the stories of gun violence and its impact are held by many, including physicians and other healthcare professionals, educators, social workers, and others for whom this is very much their lane. To hear more about these stories, we asked Megan what it’s like to care for victims of gun violence.
Megan: So, taking care of victims of gun violence has been part of the bread and butter of emergency medicine, sadly, since its inception as a specialty. It’s part of our basic training. We actually spend a lot of time thinking and learning about how to save people's lives after they've been shot. And as part of that training, you learn how to develop an emotional distance from folks who have been shot.
The experience of taking care of a victim of gun violence is qualitatively and quantitatively different from taking care of any other illness or injury in the emergency department. People who have been shot are so scared, whether or not the gunshot wound is actually life threatening. And the mere fact that they've been shot means that they're going to get descended on by this huge team of physicians, respiratory therapists, trauma surgeons, medical students, social workers; there’s just this big team that comes into the room and almost overwhelms them.
Early on and taking care of those patients, I felt their fear and empathized with it. But as part of my training, I, and every other ER doc and trauma surgeon out there, learns to distance yourself emotionally so that you can do the best thing for the patient in that moment. So that you can have the greatest chance of saving their life. But that emotional distance also means sometimes that we lose a connection to the humanity of the person who's sitting in front of us, and that we stopped thinking about the fact that we're taking care have a terminal event, and there was an awful lot of stuff that happened before the person came through our door that could have been an opportunity to change their trajectory.
Sonali: After speaking to Megan, we also asked one of her colleagues, Dr. Ameera Haamid, to share her experiences. Ameera is an emergency medicine physician at Cook County Hospital in Chicago and the assistant medical director of the Chicago West EMS System.
Dr. Ameera Haamid: I think, as physicians, we do a really good job especially as emergency physicians compartmentalizing. That's something that we're kind of taught during medical school is to kind of put things in a box, put things aside, don't let it affect you. And basically, it's kind of like this protective mechanism that you come up with to protect your own mental health when you're dealing with a lot of traumatic— not even just gun violence. I mean, because you're getting gun violence victims on top of people who are suffering massive heart attacks, who were coming in with cardiac arrests. So it's a stressful job to have, especially when the family is there and they're pouring their hearts out and they're crying and you're basically the only person or, you know, maybe a leader amongst people that is leading a resuscitation trying to save this person's life.
To have gun violence victims come in, me, being a Black woman and a Black physician, I think that it is incredibly traumatizing to us because a lot of our gun violence victims within the city of Chicago, or within urban settings, are African Americans, or, you know, people of color. And we can talk about all the reasons that that exists, but when you start seeing everyone coming in as people that look like your mother, people to look like your father, your brother, your cousin —it does something to you psychologically. And it's kind of like this unspoken —it's an unspoken angst or an unspoken, like secret trauma that Black emergency physicians and Black, probably trauma surgeons experience, because they keep seeing people that look like your family members that are brought in.
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Sonali: In addition to speaking with Megan and Ameera, we also reached out to Dr. Garth Walker. Garth is an emergency medicine physician at Jesse Brown Veteran Affairs Medical Hospital in Chicago, as well as a health equity fellow with the Northwestern Emergency Department and Northwestern Buehler Center for health economics and policy.
Dr. Garth Walker: Typically, in emergency medicine there's there are very common practices, like standard of care and things of that nature, but there can be a lot of variability, too. And for gunshot wounds, when people come to the hospital, you're typically assessing whether it has violated any major organs, any life threatening injuries, or anything that might inhibit that patient from being able to go home care for yourself and do what they need to do. So, if it penetrates an artery, if it penetrates a bone and shatters a bone, you’re likely to probably be admitted. What we tend to think less of is, “what are they going back home to?” So, is it safe to go back home? Is it safe to go back home within 15 days? safe to go back home in 30 days? And it probably feels even more intuitively significant for pediatrics —children, right? Because at our hospital, anybody that was related —at a safety net hospital that I used to work at —any child that was either indirectly or related was at least brought in for observation for social services and social work. We don't necessarily do that with Black men 18 to 25.
Maybe it's just a difficulty to kind of empathize with an adult. But I think where research will probably be most beneficial going forward is thinking about how we stratify high risk environments, people that are affected by gun violence and what we can do in that short term post violence to help reduce recidivism and reduce some of the negative externalities related to it like mental trauma, stress, things of that nature.
Ameera: The news stations typically report from the scene where the person was shot. But the news does not show you the despair on scene, the emotion, the psychological and physical stress surrounding the victim being shot at the time that they are shot. The news also doesn't show the raw emotion of friends or family members who show up at the hospital, hoping that that person is still alive, literally praying, pleading and begging for that person's life. Lastly, the news doesn't show you that light that flickers from their face when they see their loved one underneath a white sheet. The despair is unthinkable. And people don't focus very much on that component. The emotion and psychology behind losing someone you love to an act so violent, so ugly and brutal, is hard to watch. And in the ER we’re witnesses to that testimony.
Some of those that articulate their agony or pain are our mothers of color that, in all honestly, fear that a day like this may come. These mothers know that this is a real possibility. It is a possibility for someone in their family to die at the hands of gun violence. As a mom, you may try everything in your power to keep your family safe, but when this particular mom walks into the room to see her slain son or daughter, she's now appreciating her biggest fear that she has ever had. And she is now entering the worst day of her entire life.
There is a scream that can be heard, and that can be felt throughout the entire department and possibly the entire hospital. That's the scream from someone who saw her eight year olds life obliterated right in front of her. It's also the scream for someone who unfairly and unjustly has been victimized by gun violence. It shouted by mothers across our nation and it is heard by all ER physicians. That scream, in itself, is the definition of despair. And that scream is a call to action.
I say this because I think that if more people were in our ER to to hear these screams, to witness a family destroyed, witness a community destroyed and to meet the family and friends of this victim that will never be the same that will have PTSD, psychological traumas, depression, anxiety, they’d empathize or sympathize with our patients as we do, and they would want to do everything in their power to stop gun violence, regardless of whether or not they felt that their families will be personally affected.
Megan: We've seen, not just theoretically, but in very real terms, the ripple effect of a single shooting across a community. Whether it's because a parent gets addicted to opioids or alcohol to numb the pain of losing their loved one, or whether it's because one kid get shot, and then another kid gets shot, or whether it's a series of suicides. And those sit with us and again, because I think traditionally we haven't thought of gunshot wounds as being something preventable. They just feel hopeless. And, again, you kind of have to numb yourself to get through them. I think it's also part of the reason why we saw such an outpouring of stories and frustration in the fall of 2018 with the This Is Our Lane hashtag. So many of us have been holding these stories inside for so many years. That hashtag gave a lot of people what may have been their first chance to discuss the trauma that they've seen and held on to for many years.
Sonali: Megan, along with physician Christopher Barsotti, co-founded the American Foundation for Firearm Injury Reduction in Medicine or AFFIRM, a non-partisan network committed to the reduction of firearm injury. This network supports gun violence research and creates space for a variety of perspectives, such as those we just heard, in developing solutions to gun violence.
Megan: So, AFFIRM Research, or the American Foundation for Firearm Injury Reduction in Medicine, is a 501(c)3 that Christopher Barsotti and I co-founded a little over two years ago. It represented the culmination of years of work that we had done to start changing the narrative around gun violence among medical professionals and derived from our belief that to really move our public conversation forwards, we had to step out of our silos of individual hospitals or universities or specialties, or even our silos of roles in healthcare, you know, nurses, doctors, social workers; we had to all join together to change the conversation about gun violence and define new ways of approaching it.
Part of our underlying philosophy was that it is inherently a health problem, so we can address it with the same techniques that we've used to reduce every other form of injury and illness across history. But also that when we approach it as a health problem, it doesn't have to be politicized. A really important thing to know about me and Chris is that I am a fellowship trained, injury prevention researcher. Chris is a community ER doc, he is a gun owner and he is a 4H rifle safety instructor. And it was critically important to us that we bring together those perspectives, and that we make AFFIRM be something that wasn't just ivory tower, but really was based in the lived experiences of communities that are both at risk of and have the ability to prevent firearm injury.
Sonali: Ameera and Garth, in addition to being emergency room physicians, are also on the Research Council for a firm and came to the organization because of the same event. The death of their close friend, Dr. Tamra O'Neill Tamra, along with two other doctors at Mercy Hospital in Chicago were lost to gun violence in late 2018.
Garth: So when I joined AFFIRM — I joined the firm actually at the beginning of my third year, but I hadn't actually had a conversation with Megan. But it was until really that my friend passed away while I was on shift. So my friend, one of my best friends was a victim of gun violence. She essentially was an ER physician at Mercy Hospital. I was working the shift that day as a senior resident. It wasn't until that one of my colleagues said an African American female was shot by her fiance at Mercy Hospital and I immediately broke down because I knew exactly who that was. Because the specificity for an African American female, that had a fiance and to be an emergency physician doctor. It's just so specific, that I knew it could be nobody other than my close friend Tamara O'Neill. And that was one of the worst days of my residency. I thought about quitting residency, I was close to being done. I already had — you know, residency is stressful. And then, for me practicing on the south side and practicing in Chicago was always different for me relative to other residents because I was always running into people that I knew. So it wasn't the first time that I've dealt with somebody close to me. But in the context of, as a physician, and then also just had simply speaking to her earlier, it just hit home harder. I had, essentially a loss of words couldn't think straight, clinically.
The following day, I was inundated with invites to talk to different news outlets. I declined them all. I essentially recoiled. I spoke to one and at the request of a close friend, and it was just hard. It was like, you just need that time to grieve. And during that context was when two organizations, FemInEM reached out to help manage the funeral costs, and then Megan Ranney. And we hadn't had a chat via firm yet, although I was basically on the advisory board. And they were just a huge help.
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Ameera: So I got interested in AFFIRM... So prior to AFFIRM— and I, you know, tell people this all the time —I wasn't some massive gun violence researcher. I wasn't someone who is an expert on gun violence. But I think that me being African American and also being from the city of Chicago and from the Chicagoland area, I think a lot of us, just by association, are experts in gun violence. And, I think, being a physician at that, I think adds a little bit more to that as well. But the question is, what do you do? Where do you go? And AFFIRM, basically, I wasn't, a researcher, I didn't do any of this life work. I wasn't some immaculate, you know, I didn't do a fellowship and all these other amazing things. It was the fact that my one of my closest friends died from gun violence and none of us saw it coming.
She was in a relationship that we knew was often on, and kind of it sounded like they were getting married, it was on track and then it fell apart. And you know, that happens in life, right? But people don't die from it a lot of times —at least we don't think so. But once Tamara died, we're now faced with this reality that gun violence definitely hits home. And we can no longer say that it's only certain people, or it's onl, you know, happening at this time of morning, or it's only happening in this neighborhood. No, it's happening to all of us. People are committing suicide, people are dying by by the hands of their domestic partners. So if that's the case, and there's an opportunity or opportunity presents itself, for you to jump in and help, I think that that's that's the way that some people can take care of themselves. And that's the way that I chose to take care of myself.
Sonali: AFFIRM brings together nurses, doctors, researchers, public health professionals, and many others, as a means of finding ways to reduce the American endemic of firearm injury. Megan told us about how AFFIRM is inspired by other models of successful public health interventions to bring together unlikely partners to reduce gun violence.
Megan: An example of another type of public health intervention that I think models what we're striving towards in this movement is the reduction of deaths from car crashes. So, in the United States, we have decreased the mortality rate from car crashes by over 70%, not by taking cars off the road, there are actually more miles driven more cars on the road than ever before, but rather by bringing together strange bedfellows to create safer cars, to change patterns of driving, to educate people about the dangers of drunk driving in to empower bystanders to say to their friends, “hey, you might not want to drive tonight.” By teaching parents about the importance of car seats and making them easily available. There are so many parallels between the ways that we've decreased car crash deaths and gun violence. And I will actually say as I make that analogy, that early on, car manufacturers fought tooth and nail against efforts to make cars safer and to change the design of roads, and even against efforts to talk about drunk driving. But now car manufacturers compete to see who has the safest car, right? And it’s a tremendous parallel.
Sonali: So, as we research how to reduce gun violence and make efforts to change the reality of this endemic, we wonder what challenges lie ahead and how we can overcome them. In addition to including a variety of professional perspectives as a component of the solution, Garth and Megan shared additional thoughts about how we move forward.
Garth: But when we do have a time to kind of digest what happens, it's best to take time to also understand the person who caused it, kind of what are they dealing with as well. And then when it comes to urban violence, what are some of the variables at play that allow repeated homicides to occur on a regular basis. And to me a lot of that has to do with economic initiatives, race — being clear about it and what that means, and being intentional with initiatives going forward. And thinking about what we can all do in our day to day activities. If you’re the chair, are you thinking about diversity? Are you hiring, Black and brown faculty? I think it may not seem directly related, but who's most likely to research this stuff? Who's most likely to do something about it? Who's most likely to add an intellectual or different type of five to these type of initiatives? You're always more likely to do it that way.
Megan: One of the biggest challenges in creating a public health response to gun violence is that people think it can't happen to them. Or they over inflate their risk of being affected. So on the one hand, for a very long period of time, people thought that gun violence was something that only happened in inner cities. And it was totally tied up with all of these kind of structural racism and socioeconomic issues and was able to be kind of put in a little box and ignored by people in power, because it was thought to be something that would never touch their community. Now with the rise in mass shootings, which are horrific and should never happen, now every parent across the country is scared, right? We think about where we sit when we go to the movie theater because of Aurora. We worry about going to work because of things like the Molson Brewery shooting that happened just a few weeks ago. But that level of fear is also disproportional, because the truth is that less than 1% of gun deaths nationally or mass shootings. Nobody talks about the fact that two thirds of gun deaths are suicides. And when they do they say, “well, gun violence is just a mental health problem and you can't fix it” and there's this sense of fatalism about suicide. And so, as we create a public health response, part of our job, as researchers as physicians, certainly within AFFIRM Research, but also within other groups that I work with, is to again redefine the way that our country conceives of firearm injury and firearm injury prevention.
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[Theme music lowers, Sonali begins credits]
Sonali: Thanks so much for listening to this episode of (Re)Search for Solutions. Tweet us your thoughts about the episode using the hashtag #R4S - we'd love to hear from you. That's hashtag R, the number 4, S.
This episode was produced by Azsanee Truss, Joe Riina-Ferrie, Sonali Rajan and Lalitha Vasudevan. It was edited by Azsanee Truss, with the help of the (Re)Search for Solutions team. A special thank you to Drs. Megan Ranney, Ameera Haamid, and Garth Walker for their amazing partnership in creating this episode. Our music is Research Area by Poitr Pacyna and can be found on shockwave-sound.com. You can find us online at researchforsolutions.com and you can listen to our next episode on Apple Podcasts, Spotify, SoundCloud, and Google Play.