 |
Perspective |
The Quiet Room
N Engl J Med 2017; 377:2411-241 December 21, 2017DOI: 10.1056/NEJMp1714825
At the end of an inconspicuous hallway and strategically placed far from the controlled chaos of the trauma room lies a dimly lit waiting area that we in the medical field call “the quiet room.” It is a bland spot; a few soft chairs surround a table that holds a box of crisp institutional tissues. There may be a picture or two on the wall, but generally it is an unassuming room where we physicians tell mothers about the deaths of their children, far too often because of firearm violence.
As we make our way to this room, we recite a careful script; we use words intended to ease this painful first-and-only meeting. The reality is that over the years, we have found that there is no good way to tell a mother that her child has died, especially when the unexpected death might have been avoidable.
We introduce ourselves as the doctor who took care of their child. We take a deep breath, look into their eyes, and quickly break the devastating news — there is no reason to delay. What follows is the visceral, piercing shriek of a mother’s wailing, “Please God, not my baby!” We often weep with these mothers, we sometimes quietly blame ourselves for not being able to do more to save their baby’s life — and when they are alone, as is often the case, we hold them up while they cry.
We walk away from the encounter, our stomachs churning from the stale, metallic scent of a child’s blood barely dried on our clogs, our faces streaked with tears, and our hearts gripped in a vise as we tell ourselves that this senseless dying must end. But it doesn’t end. Another child is shot, and another mother is heartbroken.
There is nothing quiet about this room.
In the month since the mass shooting in Las Vegas, over 1300 more Americans have been killed, and more than twice that number have been injured, by firearm violence. Every day, 46 children and teenagers are shot and 7 of them die. The overwhelming majority of those shootings and deaths are the result of interpersonal violence, though some are from an accidental discharge of an unsecured firearm and some are suicides and are attributed to underlying mental illness.1 Sometimes the shooting is described in a bylined article in the local newspaper, but most of the time it is not reported at all. What does get reported skews toward senseless acts of terror, with the blame placed squarely on the shoulders of a mentally ill monster. But gun violence in the United States is not primarily a mental health problem.
Nearly a month after the deadliest mass shooting in modern American history, which killed 58 people, we predictably find ourselves witness to another mass shooting, this time in a small town near San Antonio, Texas. In this attack, 25 Americans, including a pregnant woman and up to 14 children (the most children affected since the shooting in Newtown, CT, in 2012), were murdered by a single perpetrator during Sunday prayer services. On the evening news, only hours after the tragedy, we are told once again that it is time for “a national conversation about guns.”
From the vantage point of a trauma surgeon, conversation seems a terribly feeble response. Gun violence, whether on the streets of Chicago or in the churches of Charleston and Sutherland Springs, is a national health emergency. It is an epidemic as deadly as the global Ebola crisis or the opioid epidemic in this country. But in those emergencies, a call for action has been followed by at least some action, not simply by the ritual and empty call for thoughts and prayers and, at most, a mere discussion. Congress appropriated $5.4 billion for the Ebola response as part of its final fiscal year 2015 spending package. The Centers for Disease Control and Prevention is awarding more than $40 million to support state efforts to address the opioid-overdose epidemic. After the introduction of the Dickey Amendment in 1996, government funding for research into firearm injuries and deaths has been restricted.
President Donald Trump has said that gun violence in America is a mental health problem, but the issue is far more complicated. Only if funding for research on firearm-violence prevention and public health surveillance is reinstated can we determine the best approach to addressing the public health crisis of firearm violence. Furthermore, expanding the National Violent Death Reporting System from 40 states to all 50 states plus Washington, D.C., would provide more information about where we should be focusing our attention.
In addition, the American Academy of Pediatrics has laid out three key priorities for confronting the crisis2: access to appropriate mental health services, particularly to address the effects of exposure to violence; enactment of firearm legislation that includes stronger background checks, banning assault weapons, addressing firearm trafficking, and encouraging safe firearm storage; and protecting the crucial role of physicians in providing anticipatory guidance to patients about the health hazards of firearms.
It is time for more than a discussion. Surely there is, in our collective power, some more concrete way to address the public health crisis that is gun access. We can no longer allow one mother after another to know the pain of losing a child to senseless gun violence. We remain haunted by their screams.
