The Christmas Eve of Dr. Mary Brandt will forever be associated with rescuing the life of a little girl who was nearly killed in a shot more than 25 years ago.
The teams were in transition when a six-year-old came to an emergency room at the Texas County Hospital with massive gunshot wounds to his shoulder and chest. Her mother was fatally shot by her boyfriend. When the girl tried to call 911, the man turned his gun on her.
After hours of operations, Brandt rescued the child. Since then, Brandt, now a pediatric surgeon at Texas Children's Hospital in Houston, has operated on many more child molesters. "We all have patients we can not forget," Brandt said of the young girl. "It took months and months not to be sad. I'm probably still a little sad about it. "
Few people in the world are more familiar with gun violence than emergency physicians and surgeons like Brandt. Until recently, however, they have largely remained silent about their experiences at the front of this public health crisis.
This changed in November after the American College of Physicians issued new guidelines on how doctors can help protect patients with gun violence ̵
The NRA wanted these physicians to shut down a subject that touched their lives daily. This resulted in a record high of  with nearly 40,000 deaths  in the year Year 2017, according to the latest data from the Centers for Disease Control and Prevention and about twice as many injuries a year.
The NRA response was enough to get many doctors to break their silence. Under the banner of "This Is Our Lane" surgeons and other physicians engaged in the arms discussion, exchanged photos from operating theaters, and talked about the torment of treating an endless stream of shooting victims. 19659002] Medical organizations also doubled, calling for further investigations into gun violence and calling for further measures such as universal background checks waiting times for the purchase of weapons, safekeeping initiatives and so-called "red flag" firearms firearms People who can pose a danger to themselves or to others.
In a series of interviews with HuffPost, physicians shed additional light on the subject and paint a diverse portrait of a problem affecting communities in various forms. These include mass shootings, assaults, accidents, intimate partner violence and suicide.
Their reports describe the exhausting work that doctors have traditionally carried privately. Many doctors told HuffPost that it is their moral duty to show the truth to the public: gun violence is omnipresent in emergency departments across the country.
Introducing people to this reality could sound like a way to present general facts and figures about gun violence. I have not shown Americans that it is necessary to take steps to tackle the crisis, Brandt said.
"People do not change their minds simply because of data."
I wish I could do something about it, but I feel helpless.
Dr. Adam Schechner, Prince George's University of Maryland Hospital Center
When doctors see patients with gunshot wounds daily, it's hard to keep track of how many have treated them.
"I wish I knew. Too many, "said Dr. Adam Schechner, an accident surgeon at Prince George Hospital, University of Maryland, Cheverly.
Schechner estimates he cared for hundreds of shooting victims, most of them young men from Washington and the suburb of Maryland of Prince George's County. Schechner recalled a case in which a young man died of his injuries. When Schechner informed the patient's mother, she collapsed. The woman gathered long enough to explain that the son she had lost was the only family she still had. Her other son had been shot several years ago. She was alone.
"This really appealed to me," said Schechner.
Even if his patients survive, it can feel like he's working against a flood that will eventually wipe out his work, Schechner said. Many of the victims of the shooting that were hospitalized were shot dead earlier.
"It's daunting, because it seems they just do not care, [like] they do not seem to appreciate the second chance they appreciate, I've given," said Schechner. "This is really the hardest part of my job: working to save someone's life and then not appreciating life."
Last year, the hospital where Schechner works has launched a program to help survivors who have been shot or stabbed several times to provide comprehensive care and social services based on the causes of violence. The evidence to date suggests that it works.
The program is a critical step towards prevention, but it's hardly a solution to violent violence, Schechner said. The more victims he treats, the more he realizes he is concerned not only as a doctor, but also as the father of small children whom he fears will one day appear on a surgical table with a gunshot wound.
"It makes my life outside the hospital all the sadder, because I wish I could do something about it, but I feel helpless," said Schechner. It was like a scene from hell.
Dr. John Fildes, University Hospital of Southern Nevada
Even as a traumatic surgeon for two decades, Dr. Ing. John Fildes did not really prepare for the terror he was exposed to on 1 October 2017.
Fildes began his shift at the University Medical Center in Las Vegas, just minutes after the shot at the Route 91 music festival, the scene of the deadliest mass shootings in modern American history. There were already 35 people with gunshot wounds in the trauma area, he said.
"There was blood all over the floors and the cucumbers, and there were patients who put pressure on their own wounds and told me to take care of the sick patients," Fildes said. "It was like a scene from hell."
Fildes and his colleagues tried to get the most injured patients into the operating room and worked to stabilize the others. Most of the team managed to overcome the crippling horror of the moment, although a handful of employees were so emotionally shaken that they had to be pulled away for a short time to assemble themselves, Fildes said.
Despite the circumstances, Fildes and the surgical department he supervised rescued each of the 104 shooting patients who arrived at the hospital alive.
Any feeling of victory is short lived, Fildes said. He still has trouble finding words to describe what happened that night .
"These were 1100 rounds of ammunition sprayed by military-grade military personnel," he said. "There is no other of these cases."
Although the medical center has begun post-traumatic stress disorder interventions the very next day since the shooting, staff report insomnia and repeated nightmares, Fildes said. A handful required serious care.
The filming of Route 91 Harvest Festival was a terrible outlier, and Fildes said he hopes no surgeon will have to face another massacre of this magnitude. But even doctors lucky enough to avoid mass shootings can not escape the constant drumbeat of ordinary firearms injuries and deaths, he said. For many, this bloodshed is reason enough to speak out about violence against gun violence.
"Doctors have no weapon problem; They have a bullet problem "said Fildes, adding that a renewed focus on the safety of firearms, preventing and enforcing existing gun laws would make a big contribution to saving lives.
There is only a degree of separation between you and everyone else.
Dr Christopher Barsotti, Berkshire Medical Center and Southwestern Vermont Medical Center
When Dr. Christopher Barsotti, an ambulance, moved from a bustling Chicago hospital to Chicago for He hopes he will leave rifle violence behind, but hopes it will be more personal.
Barsotti sometimes recognizes patients he or she is treating at the emergency room, or at least has met his relatives or neighbors, he said Making matters even more difficult, as he learns of the often tragic circumstances that precede the shootings.
Aside from self-inflicted gunshot wounds and cases where people "settle points", rural hospitals have numerous hunting accidents, domestic violence or shootings involving children who have accessed unsecured firearms, Barsotti, himself a gunowner, said , In the worst case Barsotti may like to convey bad news to a person he knows.
"When you live out here, there is a two-degree gap between you and everyone else," Barsotti said. "If you actually work and take care of people, there is only one degree of separation."
Sometimes the unthinkable happens. Dr. Richard Miskimins, an accident surgeon at the University of New Mexico Hospital in Albuquerque, recalled the operation of a patient who had been shot in the face. Hours later, he realized he knew the man.
"He was so terribly disfigured that I did not realize it," Miskimins said.
Albuquerque is not a rural town, but the only stage of the state in which the state lives Trauma Center, Miskimins and his colleagues treat a number of patients who were transferred from smaller circles of the state. Miskimins said that self-injured gunshot wounds are particularly common. Although the vast majority of people attempting to kill themselves with a firearm will die, those who do not have any neurological or physical injuries that require intensive treatment are usually hampered.
Several years ago Miskimins treated a patient who I deliberately shot myself. After a long recovery, including a facial reconstruction, the young man regularly visited the intensive care unit to thank the staff, Miskimins said. The patient has been involved in national suicide prevention measures since .
"Suicide is so often just an impulsive thing in which they act in the depths of despair," he said, citing studies many people who survive suicide attempts do not try again . When a weapon is available, these impulses end much more with death.
It's not just the person who suffers the injury.
Dr. Richard Miskimins, University of New Mexico Hospital
Violence is not just a story of victims and perpetrators, Miskimins said. Whether deadly or not, every shooting leaps out and touches not only those directly affected, but also their families, friends and loved ones, as well as the medical professionals who serve as mediators in these painful trials.
Person who suffers the injury that has significant psychological effects on her; It's also her family that sees and sees her, "Miskimins said.
As demanding as it can be for everyone to recover after a shoot, it fades in comparison to the alternative of telling a parent that his child was fatally shot It has never been easier, said Dr. Mark Seamon, trauma surgeon at the University of Pennsylvania's Perelman School of Medicine . He said he turns into clean scrubs and exhales a few times before taking the
"You never know how they will react," Seamon said, "I had reactions where the mother would say," Well, we knew it would come, "and just went out."
Even if a family fears the worst They are never really prepared for it.
"There is a certain tenor, there is a certain pitch for their voices or the scream they give when you tell them that their lover has died," Barsotti said. "It's a sound that hits you in the pit of your stomach."
The day you do not cry is the day you should stop.
Dr. Mary Brandt, Texas Children's Hospital
The emotional burden of rifle violence weighed heavily on the minds of all the doctors HuffPost was talking to. When asked how they handle it, there was less agreement.
Some emergency rooms try to fight the grief in real time. If someone dies in the trauma bay of the University of New Mexico Hospital, he will have a brief silence to reflect on the loss and acknowledge the staff, Dr. Stephen Lu, an accident surgeon.
"It takes like 30 seconds, then we continue with the rest of the night," said Lu.
To cope with the stress of a life-or-death job in the operating room, many doctors said they needed to For some, this may just be an attempt to bury the brutal reality of their experience.
Schechner, a doctor from Maryland, rarely talks about how his job affects him personally, and notes that surgeons in general are Suspicious are signs of weakness in the context of their work.
"Every person whom I have declared dead, suffers a little bit from me," said Schechner. "The fact is that we are human, too, and we should not behave like that. "
Despite doctors' perceptions as unshakeable or even rigid, these qualities are only part of the job, said Brandt, the Texas pediatric surgeon, the other half being human in. In the operating room, surgeons need to focus on saving lives. "After that we allow ourselves to meet," Brandt explained. "One of the things I've always felt, and I've taught, is the day you do not cry, is the day you should stop."
Doctors manage these emotions with varying degrees of success. Dr. med. Jo Shapiro, director of the Center for Professionalism and Peer Support at Brigham and Women's Hospital in Massachusetts, Massachusetts, views self-care as selfish, claiming that the physician's own needs are secondary to patients.
] After three decades of surgical practice, Shapiro has been given the lack of attention paid to the people who do the work. It finally became clear that the doctors could no longer sit down. Studies have shown that burnout, depression and other mental health problems plague the health profession. And the doctors HuffPost talked with quickly realized that the cascading effects of gun violence did not stop with doctors. They can address anyone, from nurses to hospital staff, to the custodians who clean the floor of the emergency room.
Shapiro now runs a program that trains doctors to assist each other when they suffer trauma at work. It is an acute response to a particular case or the cumulative weight of incessant gun violence.
"There has to be someone to help patients who've been shot, but it's very frustrating and sad [and] always hard to do," Shapiro said. "It can be demoralizing."
If you did not have someone in your hands, that's easy to say.
Dr. Stephen Lu, University of New Mexico Hospital
Some doctors see the movement "This is our Lane" as a way not only to start processing their grief, but also to devise solutions.
"It's such a pleasure to think I'm not just concerned with the bottom line, I'm helping to prevent this," Shapiro said. "[It’s] so that we can bring our humanity back to our work."
This emphasis on prevention is also well-known in the field of medicine. Doctors use similar methods to combat past health crises such as HIV or smoking, motor vehicle deaths or environmental hazards and pollution. First, they examine a problem to identify its patterns and causes. Then they work to develop guidelines to reduce these negative effects, rather than simply treat them as they arise.
With regard to firearm deaths and injuries, political polarization has been reluctant for many doctors to comment, said Lu, the New Mexico trauma surgeon. He said that the doctors had unintentionally rehabilitated the shootings that broke tens of thousands of times a year in American streets, homes, schools, and eventually in hospitals.
"Americans are generally protected from death," Lu said, adding that this is one of the reasons for the lack of compassion and empathy in the weapons debate.
However, it is people who lack this exposure, who have probably never seen a shot at close range and hopefully never will, who now tell the doctors that weapon is not their concern.
"Unless you have someone in your hands, that's easy to say," said Lu.