Editor's Forum, Editorial

Letter from the Editor: Enough is Enough

EXCEL Gold Award Winner Editor's note: This editorial won a 2019 EXCEL Gold Award for best editorial/opinion piece in a magazine, earning top honors among 1,200 entries.


“Time of death — 2:31 am.”

I stared at the lifeless child in front of me — the focal point of a quiet, well-disciplined trauma resuscitation. There were blank faces around the room. And for a moment, absolute silence.

Then, from beyond the curtain, a slow, piercing cry.

I carefully removed my blood-stained gloves and gown, pausing to ensure that my scrubs bore no evidence of the grisly scene that just unfolded. I washed my hands and took a deep breath. As I stepped out of the resuscitation bay, I came face- to-face with the patient’s mother. Words cannot capture her desperate, glassy stare as her eyes met mine.

Before I could even speak, she knew.

In the moments that followed, we shared a simple discussion that would change her life forever. I explained that her child had suffered a gunshot wound to the chest that caused her heart to stop beating just prior to reaching the hospital. Without divulging too many details about the exhaustive measures that were attempted to revive her upon arrival to the ED, I assured the grief-stricken mother that every effort was made to save her baby. “I’m sorry,” I concluded. “She died.”

Not 20 minutes later, I was back at my workstation and catching up on charts during a rare lull in the steady onslaught of new arrivals.

Gun violence has become so routine in the ED that not even the gruesome death of a young child can interrupt the daily grind. In fact, the U.S. now has the highest rate of gun-related deaths among industrialized countries.1 Every year, the number of Americans who will die from gunshot wounds rivals the number of those who die from sepsis.2 Perhaps a striking statistic to some, this should come as no surprise to those of us working in crowded EDs across the country.

Despite the media attention and public outcry associated with the violent deaths of young children, the sobering reality is that the majority of gunshot-wound fatalities in America occur in adults and are self-inflicted.2 These stories will never make the evening news. If only we could do a better job of identifying those at risk and intervening earlier, perhaps these deaths might one day be preventable.

Embarrassingly, we have dangerously limited data pertaining to gun violence. This is critical information we need to save lives. Compared with other leading causes of death, gun violence was associated with less funding and fewer publications than predicted based on mortality rate, with approximately 1.6% of the funding and 4.5% of the volume of publications predicted by a regression analysis incorporating the leading causes of death reported by the CDC between 2004-2014.3 While the reasoning for this is multifactorial, the major driving force is the gun lobby — a collection of various groups working tirelessly to restrict federal funding for researchers investigating gun violence.

Life in the ED is unpredictable. We routinely come face-to-face with the struggles of our communities. Over time, there is a tendency to normalize the ugliness and even accept it as unchangeable, insurmountable. Yet, there are some things that should never be normalized.

The next time you hold a parent’s hand while confirming the worst possible news, here’s my advice. Apologize.

Apologize that our society normalizes gun violence to the extent that no action will be taken to address the systemic flaws that contributed to her child’s death.

Apologize that our professional organizations have failed to reverse the caustic legislation preventing us from collecting and analyzing the data we need to create evidence-based guidelines to fight gun violence across the country.

Apologize that emergency medical and surgical staff have become immune to the emotions associated with gun violence and death.

Talking to my patient’s mother that night, I told her that we had done everything in our power to save her child. But what about my next patient? Have I done everything in my power to prevent others from becoming victims of gun violence?

As the frontline of the healthcare system, gun violence is our problem. It is our responsibility to stand up and take ownership of this. Short of that, we are doing an injustice to our patients. Every time we quietly go back to work after another young person’s violent death, we make it easier for this to remain the status quo. As physicians, it is our duty to speak up for those who cannot speak for themselves.

I speak for my deceased patients when I say that enough is enough.


  1. Grinshteyn E, Hemenway D. Violent Death Rates: The US Compared with Other High-income OECD Countries, 2010. Am J Med. 2016 Mar;129(3):266-73. 
  2. Centers for Disease Control and Prevention. Accessed May 12, 2017.
  3. Stark DE, Shah NH. Funding and Publication of Research on Gun Violence and Other Leading Causes of Death. JAMA. 2017;317(1):84–85.

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