S3E34 / #ThisIsOurLane / Cedric Dark, Damon Clark, Joseph Sakran, Meghana Rao

Joseph Sakran was shot in the neck as a teenager. He went on to become a trauma surgeon. When the NRA tweeted doctors should “stay in their lane,” Joseph and others were outraged. Joseph started #ThisIsOurLane, an umbrella for health care providers and all the other communities who’ve lived and borne witness to gun violence.

Celine Gounder: Hi, everyone. Dr. Celine Gounder, here. I’m the host of “In Sickness and in Health.” We really appreciate all our loyal listeners, and I’m hoping you can help us grow this community even more. If you like our podcast, please consider supporting our show. Go to glow.fm/insicknessandinhealth and become a member today. We’re a 501(c)(3) non-profit organization, so your donation is tax-deductible. That’s glow.fm/insicknessandinhealth.

Damon Clark:  I think it’s absolutely insane that we don’t treat violence like a disease similar to cancer and heart disease, diabetes and obesity. The amount of resources in terms of research and government funding… we don’t get that for violence… And it’s a disease that’s specifically targeting… our most vulnerable.

Cedric Dark : And they’re not going to get us to be silenced because our job is to speak up for those who can’t speak for themselves, as physicians, and for those who are permanently silenced…

Meghana Rao: It’s not just the mass shootings, it’s not just the trauma surgeons, but it really is something that from a primary care perspective, and taking care of women… it is something that affects them every day and it’s something that we need to tackle and address as a public health crisis.

Celine Gounder: On this episode of “In Sickness and in Health,” we explore another relatively new constituency in the gun movement: doctors. What has moved them to take action? and how has having health professionals join the conversation changed how we see the problems of gun violence and potential solutions.

Celine Gounder: In 1994, Joseph Sakran was a 17-year-old boy growing up in Fairfax County, Virginia. He was a student at Lake Braddock Secondary School. On September 23rd, he came home after SAT tutoring…

Joseph Sakran: And I remember getting home and there was the first high school football game of the year…

Celine Gounder: His friend was waiting for him to pick him up. So, in a hurry, Joseph rushed inside to drop his books off and change. He remembers he hardly had any time to say hello to his parents who were asking him about his day at school. He was a teenager in a rush, already out the door.

Joseph Sakran: I quickly answered them and then, you know, jotted out. And, you know, fast forward a few hours later after the game… Who would have thought that they would be getting a call that they need to come to the hospital because their son has been injured?

Celine Gounder: After the football game, Joseph and his friends were hanging out at a park near a friend’s house, by the elementary school.

Joseph Sakran: While we were hanging out, a fight had broken out that we had nothing to do with, and a guy pulled out a gun and started firing…

Celine Gounder: One of the bullets hit Joseph in the neck.

Joseph Sakran: And I remember looking up as people started screaming and just seeing flashes of light. And it was almost as everything had just a slowed down and was going slow motion. And I realized that something was wrong because my entire body felt numb.

Celine Gounder: By the time the EMS team arrived, his whole body was covered in blood. They rushed him to the hospital. Hours later he woke up in the intensive care unit, with a tracheostomy tube in his neck to help him breathe. Yeah, he was alive, but the recovery was long and hard.

Joseph Sakran: In addition to rupturing my, my trachea, I had an injury to my left carotid artery, and I have a paralyzed vocal cord as a result of my injury as well.

Celine Gounder: For Joseph, the months of recovery after he got out of the hospital, were almost as devastating as the gunshot itself.

Joseph Sakran: I had to relearn a lot of things… even just some basic things like learning how to walk again, because having been in the hospital bed for so long, you lose a lot of your muscle mass. And these are things that, at the age of 17, you never really think about and kind of take for granted.

Celine Gounder: Being shot, changed Joseph’s life. It set him on an entirely different personal and professional path.

Joseph Sakran: I was 17 when the injury happened, I had no idea what I wanted to do with my life. I think like most, 17-year-olds, not only do they not know what they want to do with their life, but they don’t realize they’re mortal.

Celine Gounder: Then one day, soon after he got home from the hospital, he looked at himself in the mirror.

Joseph Sakran: …and I was… looking at, you know, the scars on my neck and the tracheostomy tube that I had… And what I didn’t realize was my father was standing in the corner. And my father, I think, appropriately realized… the look of devastation in my eyes. And he walked in and he, he said, “Listen, you have two options. You can either feel sorry for yourself, or you can take like this horrible incident and try to impact the lives of other people.” And it was really that moment, I think, which made me realize, both the opportunity and the responsibility that I had to try to give other people that same second chance.

Celine Gounder: Joseph went on to become a doctor. He’s now a trauma surgeon at Johns Hopkins Hospital, where he’s the Director for Emergency General Surgery. Being a victim of gun violence helps him connect with his patients. He says he doesn’t bring it up at first, but once the acute phase of caring for a patient is over, and he’s stabilized them, Joseph’s personal story sometimes comes up. And when it does…

Joseph Sakran: I go from being this person wearing a white coat to someone that actually understands what these patients, both have been facing in their communities, but even more recently, have faced personally themselves.

Joseph Sakran: And I think as you look to not just my own career, but I think a lot of people, their own professional path, the more you learn, the more you realize how maybe things should be a little bit different…

Celine Gounder: At some point as an adult, the words of his father that day, as Joseph stood in front of the mirror, those words took on a new meaning.

Joseph Sakran: I realized that not only do I have the responsibility of taking care of that one patient in front of me, but I have the responsibility of thinking beyond the operating room, beyond the four walls of the trauma center, to try to impact populations. And that’s why I’ve been working at this intersection of medicine, public health, and public policy.

Celine Gounder: And Joseph wasn’t the only one. As Americans have become increasingly worried about gun violence in their communities, doctors and other health care workers, witnessing the fallout from a unique vantage point, have become increasingly concerned.

Celine Gounder: In 2018, the American College of Physicians published a position paper on reducing firearm injuries and deaths. It called for things such as increased regulation of the purchase of legal firearms and recommended that guns be subject to consumer product regulations. The paper also encouraged physicians to discuss with their patients the risks associated with having a firearm in the home and encourage safety practices that reduce the risk of injury.

Celine Gounder: In response, the NRA tweeted, “Someone should tell self-important anti-gun doctors to stay in their lane.”

Joseph Sakran: That communication, I think resulted in a lot of people being incensed as to the fact that an individual or an organization would actually think that doctors and healthcare providers that are front and center and taking care of these patients don’t have a role and coming up with solutions around this issue.

Celine Gounder: The online response was immediate.

Joseph Sakran: A huge number of clinicians and non-clinicians, frankly, across the spectrum, respond back and say, ”No, actually, we do have a role to play in this.”

Celine Gounder: Joseph created a Twitter account @ThisIsOurLane, which sparked vivid and often graphic conversation online among people in the medical field about what it’s like to care for gunshot victims at a time when it’s become all too common.

Joseph Sakran: When all that happened… I think a lot of us realized… health care providers were looking for a platform to actually be able to have their voice heard on this issue.

Celine Gounder: Joseph says this movement showed that healthcare providers had been eager to voice these concerns all along and be more active in finding solutions to what they saw as a public health crisis.

Joseph Sakran: And so what was initially a moment turned into a movement.

Celine Gounder: Damon Clark is Assistant Professor of Clinical Surgery and Associate Medical Director at USC. He grew up in northwest Detroit.

Damon Clark: A neighborhood that was filled with a lot of poverty… a lot of violence, a lot of substance abuse.

Celine Gounder: He saw many of his friends and his brother’s friends become victims of gun violence. He says that growing up in this environment pushed him to graduate from high school, college, and eventually, Harvard Medical School.

Celine Gounder: As a physician, Damon has worked in Norfolk, Virginia, Detroit, Baltimore, and Los Angeles, focusing mostly on at-risk communities similar to the one he grew up in. He remembers the first time in his residency that he experienced gun violence as the person caring for and treating a gunshot victim, one of his patients.

Damon Clark: He was shot multiple times in the abdomen area and the chest area. … But the thing that I saw growing up and also saw during that moment is the toll… that violence and death of young people… really destroys their family, destroys their parents, destroys their siblings, destroys the whole community, that knows in the schools.

Celine Gounder: Damon’s patient died from those injuries.

Damon Clark: But the thing that I remember most, and the thing I remember all the time now was the interactions that you have to have with the parents and the family.

Celine Gounder: Damon believes gun violence should be treated like other diseases, holistically, with different kinds of treatments, including preventive treatments.

Damon Clark: When we take care of cancer, there’s surgery, there’s chemotherapy, there’s radiation, there’s preventive measures.

Celine Gounder: Damon says that hospital-based violence intervention programs, which provide social services for victims of gun violence and encourage lifestyle changes, these are an important part of the treatment for gun violence. But Damon thinks there’s a lot more that could be done.

Damon Clark: A lot of those are “secondary treatments” because the injury has already happened.

Celine Gounder: There could be more community supports put in place, he says. These are what Damon calls “primary prevention.”

Damon Clark: Changing things in the community with substance abuse counseling or job placement or improving our school systems or after-school activities.

Celine Gounder: More resources in this area, he believes, would go a long way towards preventing violence among patients like his, patients who live in high-risk neighborhoods. Currently, Damon is involved with several initiatives around Los Angeles and works with community partners and trauma centers to do this kind of “primary prevention” work.

Damon Clark: One of our main projects was we would find these schools and these people that are in high-risk areas or schools… And we would go in and talk to these kids about what violence really is, and it’s not what you see on TV.

Celine Gounder: In yet another program, medical professionals go into the schools and talk to kids about different careers in the medical field.

Damon Clark: Trying to get these young folks that understand that just because you’re at this school or in this neighborhood doesn’t mean you can’t get a job or a profession in health care. We would break it down into, you know, if you have a high school diploma or associate’s degree or bachelor’s or a master’s or some sort of specialized doctorate degree, you can go into these fields, and we have different people from all these different specialties come talk to them.

Celine Gounder: They would invite students to the hospital campus, organize visits to the emergency room, show them around the ICU, introduce them to nurses, doctors, and staff.

Damon Clark: …treat these young folks as human beings and people who have a chance and treat them as if they belong here and they can work here and be professionals here.

Celine Gounder: He also works on the American College of Surgeons’ Stop the Bleed Campaign, to teach teachers, school nurses, students, and parents in a community basic skills on how to stop the bleeding, by doing tourniquets or packing wounds, because, sadly, those skills are increasingly necessary.

Celine Gounder: Damon says there isn’t one treatment for gun violence. It’s a problem that requires many treatments, and he’s outspoken about that.

Damon Clark: Why I think it’s very, very important for me, myself, personally to go into these communities… very, very poor socially and economically, is ‘cause I’m a living, breathing example of you can get out.

Celine Gounder: The idea that physicians will get involved in the lives of their patients beyond the hospital walls, outside the exam room, makes sense for many in the healthcare community.

Kereen Constant: Because as a medical student and as physicians, we pledge to give the best to the patient… it’s not just given a drug or a regular checkup or a surgery, it’s everything. People aren’t just their conditions or their disease.

Celine Gounder: This is Kereen Constant, a second-year medical student at Howard University. Kereen grew up in Miami, Florida, and when she goes back home to visit her family, she can’t help but notice how much her neighborhood has changed. Violence, and gun violence specifically, has become more and more common.

Kereen Constant: Fighting was always a thing and whatnot… But nowadays it’s more of like pulling out a gun and stuff like that versus like exchanging words. And I think that’s why like people get shot more, people get stabbed more, because like people don’t fight with their words or just like have a regular fight and then squash it.

Celine Gounder: She’s not sure what specifically changed in her community: whether it was the neighborhood boundaries being redrawn, the increased access to guns both legal and illegal, an economic downturn. But even without having an answer to the whys, Kereen believes there’s a lot physicians can do.

Kereen Constant: So if we’re pledging to give our best to the patient… why shouldn’t that include going into like their social lives, their personal lives, and making sure that person is 100% not only on a physical level but a mental level, a financial-social level, to really see the patient for who they are as a whole. Because at the end of the day, we aren’t pieces. We’re one person.

Celine Gounder: As a future doctor, Kereen sees that as her lane, too.

Celine Gounder: It’s easy to understand why doctors like Joseph Sakran, Damon Clark, and medical student Kereen Constant feel compelled to get involved in public policy around gun violence. Joseph was himself a gunshot victim, and Damon and Kareen come from communities plagued by gun violence. They feel a duty to get involved, and their lived experiences give them a certain credibility that can help shield them from criticism.

Celine Gounder: However, these days, it’s easy to see how almost any health care worker might feel they’ve borne witness to the toll of gun violence, that their perspective does matter, and that because of what they see day in and day out, and the emotional impact it’s has on them, they too are important stakeholders in the gun violence prevention movement.

Cedric Dark: So, just for context, I work at a level one trauma center. We get about 500 to 600 gunshots per year. About 10% of those are fatal. And so that’s what we see, you know, in addition to the car wrecks and the knifings and just people getting busted upside the head with a brick. And we see lots of violence in that sense.

Celine Gounder: This is Cedric Dark. He’s an emergency physician. Cedric works at the county hospital in Houston and at the Baylor College of Medicine, teaching residents and medical students.

Cedric Dark: So usually a week doesn’t go by where you don’t see someone that’s been shot on shift.

Celine Gounder: It’s pretty routine, he says.

Cedric Dark: The nice thing about trauma is we make it super-duper simple so that people like me can understand it, and you essentially figure out, okay, do they have an airway? Great. Do they have breath going into both lungs? Awesome. Do they have a pulse? Wonderful. After that, then you can start looking around and count holes and figure out where those holes are, and if the holes are in certain places, they go to the operating room. … Is there a hole in the aorta? Is there a hole in the heart? That kind of thing. You know, cross, you know, you’re clam-shelling somebody doing a thoracotomy, opening them up, figuring out, what you can do to try to save that person’s life. And when you can’t, then the next thing that comes is being able to talk to a family member about it. And that’s one of the more difficult things. It’s very easy to see somebody in the ER and say, “Oh, you’re shot, and you need to go to the operating room. The trauma surgeon’s going to take you up there. Bye.” It takes all of 15, 20 minutes or so. And then we do our charting, and we go about and see the stubbed toe. … It’s a lot harder when you have to walk into a room and speak to a parent and say their kid has just been killed. You know, having never seen that person before in your life, you know, have to instantaneously try to make some kind of connection with them and empathize with them, uh, when probably an hour ago, their world was perfect, and then now you’re giving them the worst possible news as a parent that you could imagine having to give to somebody.

Celine Gounder: #ThisIsOurLane exposed the violence and tragedies that occur in hospitals, behind closed doors. It shined a spotlight on the stories about the aftermath of a gunshot, the medical complications, the lengthy recovery time, and the suffering of the families of the victims.

Celine Gounder: The movement also shed light on how those of us who care for victims are impacted, and why medical professionals often suffer from their own PTSD from these encounters and are sometimes referred to as the “secondary victims.”

Joseph Sakran: It’s afterwards when I think the emotional kind of trauma to us as healthcare providers happens…

Celine Gounder: Joseph Sakran again.

Joseph Sakran: …where you’re really reflecting on what just took place, knowing that this is preventable… but it’s not lost on me that this does impact the healthcare community, including myself.

Celine Gounder: Within healthcare, it’s not just about emergency physicians and trauma surgeons. They might be the first to care for a gunshot victim, but they’re not the ones caring for these patients, those that survive, over the long haul.

Celine Gounder: Me? I’ve also cared for victims of gun violence. As an internist and an infectious diseases specialist, I don’t piece people back together after a gunshot wound. I manage the complications that follow: abdominal abscesses resulting from torn intestines; bone infections requiring amputations; urinary tract infections and pressure ulcers in patients left paralyzed by spinal cord injuries; and more. And seeing all that? It leaves a certain psychological residue.

Celine Gounder: Cedric Dark again.

Cedric Dark: You know, there are internists and family medicine doctors that have to deal with the long term sequelae of gunshot victims and the injuries that they have, psychiatrists that are dealing with PTSD and trauma and anxiety and depression and all those things that are the consequences and sometimes even the precursors.

Celine Gounder: As #ThisIsOurLane grew online and offline, it started to attract all those other healthcare workers, not just trauma surgeons and emergency room staff, who were seeing the impact of gun violence on their patients.

Meghana Rao:  I was working on Labor and Delivery, and we were called down to the trauma bay for three patients who were, who had been shot in gang-related violence.

Celine Gounder: This is Meghana Rao. She is an OBGYN and at a clinic catering to underserved patients in Maryland.

Meghana Rao: Our patient was a pregnant woman who, her boyfriend had been involved in the shooting, and she was accidentally shot as well in the abdomen. And we, in conjunction with our trauma surgery colleagues, did a C-section. And, one of the experiences, that really affected me from that C-section was when we took the baby out, and the trauma surgeon asked, “Are there any holes in the baby?” I mean, that was just something that I couldn’t even fathom how gun violence is affecting and, you know, and a baby before it’s even born. Um, and the reason the trauma surgeon had thought to ask that question was because only a few months earlier, there was another victim of gun violence who was also a pregnant female who the bullet had actually hit her baby while it was still in the uterus. And so when the baby came out, they saw the gun, um, the bullet had gone through the baby’s arm.

Celine Gounder: Meghana says that even outside of the operating room, gun violence comes up frequently in conversation with her patients.

Meghana Rao: I would say probably a third of my patients are victims of domestic violence. And then when there’s guns in the house, it’s a very high chance of them being victims of homicide. And so it’s something that I do see very, very frequently. I have several pregnant patients who have been shot in the past, and so then we worry about what their kind of scar tissue in their abdomen looks like if we do have to do an emergency C-section…

Celine Gounder: There are other subtle ways in which she sees gun violence having an impact on her patients’ lives. Even if they themselves are never direct gunshot victims, their health and well-being suffer.

Meghana Rao: When I talk to patients about being healthy and going out for walks, and I’ve had multiple patients say, “I don’t feel safe going for a walk in my neighborhood. I was mugged at gunpoint, and so I don’t leave the house.” And so when we talk about physical activity and healthy lifestyle, it, it truly affects our patients every single day.

Celine Gounder: This side of it, she feels, doesn’t get covered by the mainstream media. And that lack of coverage has fueled her activism.

Meghana Rao: It really is something that I see on a daily basis, and that’s what’s motivated me to go into, to do advocacy on the subject.

Celine Gounder: While many of the physicians who speak up and get involved in the movement are also trained in public policy and public health, they also recognize the need to tread carefully when they step into the field as advocates.

William Jordan: We’re trained to be experts. And so often take on that role, even when maybe it’s not the best role for us. So I think that’s the thing that I worry about most is that we don’t come to the table with enough humility to listen to the people that have been living with this violence for a long time and speaking out about it, but not being heard.

Celine Gounder: So it’s almost like we’re late to the party, and we’re getting heard. But they’ve been there all along, and they haven’t been heard.

William Jordan: Yes.

Celine Gounder: This is Bill Jordan. Bill is a family doctor, living in Queens, New York. He’s also a civil servant and works for New York City’s Health Department. When I spoke with Bill for this show, he spoke for himself, not on behalf of the city. When speaking about the way he advocates for his patients and victims of gun violence…

William Jordan: I think the best thing that I can do is give their stories a wider audience and step aside so that they can tell their stories.

Celine Gounder: Data and research are important, but data alone doesn’t move people. Storytelling is important, and the way #ThisIsOurLane has brought to light stories the public doesn’t often see has been a strength of the movement. And that’s why Bill focuses on storytelling.

William Jordan: A lot of the work that we’ve done and on my team and with some of my colleagues has been around providing training to community organizations, nonprofits, but also to their frontline workers, to community health workers often, or peers… And so one of the training we were able to offer recently, and this was with large public grant funding, was around storytelling… Most people who received that grant wouldn’t have picked that training. They might’ve picked a training around health education or dietary counseling or something like that…

Celine Gounder: Bill says that when working with people and communities impacted by gun violence, it’s important to make space for them to tell their own stories. He says he worries sometimes that #ThisIsOurLane isn’t as conscious of that as it could be.

William Jordan: I think you have to make space. When you’re in a position of power, you have to give up some of that power. I think that’s the only way.

Celine Gounder: Yes, Bill says, as medical professionals we should write op-eds and editorials, which he does. Yes, we should organize violence-prevention summits to connect professionals in the field with the communities they serve, which he also does. And yes, we should show up to marches and demonstrations, as he does.

Celine Gounder: But what Bill says #ThisIsOurLane should also be doing is to allocate resources to elevate the voices of those most impacted, to support them in telling their own stories.

William Jordan: I think it’s giving credit when you hear a story to the person that told it and directing people back to them so that they can learn more directly from that person.

Celine Gounder: Bill also advocates within the medical profession often speaking with his own colleagues about the problem and potential solutions to gun violence.

Celine Gounder: The medical profession—historically more male, white, wealthy, and with a lot more privilege than the communities it serves—has many blind spots and unconscious biases. This, Bill says, sometimes makes it harder to convince his colleagues that the same social drivers of health are also at the root of the gun violence problem in America.

William Jordan: Walking into that space and trying to convince my colleagues that, as doctors, we should be pushing for more investment in communities…

Celine Gounder: When he hears colleagues begin to make arguments that explain gun violence as something that happens to “bad people,” he tries to nudge them to consider the problem from a different angle, to look at the broader context.

William Jordan: You know, as a good doctor, we’re always encouraged to have a differential diagnosis. Well, what else could be going on?

Celine Gounder: #ThisIsOurLAne has been subject to criticism from outside the medical field as being exclusive, leaving out other stakeholders, whether it’s affected communities or gun owners. But Cedric Dark? He’s a gun owner.

Cedric Dark: I’m not someone to be afraid of firearms or to say that everybody with a firearm is crazy or a gun nut or anything like that. A lot of the nurses and docs that I work with have firearms. We’ll go shooting. You know, that kind of thing. It’s, it’s not so much a sport for me, but for others it is. And I totally understand that, and I respect that.

Joseph Sakran: You know, perception is not always reality, and the intent is to include all folks, not just doctors. In fact, we have many active nurses, social workers, gun owners that feel passionate about this issue.

Celine Gounder: Joseph Sakran insists #ThisIsOurLane is meant to be as inclusive as possible and aims to help people within and outside medicine find common ground.

Joseph Sakran: Because we understand that it requires numerous stakeholders… with numerous perspectives to actually be able to solve this problem. Anyone that thinks they can do it on their own, either don’t really understand the issue, or they’re not serious about moving the needle forward.

Celine Gounder: Moms, students, veterans, and health care providers have all joined the gun violence prevention movement. But what about the people who’ve been advocating for change all along? The neighborhoods where gun violence is a daily affliction? The pastors who’ve taken to walking the streets at night, reaching out to local youth before it’s too late. The educators trying to break the school-to-prison pipeline? The mothers who’re organizing their communities to address the root causes of violence?

Celine Gounder: In our second to last episode of the season, we’ll hear from the advocates who’ve been there all along. That’s next time on “In Sickness and in Health.”

Celine Gounder: “In Sickness and in Health” is brought to you by Just Human Productions. Today’s episode was produced by Virginia Lora and me. Our theme music is by Allan Vest. Additional music by The Blue Dot Sessions.

Celine Gounder: Thanks also to Briah Fischer, Shangnon Fei, Hussain Lalani, and Gilead Lancaster, who also spoke to me for this episode.

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Celine Gounder: You can learn more about this podcast, how to engage with us on social media, and how to become a member and support the podcast at insicknessandinhealthpodcast.com. That’s insicknessandinhealthpodcast.com.

Celine Gounder: I’m Dr. Celine Gounder. This is “In Sickness and in Health.”