My phone rings: I’m asked to look at another CT scan of the abdomen and pelvis on a patient who was just shot. The second of the night.
Three months ago, when everything was COVID-19, cases like this happened maybe once or twice a week. Now, these gunshot cases are a nightly occurrence. I open the study on my computer monitor and immediately notice numerous tiny glinting metallic fragments scattered throughout the patient’s abdomen – shrapnel, usually meaning more soft-tissue damage. As I look at the images, I note the injuries: bowel perforation, fractured pelvic bone, blood around the liver. My phone rings again and it’s the ER doc on the other line. She wants to know if there is any catastrophic vascular injury. No, I tell her.
As COVID-19 continues to subside in neighboring New Jersey, New York, and much of Pennsylvania, a long-standing epidemic surges in the City of Brotherly Love: gun violence.
So far this year, 282 people are victims of homicide in Philadelphia, up 33% compared with the same time last year. In fact, Philadelphia now ranks second in the nation in total homicides, only behind Chicago.
But homicides are just one part of the story — approximately 33%, to be more precise. While about 40,000 people are victims of deadly gun violence every year, more than 120,000 people total are shot in the United States. Even for those who survive, this leaves generations of survivors to face a lifetime of psychological and repetitive physical trauma. In fact, of the $229 billion that gun violence costs the U.S. economy, almost all of it are indirect costs, including loss of quality of life for survivors and economic loss (i.e., lost wages). According to the Philadelphia Department of Public Health, as of 2018, there were four nonfatal firearm injuries for every firearm homicide in our city, a statistic likely to rise in 2020 as shootings increase.
Recent research has shown that many patients who survive a COVID-19 infection have long-term health consequences: lung fibrosis, kidney disease, heart damage. It’s the same with surviving a gunshot wound.
Many survivors of gun violence face years of physical therapy, repeat hospital admissions, and multiple surgeries. For example, peripheral neuropathy, a chronic condition resulting from damage to nerves and common among gunshot wound survivors, causes weakness, pain, and numbness in the extremities. Patients with peripheral neuropathy often can’t feel their hands or feet, and as a result develop sores in these areas that may become infected and require amputation to save the person’s life.
Survivors of gun violence are also more likely to face unemployment, substance abuse, depression, and PTSD, even when injuries are minor.
We know that socioeconomic status and race are huge social determinants of health. Where in the body someone is shot also predicts how often they might return to the hospital with complications. I’ve read countless abdominal CT scans on young, mostly Black, men with intestinal obstructions due to adhesive bowel disease, a common complication from bowel trauma. Their common denominator? They were all shot in the abdomen months, sometimes years before.
The disturbing reality is that both the pandemic currently waning in Philadelphia, and the gun epidemic that’s surging, predominantly affect our city’s Black population. People of color are also more likely to not receive the aftercare or home care they need following trauma.
The Inquirer’s 2018 “Shot and Forgotten” report, from David Gambacorta and Helen Ubiñas, chronicled the lives of many gunshot wound survivors with chronic, often severe, lifelong disabilities. While firearm homicide is the leading cause of death for young non-Hispanic Black males, little research has examined the leading cause of physical or mental health disability in young Black men, particularly in Philadelphia.
So where do we go from here?
More dollars should be allocated to research the long-term health and social effects of getting shot. Similar to how patients with a long history of smoking are screened for lung cancer, patients with a history of a gunshot wounds should also prompt a red flag from health-care providers to screen for mental illness, physical complications, and social determinants of health such as access to quality education and job training.
Overcoming the COVID-19 pandemic is a multifaceted challenge that will take high-quality inpatient hospital care, intense research, and preventive medicine. Assuaging the pain and suffering caused by gun violence demands a similar effort.
Corbin Pomeranz is a physician and chief resident at Thomas Jefferson University Hospital in the department of radiology.