Did I shoot them? Am I bleeding? And does all bleeding stop?

I remember the first gunshot wound I treated in the emergency department at Jacobi Hospital in the South Bronx 35 years ago. Only one of two I saw that month in the second busiest trauma ER in the country. Gang fight. Troubled youths. In the middle of the night. Hand guns.

We couldn’t save him. I was devastated. My chief resident, an aspiring trauma surgeon, took me aside and matter of factly told me, “You didn’t shoot him. You weren’t bleeding. All bleeding stops.”

Not terribly reassured at the time, I have come to realize that while everything he said was true, at the same time, none of what he said is true.

Fast forward to last week’s shootings. A school. A mall. Mentally ill people. A semi-automatic rifle. In broad daylight. All the words have been used up to describe this sad, unbelievable, senseless killing.

Moving on the descriptive to the prescriptive, I ask, “Did I shoot them? Am I bleeding? And does all bleeding stop?”

The answers are not obvious. Ask yourselves:

Did I shoot them? Yes, in a way. By allowing a culture of violence to evolve into one where we have unrestricted violence creep into every facet of life, without relief, without context, without considering the consequences. Graphically in video games, gratuitously in movies and on TV, and glaringly in the discourse of how we express ourselves with whom we disagree (e.g. the last election as case in point).

By allowing our “freedom” to carry firearms outstrip the commonsense that framed our constitution. Hunting rifles and firearms for protection do not resemble the military grade weapons that are finding their way into the hands of the mentally ill.

By allowing ourselves to ignore the ravages of mental illness that are becoming more and more prevalent in our children and in our society. How many of our children have a behavior problem and are on medications from an early age? My office is full of them. Oppositional defiance disorder, ADHD, bi-polar and much more. Where were these kids 30 years ago? They didn’t exist. And too many parents are ill-equipped to deal with these children, as are the schools. We are failing in our inabilities to get them help unless they are deemed a clear and imminent danger to themselves or others in that moment. Otherwise they roam free as adolescents and young men (almost all are men where hormonal realities more readily imprint violence as a solution to problems.)

Am I bleeding? Yes, I am. I am bleeding the optimism that drives my abilities to carry on a normal life where I try to bring safety and security, health and happiness to my family and my patients. As an observer, I am bleeding out my resilience to adapt to circumstances I cannot control. I am bleeding the energy I need to change what I can so this cannot happen again.

And does all bleeding stop? No, it doesn’t. As a parent, I know that these families will feel this bleeding for the rest of their lives. Some will never be able to resume, others will find a way.

Guns have always existed. They aren’t going away. Greater control may or may not help this situation. This was a greatly disturbed family. A greatly disturbed parent who left 3 military grade weapons in her home where she had a greatly disturbed “child.” A “child” who has had a lifetime of violence thrown at him so that the consequences of that violence have inoculated him to become immune to what happens in real life.

And so last week we were confronted by what is becoming a more common event. We remember Columbine for how unique it was. How many more names will we remember? How many more faces will we forget?