An excerpt from Under the Gun: An ER Doctor’s Cure for America’s Gun Epidemic.
My phone buzzed in the pocket of my blue jeans one Saturday night at around 10:30 p.m. as the standing-room-only crowd at Minute Maid Park, clothed in vibrant orange tones, erupted in cheers. It was game two of the 2019 American League Division Series playoffs between the Houston Astros and the Tampa Bay Rays. My work life was soon about to mix with my personal life.
“Lee’s been shot,” the text from Chelsea Livingston, a medical student at the institution where I practice and teach emergency medicine, read. Lee was my next-door neighbor, an older Black man I chatted with most days when he walked his dogs.
I jumped up from my seat and ran to a pair of heavy green metal doors securing a stairwell. I pushed through the doors, entered the stairwell, and dialed the front desk of my ER while a cacophony of hoots at the ballpark got louder.
“Hi, this is Dr. Shinthia,” the voice on the other end said.
Nashid Shinthia was one of our newer attending physicians, a short South Asian woman with mocha skin and large round glasses framing her face.
I pressed a finger into my left ear to drown out the noise.
“Hey, this is Dr. Dark,” I said, relieved that I was talking to someone I had met before. Even though she was new to our department, she was not unfamiliar to me. “One of my neighbors has been shot. Is he over there with you?”
Dr. Shinthia hadn’t seen any Code 1 traumas that night, the designation we give to the most seriously injured patients. A Code 1 trauma call activates the entire trauma team, including all the emergency department residents, the emergency department faculty, the surgical resident, and the surgical attending.
“But wait, I did hear a page for a Code 1 earlier,” Shinthia said.
“I think another attending took that one. Let me have them call you back.”
I knew I wouldn’t hear my phone ring amid the raucous cheers of baseball fans. “Have them text me,” I said, walking back to my seat. My wife was high-fiving the fans sitting next to her. I pictured Lee’s smiling face. What if Lee is dead? I thought. Who would shoot a nice older guy like him? What had happened on our block while I was at the game?
We had arrived in Houston during a typical 100-degree summer in 2013 and moved into a home a few doors down from Lee. The house had been built in the 1940s, a time when Jewish people, excluded from wealthier parts of Houston, had created an enclave that was considered to be the Jewish River Oaks. River Oaks remains one of the wealthiest neighborhoods in Houston, featuring luxurious homes, designer shopping, and an air of exclusivity. Third Ward sought to emulate those palatial homes with residences on large lots nestled along the bayou. Following World War II, the Third Ward began to desegregate, but racial tensions flourished. One of the first Black people to move into the neighborhood, a cattleman named Jack Caesar, had his home bombed with four sticks of dynamite by two white men. In the 1950s and 1960s, the Jewish people in Third Ward, especially in the homes around MacGregor Way, moved upstream from Brays Bayou, leaving the neighborhood to become what Texas Monthly magazine writer Lawrence Wright described in 1982 as “the richest, stateliest, black neighborhood in Texas.”
Our two-story house had been freshly renovated; the newest home on the block to receive a makeover. Lee, a man in his mid-50s, was happy to see a young Black couple move into the neighborhood to buffer the waves of gentrification that were on the horizon. Like many of the residents on our street, Lee was an older Black man who had seen the neighborhood change over the course of his years. He had grown up in the Third Ward during the 1960s and 1970s, a time when Black doctors, lawyers, and business tycoons congregated in the large homes along the bayou. He moved to Los Angeles, California, in 1985 to pursue a career in the entertainment industry, but ultimately returned to the Third Ward to help care for his elderly mother in 2011. Houston’s Third Ward was Lee’s true home. His block was now my block.
In our morning talks, Lee had told me about white families who had been buying property, lauding our neighborhood’s culture and history and driving up the cost of living, making it unaffordable for many Black families who had called the Third Ward home for generations. White folks felt that the neighborhood was getting safer, Lee said, but these streets weren’t entirely protected from violent crime. One spring afternoon, another neighbor’s lawn man was robbed at gunpoint for his leaf blower. I came home from work one night in 2014 to find someone had broken into my house, and in 2015 a man was shot dead in the parking lot of Good Hope Baptist Church, a few minutes’ walk from our block.
At the game, the Astros put another run on the scoreboard, causing my wife, a fan of all things Houston, to jump out of her seat in celebration.
My mind was racing, distracted by the potential route of a bullet through Lee’s body.
If he had been shot distal to the knee or elbow, the speakers in the emergency room would have rung out with a Code 2 announcement, letting staff know that the bullet had missed vital organs and that the senior surgeon could stay in the operating room while her surgical residents examined the patient.
But if Lee was struck higher up, proximal to the knee or the elbow, it would have been called out as a Code 1 trauma. Almost everyone shot in the precious area containing the vital organs of the chest and belly needs some type of surgery to reinflate a collapsed lung, repair critical blood vessels, or explore the bowels in case the bullet has pierced the gut, forcing undigested food and feces into the abdomen.
In my mind’s eye, I traced the course of Lee’s major blood vessels, the pulsing aorta as it curves from the top of the heart and heads downward toward the major organs—liver, kidneys, and spleen. If these had been hit by the bullet, he could have bled to death at home even before an ambulance arrived.
The stadium crowd was erupting into cheers again when my phone buzzed with another text from Chelsea.
Ping!
“Heard Lee and his brother got into a fight in Lee’s garage and his brother shot Lee in the leg.”
I immediately thought of Sean Taylor, the Washington NFL player who was shot in the groin by a man during a home invasion. The bullet hit Taylor’s femoral artery, the main artery of the leg, and he bled profusely, dying the following day. Was Lee struck like that?
Bullets don’t move through the human body smoothly.
Whenever a high-velocity projectile enters the skin, it begins to slow dramatically upon impact with bodily tissues, not only distributing its kinetic energy to the tissues it comes into direct contact with but also converting its energy into the form of a shock wave. This shock wave, or cavitation effect, can cause damage to vital structures out of the direct path of the bullet that can be just as bad, if not worse, as the damage to the tissues along the bullet’s known trajectory. Not only that, but bullets don’t just penetrate the skin and travel in a straight line, like an arrow or a knife; they tumble, they fragment, and they can ricochet, spreading their deadly force in any direction imaginable.
In the trauma bay, we often have to go searching with X-rays to identify the resting place of a bullet that began in one place and lodged somewhere unexpected.
Two physical properties determine the amount of energy a bullet can carry to its intended victim—its mass and its velocity. Mass, or how much a bullet weighs, is an easily understood concept in terms of delivering the impact of a bullet. A smaller projectile, like a .22-caliber round, will deliver significantly less punch than a .45-caliber bullet.
Once, a particularly lucky man crossed my path in the trauma bay. He arrived having been shot in the forehead. To everyone’s surprise, as the man rolled in on the EMS gurney, he was sitting and laughing with the paramedics. Perhaps he was as hardheaded as he claimed; the .22-caliber round aimed at his skull hadn’t been heavy enough to penetrate the bone.
The greater factor influencing the energy a bullet carries to its target is its velocity, or speed. The formula for kinetic energy squares the velocity of the projectile, imparting exponentially greater force to a projectile with a similar weight that is delivered in a faster manner. The bullet that fires from the AR-15, the .223, is similar in diameter and in some instances in weight to a .22-caliber handgun round. However, the velocity of the projectile fired from an AR-15 can be nearly three times as great.
The energy imparted into that bullet, therefore, is nine times as great as one fired from a handgun. While my patient survived the shot to the forehead from a .22 pistol, a single AR-15 round—with an order of magnitude greater energy—could have blown a hole in his skull big enough to reach inside and scoop out the rest of his liquified brain.
Chelsea couldn’t figure out where Lee had been taken. I was stuck playing the part of an anxious friend instead of my preferred role: the doctor equipped with details and answers. I slid my phone into my pocket and rubbed my thighs with my palms; they had begun to sweat from nervousness. Houston houses the world’s biggest medical complex, a miniature medical city within a city that was only a 10-minute drive from the stadium where I was sitting feeling worried instead of entertained. The Texas Medical Center houses 44 institutions and more than 100,000 employees and hosts at least 7 million patients and visitors each year. To which of these places had the ambulance taken Lee?
There were only two viable options—Ben Taub and Memorial Hermann—the city’s only Level I trauma centers, situated adjacent to one another and just a couple of miles from our houses.
My wife turned and smiled as the Astros scored again, but I couldn’t bear to share my anxiety with her as she beamed, not when there were so many unanswered questions. However, she could sense my unease. The smiles on her face wrinkled. I texted Lee’s phone, hoping he might respond if he wasn’t seriously injured. He didn’t respond.
All night long there was no news. We drove home after a victorious game for the Astros and I parked my car and gazed down the street toward Lee’s house, wondering exactly what had taken place there.
Sunday came and went.
Still no word from Lee. My neighbor’s house sat empty. And then, late on Monday night, I got the news. The bullet had broken Lee’s leg. Surgeons had placed a titanium pin inside the shattered bone and Lee was in recovery.
Ping!
“Thankful to be alive,” Lee finally texted back. After 48 hours of a tight chest, I could finally exhale.
Cedric Dark is an emergency physician.