The most vigorous debate on the writings of this page occurred when Dan Laskin wrote his 2 editorials, including his parting shot, on gun control.1, 2 While a reprise of the topic has been studiously avoided to this point, because guns are associated with maxillofacial trauma, it is the appropriate purview of surgeons to consider how to increase gun safety. If gun violence can be mitigated, these horrific injuries can be prevented.
While the use of the first person is frowned upon in scientific discourse, perhaps this is the JOMS editorial where the use of the first person is needed. Growing up in New York City was pretty rough. The reader should know that I have had a gun pointed at me in anger more than once, and I have been shot at. Two of my childhood friends have died in gun violence and others have been convicted of gun-related crimes.
Curiously, I have never had strong feelings about gun control, though I always admired Dan as well as his critics for their vociferous views on this issue. I think it is time again to examine where we are as a profession on preventing gun violence.
Who Is Getting Shot, and Why
Here are my personal experiences: a tale of gun violence in 2 cities.
Oregon, 2007: Yesterday, at the OHSU hospital operating room (OR), the hallways were abuzz with talk of hunting and guns. Oregon and OHSU are sharply left of center places with strong views on social issues. However, our liberal views do not extend to gun ownership and gun use. Big game season in the west fills the parking lots with pickup trucks and gun racks. A colleague left early to skin the animal he had killed the previous night. The best spots and the best days for hunting get more discussion than the success of the Oregon Ducks football team (who by now it is hoped have at least won the Rose Bowl if not the BCS championship). Even our tattooed, alternative-lifestyle OR nurse commented that she was trying to figure out how to put a gun rack on her commuter bicycle so she can “get some respect out there.” We were operating on a gunshot wound.
I commented to our OR team on how gun violence differed in Oregon from my experiences in New York in the 1980s. Here are my most recent gunshot wounds in Oregon:
•23-year-old male, self-inflicted rifle wound
•19-year-old male, hunting accident
•57-year-old male, self-inflicted handgun wound
•42-year-old female, shot by boyfriend
•64-year-old female, terrorist attack overseas
•53-year-old female, terrorist attack overseas
•29-year-old male, self-inflicted gunshot wound
New York City, 1987: There was a sickening stench in the ER when we arrived. Several of our own were on stretchers, some already dead. Our favorite restaurant for lunch, about a block from the hospital, was filled (as always) at noon with nurses, doctors, and staff when a representative from the local drug cartel entered and sprayed the room with automatic weapon fire.
These and other events traumatized the Elmhurst Hospital team and heavily influenced our thinking about gun violence and gun control. We were against guns. Here are other gunshot wounds I treated during that period:
•Young male, gang-related violence
•Young male, shot by police after shooting officer
•Middle-aged male, shot during robbery while changing a tire on the Grand Central Parkway
•Taxi driver, shot during robbery
•Young girl, shot in crossfire
In the peak years of the 1980s, there were more than 3,000 murders on the streets of New York. With 6 murders a day, only the rare event gained the attention of the public in the press, but we all lived in fear. Something changed dramatically in the 1990s that can serve as a lesson on the means to reduce gun violence. The penalties for gun-related crimes became Draconian, education of young males on gun violence was expanded, the backs of the street gangs were broken and their leaders were imprisoned, the police seemingly filled the streets and no crime was left unnoticed. These were the famous years when the aggressive “squeegee guys” that clean your windshield were driven from the streets to create a more civil and lawful society. Social programs that promoted a civil society expanded, the churches sought to increase community involvement, and volunteers worked with our kids. A wealthy graduate of an inner-city elementary school in Brooklyn showed up one day unannounced and told every child in the school that he would pay for their college education (and he did). By the time of the completion of the Guiliani administration the number of murders had been reduced by 75%! Three of 4 of those who would be dead were alive!
The museums began opening in the evenings. Police Boys Club basketball teams filled the city parks. Kids had a safe place to go after school. Sidewalk restaurants and the evening stroll in Central Park returned to the New York identity. Not only had the deaths from gunshot wounds decreased but the injuries that were 6 to10 times higher than the number of deaths per year, had undergone a concomitant decrease. By 2002, the violent crime rate in New York was about the same as in Provo, Utah.3 The reduction in carnage has continued to this day with 539 murders last year, one sixth of the rate of the 1980s. Today, 2,500 lives are being saved annually in New York City and countless maimings, including maxillofacial injuries, are being prevented due to the improved social and enforcement policies initiated in the years 1994-2001. Importantly, no substantial differences in gun registration or gun control had been made during those 2 decades.
Preventing Gun Violence
Oral and maxillofacial surgeons have a role in promoting gun safety and social responsibility.
Show young people the results of gun violence on the maxillofacial complex. I provide images of these injuries when talking to high school students about trauma prevention. It has quite an impact.
Help young males find a meaningful place in society. There is nothing better to prevent violence than getting someone to seek a profession that cares for the sick and injured. Talking to young people about the joys of health careers will make a better society.
Help prosecutors punish those who commit gun violence by testifying when necessary as to the injuries inflicted by guns. Juries need to know what gun violence truly inflicts.
Gun violence is a social problem. Countries like Switzerland and Israel are armed to the teeth, but because of their intact social structure, the incidence of criminal gun violence is even lower there than in Oregon. Social responsibility and living in communities that care for one another are the best means to prevent gun violence. The beauty of this approach is that it will not only reduce violence in places like New York 1987, but also in Oregon 2008.
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