After Las Vegas: What is the change that needs to occur?

Las Vegas: 59 dead, 500+ injured. I worry about our medical colleagues who will suffer tremendously while treating the injured; they will be wracked with guilt for the patients they could not help and false back to the horror of that night and the ensuing days and weeks caring for the living. We must find ways to support each other help them cope as well as looking for sensible solutions.

My son was 18 months old when the Columbine shootings took place. The school and nearby park were where we spent many hours playing. I was shocked, and grief-stricken. I had friends whose children were trapped at the school, and others whose children escaped. Watching the images – of my neighborhood, my park, my community surrounded by police, with students marching out of the school — was gut-wrenching.

That was where my baby played on the swings, dug in the sand, ran joyously over the hills. How could this be happening? Helicopters, police in riot gear, weeping children and adults, gathering where he chased butterflies. Bodies lying on the ground, blood seeping slowly, people huddled in the bushes where we played hide-and-seek.

We cared for several of the injured children at Denver’s Children’s Hospital. These children returned days, weeks, months later for additional surgery, anesthesia, therapy, and pain management. We grieved at their setbacks and rejoiced in their triumphs. Maybe now, we thought, something will be done, changes will be made. Somehow we can prevent guns from getting into the hands of the wrong people. We can recognize and adequately treat mental illness; we can prevent bullying. We can do something.

Several years later, Children’s Hospital moved to a new campus at the former Fitzsimmons Army base, in Aurora. I left work one night, drove past the nearby mall and movie theatre, and returned to work the next day to find a world gone crazy. During a midnight showing of the new Batman movie, someone had walked into the theater and shot people. I heard about it when I got up in the morning, on the way into work, driving past the movie theater. We received several patients from that massacre. University Hospital got most of them.

My colleagues who had been on call that night were still there, shell-shocked, grappling with disbelief. We mourned, wept, remained professional, took care of our patients, and helped “mop up.”  We shook our heads at the frailty and strength of the human body, and at the incomprehensible human brain that could be capable of committing and justifying such actions.

We worried about each other and our colleagues at the University Hospital. Some got counseling; others coped by talking to one another. A few struggled profoundly and a few never truly recovered.

Now there have been more shootings, worse shootings. And always, there is blame, anger, finger-pointing, and nothing changes. We live with the sorrow and keep trying to take the best possible care of our patients.

The horror is a living, palpable presence that doesn’t go away. It fades but returns unexpectedly at random times, or whenever massacres happen again … and again … and again. Most of us find ways to cope and live our lives; some don’t. Most of us are changed in ways both profound and subtle. I think about both Columbine and Aurora all the time, the patients, the murdered, the first responders the medical professionals who care for these patients in the short and long-term, the heroes and bystanders. My family and I returned to our park often, visited the memorials, and drove by the movie theater.

Sensible solutions must be possible. We are all intelligent, caring people and physicians. Some of us own guns, and some of us don’t. Some think banning certain kinds of weapons is the answer; others think banning large-capacity magazines and improving background checks will help. Many believe that people on the Terrorist Screening Center’s No Fly List should be barred from buying guns, and many believe that guns are not the problem. Diagnosing and adequately treating mental illness is a mandatory part of any solution, but the stigma and lack of resources are crippling.

Whether you believe in the unlimited right to buy whatever weapon you wish, or you believe that there should be limits, I’m sure no one wants to see more of these murders. Our lawmakers in Washington can’t seem to help; they have voted down all proposed gun control regulations from both parties.

How about studying the causes and effects of gun violence? Why is there so little research? Why don’t the scientists at the federal Centers for Disease Control and Prevention (CDC), do more? The CDC’s Division of Violence Prevention doesn’t even mention the subject.

The answer is simple: because in 1997 Congress stripped the CDC of its funding for gun violence research, and then passed a measure (known as the Dickey Amendment) forbidding the CDC to spend any funds to “advocate or promote gun control.” While the CDC is allowed to track firearms-related deaths, it has not been able to perform any meaningful research since 2001.

Though President Obama instructed the CDC to resume research after the Newtown massacre, Congress has not restored funding. Researchers have moved on to other areas, and people continue to die.

Calling gun violence a “public health crisis,” the AMA is asked Congress to restore funding and promote research about gun violence in 2016. This should be a first step. How can we treat that which we do not understand? It is time to stop the rhetoric formally study gun violence. What are the causes? How do we better recognize, diagnose and treat mental illness? What types of mental illness makes a person susceptible to behaving in this heinous and inhumane manner? How can we reduce the harm caused by gun violence in general? We study everything else – why not this? This problem, while not unique to this country, is certainly much more prevalent here than anywhere else in the civilized world. Is this what we want? Is this what our Founding Father’s wanted?

I do know that Las Vegas will never be the same: the first responders, the concert goers, the community, the physicians, the health care providers, the bystanders, and the public. We can’t keep letting the next “worst” mass shooting in the U.S. occur. We must work together to find solutions.

Rita Agarwal is a pediatric anesthesiologist.

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