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Safe Storage

I’ve Been a Pediatric Surgeon for 30 Years. I Know Firsthand What Bullets Do to Kids.

"When a child sustains this type of injury, the amount of damage is increased exponentially.”

Doctor Michael Hirsh knows the damage bullets can inflict on a child’s body. During his 30-year career as a pediatric surgeon in hospitals in the Northeast, he has treated scores of young patients with gunshot wounds, ranging from children accidentally shot by their siblings to teenagers determined to take their own lives.

Since 2001, Hirsh has worked at UMass Memorial Medical Center in Worcester, Massachusetts, where he now serves as chief of pediatric surgery. His experience in the field has led him to believe that conversations between doctors and parents about the safe storage of firearms can reduce child shootings. A new study shows that more than 65 percent of people are open to speaking with their physicians about gun ownership. But other research has found that most doctors don’t ask their patients about access to firearms. Hirsh concludes that certain state laws — such as Florida’s infamous “docs vs. glocks” ban — have had a chilling effect on his fellow physicians.

He does not share that reticence himself. As an outspoken child health advocate, he talks frequently about what he has seen on his operating table as a way to keep parents aware of the risks their children face from unsecured firearms.

I would say I’ve operated on somewhere between 40 and 75 child gunshot wounds. Several kids were just holding onto weapons and they shot themselves, usually in the foot or in the leg. That was something I saw earlier in my career while I was working in Pittsburgh, I think because hunting was so prevalent there. This isn’t unique to Pennsylvania, but there were many, many situations where a kid fell out of rickety tree stand with a gun, or where a kid had been cleaning a gun and it went off, or where someone else was cleaning a gun and it discharged, hitting a child. That we used to see a lot.

When someone is shot, there’s this effect called cavitation. The bullet doesn’t just make a path through the tissue; it actually cores out a space around it. Beyond the coring, there’s a blast effect: the area next to the bullet entry ends up getting damaged because of a concussive wave that goes through the tissue. When a child sustains this type of injury, the amount of damage is increased exponentially because their organs are much closer together. If a child is shot in the abdomen, there’s potential damage to the internal organs, internal blood vessels, intestines, and the spine, all together. It’s just horrific.

A very memorable patient from my time in Pittsburgh was a little nine-year-old girl who had been shot by her brother. She was from an Amish community. Her brother had been playing in the barn one summer day and found an old shotgun. As she ran in the barn door, he stumbled on the door jam and the gun discharged. She was peppered with close to half a dozen pellets, and they went straight into her groin area. That was a very bad spot in terms of the blood supply to her legs.

After we did our initial workup, she spent close to six hours in the operating room between my service, the plastic surgery team, the orthopedic team, and the neurosurgical team to try to reconstruct her blood vessels, her nerve connections, and the bone itself, all of which were damaged.

It took many, many weeks in the hospital and a few more months in a rehabilitation center, but she ended up regaining use of the leg — not a complete success in terms of total functionality, but the tissue was viable, and she could walk on it. She was never going to become an athlete, but her family was very happy with the results.

I remember that particular gunshot wound because it happened to a family who we would otherwise never have been able to reach out to and talk about the safe storage of guns. That gun had probably been there for 50 years, lying in the barn. That’s one of the issues with rural areas: People don’t even realize that there are barns and closets and garages with a weapon lying in some dark corner, and it may very well be fully loaded. And that poses a danger, not just because of the risk of unintentional shootings. Those are also the guns that, unfortunately, frequently end up getting involved in suicides.

When a child commits suicide, it disturbs me. I have not had a tremendous amount of success with surgeries on kids who have attempted suicide with a gun.

I remember one boy in particular. He had just found out that his girlfriend broke up with him, I think by text message. He was at his grandparents’ home, and he went out to where he knew his grandfather had stored a pistol and shot himself in the head.

When the boy arrived at the hospital, his pupils were fixed and dilated. That means there’s no brain activity. We were able to resuscitate him enough to get him to ICU so that the family could gather and process the situation.

As we drilled down a little bit more with the family, it became clear that this boy fit in with the other patterns of suicide that we were seeing. These aren’t patients who have necessarily been unhappy kids for years.

This was a boy who very impulsively made the decision to kill himself based on one little kernel of bad news. When you’re 16 and in love, that kind of rejection can seem like the end of the world, and kids often don’t have the perspective to realize that there’s plenty of life ahead of them. These decisions about suicide may only happen within 15 minutes of the act. The only preventive medicine in that case is making sure that if a firearm is around, it’s secured.

Some people say that suicide is not preventable, but I disagree. Most childhood gun injuries are preventable. The truth is that many parents are not properly storing their weapons. They’re hiding them in closets, foot lockers, and bedside tables, thinking that their children don’t know where they’re located. But studies have shown that in gun-owning families, children know where the gun is hidden around 70 percent of the time.

Safe storage should be a national priority. We need to do better in making sure that people are aware that the unsecured weapon in the home is a public health problem. Asking whether there’s a gun in the home is one of the three most important questions that a pediatrician can ask as far as child safety, according to the American Academy of Pediatrics. But many of the doctors I speak to are skipping these questions, with time restraints and the pressure to keep child visits down to 15 minutes. Some might have literature on firearm safety out in the waiting room, but I’m not sure how many parents are looking at it.

Doctors are worried about encroaching on the Second Amendment, especially after Florida passed a law to forbid doctors from having discussions with their patients about guns. That law isn’t in effect — it’s being decided in court — but it’s had its intended effect. The issue isn’t that someone can’t have a gun in the home, it’s just that having a gun in the home comes with a certain responsibility, and we can counsel about how to do better with storage. There’s a certain teachable moment that doctors have in their hands when a patient comes to them, and if they make a recommendation, it carries some weight.

[Photo courtesy Steven King/Worcester Magazine]