In the early morning hours of October 4, 2021, gunshots punctuated a routinely busy night at Thomas Jefferson University Hospital in Philadelphia. Staff were faced with a tragically familiar threat: an apparent active shooter in the building.
Dr. Gillian Naro, an internal resident, was on a late shift that night. In a poignant essay she published this week in the journal Annals of Internal Medicine, she writes about the questions she and her colleagues shared in that moment: “‘We have to respond, right? If not us, who? Are we called to aid the sick but at our own risk?’ We asked each other, “Is this part of our oath, our calling?’”
Naro and her co-workers proceeded with their work, caring for patients even as they faced an acute risk to their own safety. Eventually, they got the all-clear, and details began to emerge: A hospital employee had shot another staffer, a 43-year-old nursing assistant, in a targeted incident. The victim did not survive.
“I am different now in a way that I cannot explain. Everything is different now, and I cannot yet put it into words,” Naro writes about the experience. “I have only questions. Is it right to ask doctors to risk their lives for their patients? To sacrifice our own safety for that of our patients? Would we have incurred a moral injury of some kind had we not responded? Would we always have doubted ourselves had we not put our lives on the line? Frequently, when the night is quiet, we speak of these things in the lounge.”
This week, I spoke with Naro about the incident and her essay. She shared her thoughts on the many layers of trauma around gun violence and the burdens for health care professionals as well as victims; the dangers of society becoming numb to an epidemic of violence; and the role she sees for doctors in the fight against gun violence.
Our conversation has been condensed and lightly edited for clarity.
Your essay centers on a unique moment that you experienced, but how might we extrapolate that sentiment — “If not us, who?” — to the broader role that public health officials play in gun violence prevention?
I think that there’s a place where you can heal one person at a time or attempt to, which is what I was referring to that night. But there’s also the same kind of, “If not us, who?” calling where you try to heal communities at a time, hundreds at a time, millions at a time, which is public health, which is community outreach. I think the same sentiment stands where you can look on that precipice and feel like this is beyond my one person to tackle. But if not me, then who’s going to do it? That’s where I think the vocation and calling comes from.
People who haven’t been around gun violence, even vicariously, can become almost numb to the constant barrage of headlines that you read but don’t experience.
I think that it’s a similar parallel, honestly, to COVID in that we are getting to the point where we’re getting sick of hearing about it and we’re getting sick of living in a world where there’s constant mass shootings. We’re getting sick of living in cities all over the country where this is a common occurrence and that there can be a shooting a few blocks away from where we live. But when it impacts you personally, whether that’s COVID or gun violence, it’s harder to let yourself be numb to it. Because for me, at least, I can only speak for myself and the way that I’ve experienced it is that whenever it’s brought up, I can’t help but feel that twinge of emotion that I felt that night.
To your point, gun violence places heavy demands on doctors and especially those in adjacent violence prevention fields like street outreach work, which poses particularly acute workplace hazards. How important is it that we don’t neglect helpers also getting help?
Oh, 100 percent. I think with especially street outreach workers, community workers, folks that really interact on a personal basis to those who’ve experienced trauma, have experienced trauma themselves. There’s an element of secondary traumatic trauma, of hearing these stories every day, experiencing these stories through your patients, relating to them, feeling burdened by not being able to provide them with the services you know that they deserve. All of that is something that we carry with us and we have to cope with. And then an added layer of experiencing the trauma directly. It’s a vocation. I don’t know if many of us would be happy doing anything else. But it also is something that contributes to burnout over time. We just have to make sure we’re caring for each other.
There are a lot of potential solutions to gun violence that run through hospitals beyond treatment itself of gunshot victims. I’m curious what you think are some of the most promising solutions that people should know about and that we can focus on.
I think it’s education. Not just for our patients, but for future doctors. There has to be a shift in medicine where public health is part of medicine. We have to move from focusing on not just the pathology of the individual, but the pathology of the community. Doctors need to be a voice for that community, and they need to learn how to treat both.
I’m really proud to be working with the graduate medical education, which is all of the doctors in training at Jefferson to try to build into our curriculum a [focus on] gun violence prevention and awareness in the terms of health disparities curriculum so that doctors know: How do I not just screen my pediatric patient for various needs, but how do I talk openly and honestly to the family about safe gun storage? How do I not just address the acute anxiety, but address counseling to larger groups on the larger impact of gun violence, who may have not even experienced it yet and how to seek help? How do I not just treat the gunshot wound, but address and analyze the overall trauma that impacts the city?