VIOLENCE
People who shoot themselves have worked up an explanation
as to how the revolver in their pocket discharged. They cannot
understand why there was a round in the chamber when they
picked up the gun to clean it, or exactly what happened when they
clambered down a deer stand into a live round. True, some folks
shoot themselves with an intent to kill: either they do not make it
long enough to get orthopedic care or they are so disfigured that
plastic surgery cannot make them complete again. There are few
"Gunshot injuries are the third
leading cause of injury in the
Emergency Room after motor
vehicle accidents and falls."
repeat suicide attempts with guns.
Gunshot wounds to the skeleton differ from injuries to the
brain, the chest or the abdomen. Visceral injuries cause death,
often promptly. Broken bones lead to prolonged incapacity with
recurrent surgeries for deformity, failure to unite and infection. A
shattered tibia usually takes six months before the victim can bear
full weight, and many years until the leg is solid and the structure
of bone restored. We really lack a good system to care for prisoners
in chains who cannot walk, have painful legs, and have chronic
draining wounds. They come back for orthopedic care at uncertain
times, and there is no way to get them prescriptions for antibiotics
and painkillers.
At the trial, the prosecutor had a rifle on her desk. The purpose
in asking me to testify was to establish that the accused used ‘lethal
force’ in his attack on the victim. Wounds to limbs produce great
disability but, in my experience, these wounds rarely produce death.
I have not since my service in the Vietnam War seen a patient shot
in the arms or legs who died. The judge became exasperated since
he believed that everyone generally understands that bullets kill.
If this is the common knowledge, then the reason for asking me
to take off to spend a day in court to assert that a rifle is a lethal
weapon was unclear to me. I did remember that lawyers are thinking
about something that the rest of us do not understand and, to avoid
contempt of court the best strategy, is to remain mute.
What then should I conclude from 40 years of orthopedic prac-
tice treating wounds caused by firearms? A gun is a device which
uses an exploding chemical to propel a bit of metal into a person
where it usually damages enough bone and soft tissue to disturb
the rest of the victim’s life, whether or not it causes death or ampu-
tation. The possession of arms is a right in the Second Amendment
to our Constitution. The more I read about the Amendment, the
less clear it becomes. In United States v. Cruikshank (1876), the US
Supreme Court ruled that the Amendment only means that the
Federal Government cannot infringe on the right to bear arms, not
that there is a right to bear arms. A person’s right to own a gun for
self-defense was decided in District of Columbia v. Heller (2008).
These concepts have little to do with the “security of a free State”
or “A well-regulated Militia…”
We live in a technologically advancing society where the purpose
of self-defense with guns could equally be achieved with devices
that temporarily stopped or stunned intruders without maim-
ing them. Will a further elaboration of laws end gun violence? I
doubt it. Background investigations can be mandated and then
not performed or not reported. If school entrances are blocked, the
deranged bent on doing damage will come in the windows. Guns
still pass through airport security. There is no solution. We live in a
country with teeming cities where revolvers are inappropriate and
with open spaces where hunting is expected. A fellow orthopedist
once remarked, “The people who get shot are the people who do
not walk away.”
In a free society, the wise and thoughtful use of firearms will
reduce the tragedy of gunshot injury better than any arcane legal
attempt to define and regulate the use of common weapons of sport,
hunting and protection.
Dr. Seligson is a practicing orthopedic surgeon at UofL Hospital.
AUGUST 2018
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