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Doctors on the frontline of gun violence feel demoralized and frustrated

Doctors on the front line treating gunshot victims are often demoralized and highly frustrated at seeing the same situation, again and again, according to one of the country’s leading trauma surgeons.

Some surgeons burn out, while others seek solace in drinking and drugs, said Dr. Tom Esposito, until recently the head of the trauma unit at Loyola University Medical Center just outside Chicago.

Chicago is in the middle of an upswing in gun violence, with more than 2,200 people shot this year, both fatally and injured. Seven were killed and 100 injured in shootings in the week leading up to Saturday evening.

Dr. Esposito, who sits on the American College of Surgeons' national committee on trauma, spoke frankly of the impact on surgeons and other staff at emergency wards across the country.

“The first word that comes to mind is 'demoralizing,' because it is the same thing over and over again,” Esposito told AMI Newswire.

“It’s very akin to being in Afghanistan or Iraq at the height of these conflicts, a lot of death and a lot of bodies maimed,” he said.

“I know my strategy to deal with it: You need to separate yourself to some degree, even to the point of dehumanizing. This is not somebody’s son, sister or mother, because if you let that get to you, you will not be effective. You just need to separate that human element to keep your sanity.”

He said many surgeons burn out and some turn to deeply unhealthy ways to cope with the stress.

But there are others who thrive, living on the adrenaline, some still still operating in their 60s or 70s, Esposito said.

“But a lot of trauma surgeons are known for burnout. They are doing other things and not focused totally on trauma because it is so draining,” Esposito said. “They are doing other stuff that is not life and death.”

Esposito, himself a trauma surgeon for nearly three decades, has backed away from treating emergency trauma cases and is mainly doing wound care.

But, he said, “I miss in it in a sick sense, miss some of the action. I want to be there helping.”

Surgeons have views on how to deal with the problem of gun violence, but often feel it is “very frustrating and very demoralizing.”

“It’s a public health problem and not all about criminal justice-type problems, not all medical. It’s a public health epidemic,” Esposito argued.

“Everybody is focused on gun controls, but these are illegal guns, and not coming from the local gun dealer for the most part. Gun control is not going to do the trick.”

In Chicago, some guns do come from local dealers. Straw buyers acquire guns at suburban stores, and some are found to have been used in shootings in Chicago, according to the city’s police department.

But Esposito said it’s a wider and more complex problem than just gangs and criminal justice.

There are the four Es, he said: engineering, education, economic incentives and enforcement of laws.

Guns can be made with trigger locks, people can be educated on their use — he praised the National Rifle Association for their efforts in this area — bullets can be taxed, and laws already in place should be enforced, Esposito said.

The highly experienced surgeon has a theory why Chicago has more gun violence than other cities; more than New York and Los Angeles combined.

“Violence begets violence and, I think, in Chicago there is maybe a certain element just to keep Chicago in the limelight,” he said.

For surgeons dealing with gun violence, it’s not just about trying to save lives and patching up wounds. They also have to deal with the family and friends of the victims.

“You have to separate yourself from a human standpoint.” said Esposito. “Some are very quiet, very numbed; some animated, wanting retaliation. Some take anger out at the surgeon because he or she did not save them.”

Esposito would advise his residents not to spend a minute and a half talking about the details of what was done to try to save a life.

“I tell them just to come out and say, 'I am very sorry but your loved one is dead.' And use the word dead. There is no way to sugar coat this.

“Sometimes you go in with a chaplain and always stand by the door just in case. You have to be in a private room, not in the middle of the emergency room.

“You never know how people will react. One time, someone punched the wall next to me and I was not sure whether he was aiming for my head or the wall."