Gun Baby Gun. Iain Overton
children’s chances of survival were dependent on a host of factors. The speed of their getting treatment was crucial – the so-called ‘golden hour’. In one study in the US, it was found the likelihood of you dying from a gunshot wound was about 25 per cent higher if you were shot 5 miles or more from a trauma centre, and you could not get there within the hour.5
Also important was the wealth of the country in which they were shot. In the US for every person shot and killed, as many as nine survive. In developing countries the ratio is far smaller; more people who are shot will die – about one in three. The World Health Organization estimates that between 50 and 80 per cent of traumatic deaths in developing nations happen before people get to hospital, in part because, in many areas of the world, ambulances are almost non-existent.6
Your chances of survival also come down to factors far beyond your control. The bullet’s weight, the speed at which it hits you, even the pull of the moon has an effect. It is all about the transference of kinetic energy in a chaotic way; variables that determine the final resting place of the bullet or how badly you are hurt are all unfathomable.
Other things matter. If you’re wearing clothing at the time, there’s a greater risk of damage and infection to your body.7 If you are pregnant there are sometimes significant complications.8 And, in the US at least, whether you have health insurance plays a factor. One study said uninsured trauma patients were more likely to die after being shot than those insured.9
It is not just the immediate trauma of the wound that causes harm. Bullet fragments left in the body can also result in higher blood lead levels.10 Or you can go on to develop related health concerns – as in the case of US President William McKinley, who earned the title of being the first reported case of traumatic gunshot pancreatitis.
All in all, getting shot is a terrible lottery. The odds might be in your favour, but it’s one bet never worth taking. Thank God, then, for doctors.
In a closed room behind a steel-barred door the medic and I sat and talked. The room was lit with an ugly sterility, the overhead lights gave off a low buzz, and all around was chrome and glass, instruments wrapped in stark, sterile packages. A bleach-white smell clung to this place. For two years, Dr Taylor, a petite and vivacious young woman, had been the head of the trauma unit here in this rising, brick-built oasis of South African care: Tygerberg Hospital.
Tygerberg. It sounded like the tiredness and despair that had long ago infected the slums surrounding this place. Each month up to 2,000 patients passed into Dr Taylor’s world, fresh from the poverty of the Cape Town flats. And what she saw, endlessly, was the trauma wounds of penetration – gunshots and gunshots and gunshots.
‘In the past we got stab wounds, but now it’s gun wounds. It’s all to do with drug crimes and gangsters.’
She was thirty-four. One of those bright young doctors whose sparkle gives you faith in this world, one who had always wanted this sort of work. She was from South Africa’s Free State and had that matter-of-fact way about her that defines people. But these gunshots, this was new to her. Back home, back in Bloemfontein, a place of long pastoral lands and the languid time of rural life, it was all stab wounds and car accidents. Not like here in the Cape Flats.
We were in the controlled section of the hospital. Only the staff and the dying and those clinging to life went back here: an unseen world the gun helped create. A world of sterile swabbed pain. We had walked through clanging doors and down long lines of scuffed corridors that glowed in the off-white light and turned into a windowless room. There we sat at a metal desk surrounded by blood pressure gauges and ventilators, IV lines and machines whose purpose you didn’t want to know. Drugs lay in quick-grasp handfuls in cabinets that hung upon the scrubbed walls. Adrenaline, Etomidate, Furosemide, Atropine – alien and painful-sounding words. There were ugly things that caused pain. Scissors. Scalpels. Large-bore catheter needles, sixteen gauge. They spoke of one thing: that the pain caused by guns does not end with the pulling of the trigger. That’s just the start.
Her patient population was predominantly, almost exclusively, young black and coloured men. And the gunshot wounds were predominantly low-velocity and multiple. No AK47 rounds here; rather, small handguns and bang, bang, bang. People getting shot four, five times even.
‘One guy was shot thirty times,’ she said. ‘Mostly flesh wounds, but he survived.’ She tapped the desk. She was frustrated with the lack of resources. She wanted to help so badly, but things were never just about desire here. ‘In the US you have full body scans. Full diagnostics, all on hand for you there. All in fifteen minutes. But here – we see so much violence and we’ve only just got an ultrasound.’
Computerised tomography scans and X-rays here can take twenty-four hours to get back, and this made for hard decisions. The other day a patient came in – shot in the abdomen. They put forty units of blood and blood products back into him, but by then he had suffered renal failure, so he went on a ventilator and then into an intensive care unit for four weeks. This meant others were refused intensive care, there just weren’t enough beds – and by others she meant children with acute appendicitis or cancer. One life saved here, even if it’s the life of a killer, means another life lost.
This is the stark reality of trauma surgery in a land of scarce resources. The ratio of public doctors to patients can be as low as 3 for every 100,000 in the South African health system.11 Such state medics care for about 85 per cent of the nation’s trauma cases and these men and women in white clearly don’t have enough resources to cope.
The gun has hardened her, she said. No longer does she want to be told about the background of her patients. ‘I am not interested in knowing anything more than that they were shot. I don’t need to know that one guy, a guy we’ve spent a long time helping and given lots of resources to, that he then brags about how many women he has raped. That’s too hard to hear. I don’t want to know, because, you know, lots of them have raped and killed.’
Her voice slipped a little in the white room. I noticed an edge of anger. I suspected that she, her heart so full of care, couldn’t comprehend how others did not feel the same desire to change matters, to help. But the thing she found the hardest was that those whose lives were marked by violence – the gangsters, the young thugs – often survived the terrible wounds caused by guns. It was the passer-by – the innocent caught in the crossfire who never expected this – who died with a look of surprise on their face, unprepared for the sudden descent. That bothered her.
She had seen a change in her personality. Now she is more clinical, dispassionate. ‘Don’t come and cry on me.’ This was what this brave doctor said to people. And she looked a little guilty at what this had done to her relationship with her patient boyfriend, an engineer and a man who never had to hold a dying teenager or an infant with a gaping gun wound in his back. Other things slip, too. After days of bloody surgery, everyday chores like tax forms and bill payments and driving licence renewals just fade out. Death captures her attention like a demanding child.
‘There are days when nothing happens. Then a whole number of gun-trauma victims come in at the same time. It’s 0 per cent to 100 per cent. In those days when nothing is happening, you pace the corridors; you get bored. You find yourself only functioning when something happens – when you are on adrenaline,’ she said.
She had been soaked in blood, head to toe, several times in the last year alone. So I asked her about HIV in this land where about 10 per cent of the population are infected, and her answer was as brutally logical as her other answers. She didn’t think about it – she took the necessary precautions with double gloves and all the rest. But it’s not possible to avoid blood. If there was cause for concern, she would take antiretroviral drugs and to hell with it.
‘They aren’t good. They make you tired, give you diarrhoea. You vomit. So you ask yourself – what are the chances of getting an infection? You treat all patients with caution but you can’t discriminate.’
Blood was nothing to her. But, then again, she couldn’t watch horror films. She