WHAT BULLETS DO TO BODIES

The gun debate would change in an instant if Americans witnessed the horrors that trauma surgeons confront every day.
PHOTOGRAPHS BY
FINLAY MACKAY

1
The first thing Dr. Amy Goldberg told me is that this article would be pointless. She said this on a phone call last summer, well before the election, before a tangible sensation that facts were futile became a broader American phenomenon. I was interested in Goldberg because she has spent 30 years as a trauma surgeon, almost all of that at the same hospital, Temple University Hospital in North Philadelphia, which treats more gunshot victims than any other in the state and is located in what was, according to one analysis, the deadliest of the 10 largest cities in the country until last year, with a homicide rate of 17.8 murders per 100,000 residents in 2015.
Over my years of reporting here, I had heard stories about Temple’s trauma team. A city prosecutor who handled shooting investigations once told me that the surgeons were able to piece people back together after the most horrific acts of violence. People went into the hospital damaged beyond belief and came walking out.
That stuck with me. I wondered what surgeons know about gun violence that the rest of us don’t. We are inundated with news about shootings. Fourteen dead in San Bernardino, six in Michigan, 11 over one weekend in Chicago. We get names, places, anguished Facebook posts, wonky articles full of statistics on crime rates and risk, Twitter arguments about the Second Amendment—everything except the blood, the pictures of bodies torn by bullets. That part is concealed, sanitized. More than 30,000 people die of gunshot wounds each year in America, around 75,000 more are injured, and we have no visceral sense of what physically happens inside a person when he’s shot. Goldberg does.

Even though Amy Goldberg has been treating gun patients for 30 years, the sense of horror has never completely gone away. On the cover: A bullet she keeps in her office. She pulled it out of a patient's heart during her residency.
She is the chair of Temple’s Department of Surgery, one of only 16 women in America to hold that position at a hospital. In my initial conversation with her, which took place shortly after the mass shooting in Orlando, where 49 people were killed and 53 injured by a man who walked into a gay nightclub with a semi-automatic rifle and a Glock handgun, she was joined by Scott Charles, the hospital’s trauma outreach coordinator and Goldberg’s longtime friend. Goldberg has a southeastern Pennsylvania accent that at low volume makes her sound like a sweet South Philly grandmother and at higher volume becomes a razor. I asked her what changes in gun violence she had seen in her 30 years. She said not many. When she first arrived at Temple in 1987 to start her residency, “It was so obvious to me then that there was something so wrong.” Since then, the types of firearms have evolved. The surgeons used to see .22-caliber bullets from little handguns, Saturday night specials, whereas now they see .40-caliber and 9 mm bullets. Charles said they get the occasional victim of a long gun, such as an AR-15 or an AK-47, “but what’s remarkable is how common handguns are.”
Goldberg jumped in. “As a country,” Goldberg said, “we lost our teachable moment.” She started talking about the 2012 murder of 20 schoolchildren and six adults at Sandy Hook Elementary School. Goldberg said that if people had been shown the autopsy photos of the kids, the gun debate would have been transformed. “The fact that not a single one of those kids was able to be transported to a hospital, tells me that they were not just dead, but really really really really dead. Ten-year-old kids, riddled with bullets, dead as doornails.” Her voice rose. She said people have to confront the physical reality of gun violence without the polite filters. “The country won’t be ready for it, but that’s what needs to happen. That’s the only chance at all for this to ever be reversed.”
She dropped back into a softer register. “Nobody gives two shits about the black people in North Philadelphia if nobody gives two craps about the white kids in Sandy Hook. … I thought white little kids getting shot would make people care. Nope. They didn’t care. Anderson Cooper was up there. They set up shop. And then the public outrage fades.”
Goldberg apologized and said she wasn’t trying to stop me from writing a story. She just didn’t expect it to change anything.