EP. 130: FROM GUNSHOT SURVIVOR TO TRAUMA SURGEON

WITH JOSEPH SAKRAN

Sep 18

WITH JOSEPH SAKRAN, MD, MPH

A trauma surgeon and gun violence prevention advocate discusses how a harrowing incident when he was shot in the throat as a teenager has subsequently shaped his values on life and his approach to treating victims of firearm injury.

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Episode Summary

Joseph Sakran, MD, MPH was a teenager in a small town in Virginia when, in 1994, his life took a dramatic turn. At the age of 17, he was out with his friends after a high school football game when a nearby gunfight broke out and he was struck by a stray bullet in the throat. The bullet, tearing through his windpipe and a carotid artery, brought him to the razor edge of death before he was saved by trauma surgeons.

Thirty years later, Dr. Sakran is now a trauma surgeon who serves as Director of Emergency General Surgery at the Johns Hopkins Hospital in Baltimore and a vocal advocate of reducing firearm injury through public health initiatives at the state and national levels. Following the 2018 comment by the National Rifle Association that doctors should “stay in their lane” with regard to gun violence prevention, Dr. Sakran started the #ThisIsOurLane movement, mobilizing thousands of health care professionals to advocate for gun violence as a public health crisis.

Over the course of our conversation, Dr. Sakran shares his harrowing experience of being shot and what it was like to be confronted with imminent death, how his perspectives on and priorities in life changed after the incident, what goes on in his mind when he operates on victims of gun violence, how he connects with his patients over shared experiences of trauma, how all clinicians can be more empathetic with their patients, and why advocacy is integral to the work of a physician.

Joseph V. Sakran, MD , MPH is a trauma surgeon, coalition builder, policy advisor, public health expert, and nationally recognized advocate for gun violence prevention. He is currently Director of Emergency General Surgery, Associate Professor of Surgery, and Associate Chief of the Division of Acute Care Surgery at The Johns Hopkins Hospital in Baltimore, Maryland.
A survivor of gun violence himself, Dr. Sakran’s interest in medicine and trauma surgery began after a stray bullet nearly killed him during his senior year of high school. He has subsequently dedicated his life to treating the most vulnerable, reducing health disparities among marginalized populations, and advancing public policy that alleviates structural violence in low-income communities.
Dr. Sakran has been recognized for his public health expertise, specifically on firearm injury prevention. He has been honored by the Agency for Healthcare Research and Quality (AHRQ) and Academy Health, and he is a 2020 recipient of Johns Hopkins’ Catalyst Award for pioneering research on physicians’ role in educating patients on safe gun storage.
Dr. Sakran makes frequent appearances in print and on television and he has also testified multiple times in front of Congress on gun violence prevention. He is an active leader in the medical and gun violence prevention communities. He serves on the governing council of the Young Fellows Association of the American College of Surgeons (ACS), and he is vice-chair of ACS’s International Subcommittee for Operation Giving Back. He served on the board of The Brady Campaign from 2018-2019 and frequently collaborates with other gun violence prevention organizations.
In this episode, you will hear about:
• 2:46 - How a personal tragedy set Dr. Sakran on the path to becoming a trauma surgeon
• 9:51 - How Dr. Sakran’s perspective on life was altered by his personal experience with gun violence
• 13:11 - How Dr. Sakran’s experiences informs his approach to speaking with patients and their loved ones during traumatic situations
• 19:09 - The importance of showing empathy to build rapport with patients and families
• 23:51 - What it is like to tend to victims of violence
• 29:26 - Addressing the public health crisis of gun violence in America
• 37:41 - How clinicians can become more involved in advocacy
• 45:32 - Dr. Sakran’s advice to future clinicians
Henry Bair: [00:00:01] Hi, I'm Henry Bair.
Tyler Johnson: [00:00:02] And I'm Tyler Johnson.
Henry Bair: [00:00:04] And you're listening to The Doctor's Art, a podcast that explores meaning in medicine. Throughout our medical training and career, we have pondered what makes medicine meaningful. Can a stronger understanding of this meaning create better doctors? How can we build healthcare institutions that nurture the doctor patient connection? What can we learn about the human condition from accompanying our patients in times of suffering?
Tyler Johnson: [00:00:27] In seeking answers to these questions, we meet with deep thinkers working across healthcare, from doctors and nurses to patients and healthcare executives those who have collected a career's worth of hard earned wisdom probing the moral heart that beats at the core of medicine. We will hear stories that are by turns heartbreaking, amusing, inspiring, challenging, and enlightening. We welcome anyone curious about why doctors do what they do. Join us as we think out loud about what illness and healing can teach us about some of life's biggest questions.
Henry Bair: [00:01:02] Dr. Joseph Sakran was a teenager in a small town in Virginia when, in 1994, his life took a dramatic turn. At the age of 17, he was hanging out with his friends after a high school football game when a nearby gunfight broke out and he was struck by a stray bullet in the throat. The bullet, tearing through his windpipe and a carotid artery brought him to the razor edge of death before he was saved by trauma surgeons. 30 years later, Dr. Sakran is now a trauma surgeon himself who serves as director of emergency general surgery at the Johns Hopkins Hospital in Baltimore and a vocal advocate of reducing firearm injury through public health initiatives at the state and national levels. Following the 2018 comment by the National Rifle Association that doctors should, quote, stay in their lane with regard to gun violence prevention, and Dr. Sakran started the hashtag #thisisourlane movement, mobilizing thousands of health care professionals to advocate for gun violence as a public health crisis. Over the course of our conversation, Dr. Sakran shares his harrowing experience of being shot and what it was like to be confronted with imminent death, how his perspectives on and priorities in life changed after the incident, what goes on in his mind when he operates on victims of gun violence, how he connects with his patients over shared experiences of trauma, how all clinicians can be more empathetic with their patients, and why advocacy is integral to the work of a physician. Joe, thank you for taking the time to join us and welcome to the show.
Dr. Joseph Sakran: [00:02:43] Thanks so much for having me. Excited to be here with you both. So I have.
Tyler Johnson: [00:02:46] To say, we almost always start by asking some version of, how did you end up in the field that you were going into? And usually those stories are, you know, sort of a walk in the woods. Or my dad told me this story when I was little or, you know, whatever. But with all due respect to all the other people who we've had answered that question, I gather from what I've read that you will be the one of the higher drama entries into this particular question category. So do you want to tell us how did you end up becoming a drama surgeon?
Dr. Joseph Sakran: [00:03:16] My fiance will love hearing you say that because she just literally called me the chief drama King. But no. Look, um, yes. Like, you know, I have, I think, a story that's unique to what's driven me down this path and this profession of medicine. But I also will say that I think each and every one of us have a story that kind of has helped shape our narrative. And my story really, you know, begins as someone who is the son of immigrants who, you know, essentially was raised by parents who came to this country with very little, but who understood that one of the most important things that they could do for their kids is ensure that they had a top notch education. And that was, you know, something that they, you know, always focused on as we were growing up. I think what no one ever imagined, including myself, is at the age of 17, our lives would completely change because I went from being this healthy high school senior to collateral damage after I was nearly killed, when I was shot in the throat with a 38 caliber bullet. And I think that, you know, when something like that happens at such a young age, you know, a lot of us at that age, we have no idea what we want to do in life. We don't realize that we're mortal. We may not even appreciate the people that we have around us. And so it allowed me to grow up very quickly because I was so, you know, grateful to have this second chance at life. And, Tyler, to your question, that was the inspiration that drove me down the path of medicine. It was the inspiration that then led me to become a trauma surgeon. And it's the inspiration that has continued to push me to really kind of try to work at this intersection of medicine, public health and public policy.
Tyler Johnson: [00:05:32] Well, I want to ask two questions coming off of that answer. So the first one is just because it's such a such an unusual thing. Can you tell us what is that experience like of having a thing happen to you that because as I understand from from reading, I've done right. I think it severed one of your major arteries. The bullet severed one of your major arteries. And also, I think, severed your your throat, your windpipe. Right. Which is just to say that to your point, you went from happy, healthy 17 year old, I think I read attending a football game, whatever. And now all of a sudden, our, you know, moments or inches or however you like to put it away from death. What was it first like in the moment? And then secondly, what was it like afterwards as a 17 year old, to all of a sudden not just be aware of your mortality, but be aware that you were, you know, potentially seconds or, you know, just a lack of the appropriate surgeons away from dying.
Dr. Joseph Sakran: [00:06:37] Yeah. I mean, it's absolutely terrifying. You know, when the incident happened, it's like everything turned into slow motion. And I could see the flashes and I knew something bad had happened, but I was like, completely numb. And I didn't exactly know at that moment what that was. And I happened to be wearing all white that night, and I could just see blood everywhere. And as I walked to the curb, uh, you know, my friends tried to lie me down on the, on the sidewalk, but I was choking on blood. And as they sat me up with every breath, there was a spurt of blood that was coming out of, you know, the front of my throat because I had a ruptured windpipe. I had, as you point out, an injury to my left carotid artery. I also had an injury to my left vocal cord, which is why I have a raspy voice. I have a paralyzed left vocal cord. And, you know, I was fortunate enough, right, to be in a place where I had timely access to high quality care. I was taken to Inova Fairfax Hospital, where doctor Bob Ahmed was the trauma surgeon, and I ended up needing a whole variety of subspecialists, including Doctor De Mukherji, who was the vascular surgeon that repaired my carotid artery, and Doctor Timothy McBride, the otolaryngologist that repaired my my windpipe. And you can perhaps, you know, imagine how scary it must be for this 17 year old to show up, not really know what's going on to see, you know, now what I of course understand as a trauma surgeon, a whole slew of providers and clinicians that are standing around gowned up, not knowing whether you're going to live or die.
Dr. Joseph Sakran: [00:08:22] And, you know, I always tell this part of the story. I remember the resident and the emergency department attending arguing about what they should do. And one of them saying, well, I'm not going to be responsible if we lose him. You can imagine, like, all these things happening. And it was at a time, right? This is September 23rd, 1994. There was a time when trauma surgeons, at least at Fairfax, were not in-house. So, you know, Doctor Ahmed was on his way in. And when he came in and he saw all the chaos of what was going on, you know, he said to them, you know, and excuse my language, but he said, what in the fuck are you all doing? And he unlocked the gurney and he wheeled me to the operating room. And at that point, I'll never forget this. He looked down at me. He says, Joe, he says, I have to do this to save your life. And they did an emergency, you know, tracheostomy tube on me to secure my airway. And, you know, of course, I passed out shortly after that. But it was one of those terrifying moments, you know, it's just really hard to kind of completely internalize. And, you know, even after I woke up, I think, you know, your mind is still trying to process, like, wait, did this actually happen. And, and so there's I think a lot of unknown answers, a lot of questions that kind of come out of all this.
Henry Bair: [00:09:51] You mentioned earlier that this was a pivotal, transformative moment, as we can sort of imagine so young suddenly being faced with your mortality. I'm wondering if you can share some specific ways in which the way that you viewed life, certain aspects of life was changed before versus after?
Dr. Joseph Sakran: [00:10:12] Yeah. I mean, I think I was kind of like most 17 year olds, you know, there's a Brad Paisley song that I always think about that says, you know, it's hard to see past Friday night. And I think, you know, what does that tell you? Right. It's like you're kind of living in the moment, right? You're living day by day, you know, you're, you know, seeing you you're having, you know, living your best life, so to speak. And I think I was very much like that. You know, it's not that, of course, I didn't have aspirations of a future, but did I know exactly what I wanted to do before then. No. Probably not, you know. Did I know I wanted to go to college? Yes. But, like, I didn't know what that looked like. And, you know, I was having a good time and also realizing that, like, I got parents, thankfully, that are making sure that, you know, I'm, you know, getting the grades and, you know, actually that night that I got shot was my first S.A.T. prep class. So I had parents, you know, that were understood that, like, they had to, like, you know, be on top of, you know, this young kid, not just me, but even our siblings to make sure that they were doing all the right things at a moment in time when you know you're not necessarily always thinking about that, you're thinking about hanging out with your friends and partying and, you know, going out with girls and whatever, whatever it is. Right? Like, you know, those are the things I think were for me were very typical.
Dr. Joseph Sakran: [00:11:31] And then, you know, you go from being carefree to waking up in an ICU with a tracheostomy tube with, you know, beet red scars up and down my neck staples and being on a ventilator initially and looking around and seeing your family, you know, and seeing how devastated they were as well. You know, we always think about the person that is injured that's, you know, most impacted. And they are, but it's also the families that are impacted. It's the communities. Right. And you know, I got to see that firsthand. And I think it made me realize, Henry, that I was, for whatever reason, given the second chance. And I mean, I didn't realize it back then, but I see it now where I take care of people that are shot in the throat and some of them are paralyzed, some of them die, you know, some of them stroke out. None of those things happen to me. Yes, I have sequela from my injuries, but I also am very lucky to be able to live the life that I live. And I think was, you know, at that moment, really kind of committed to ensuring that my life didn't go to waste. And I think you sometimes, while you might not realize it in the moment, I look back at it now and I think, okay, the worst moment of my life was also the most impactful because it led me to do all the things that I've been doing.
Tyler Johnson: [00:13:11] You know, when I hear you talking about that. So one observation and then a question. I mean, I am a medical oncologist. I haven't been dwelling in any detail in the anatomy of the neck for many years, but nonetheless, it's just terrifying to me to think of a bullet in that area because as you alluded to this briefly previously. Right. But there is just like the real estate. They're short of getting shot in the head, or maybe in the center of the chest. There's arguably no other area of the body where the real estate is so tightly packed and so valuable. Right. The spinal cord is right there. The carotid artery is right there. The windpipe is right there. I mean, it's like, you know, and all of that stuff is in, whatever, 5 or 6in across, right? And in particular, the idea of having a partial tear or whatever it was to the carotid artery. Right. For those who are maybe early in their in, you know, who are pre-med or whatever, who are listening to the program, that's like basically the highway through which pretty much not quite, but pretty close to all of the blood from the heart gets to the brain and everything else in the head. Right. So and yes, you have two of them, but if you get rid of one of them, I mean, then all of a sudden you have just half of your brain that all of a sudden is not getting blood or is just getting watershed from the other side, right? Anyway, which is just to say that I can't imagine.
Tyler Johnson: [00:14:31] Obviously you had no real idea. I'm sure of any of that at the time. Right. In terms of the details of what might be going on, but still, I mean, even more, I guess to me, for what the job that you do right now, having to confront the possibility of that kind of a problem and like the surgeon had in your case, where it has to be fixed right now or it's not going to be fixed at all, is just a staggering idea to me. That's thing number one. But thing number two, which is the question that I want to ask, is given that experience, and given that it sounds like your life was basically like perched on the edge of a knife and could have fallen in either direction, right? You could have been saved or you could have died, given that you yourself have been through that. How does that impact the way that you talk? Yes, to patients, but maybe even more so to the family members of the patients for whom you care now, because what about the 17 year olds where it falls the other direction and they are paralyzed or they bleed out or, you know, whatever the thing is, but they die or they're paralyzed or what have you. With such a heavy history yourself, how do you approach talking, especially maybe to the loved ones of the people who now are your patients in similar scenarios?
Dr. Joseph Sakran: [00:15:45] Yeah, I think it's a good question. I mean, I think trauma surgery, right, is a field where the stakes are incredibly high, right? And the challenges are immense. And you're often dealing with life and death situations where decisions, you know, need to be made in seconds. Right. And I think that the emotional toll can be significant, especially when the outcomes are not what you hope for. But sometimes the rewards can be equally profound. You know, saving a life, helping someone regain their health, seeing the resilience of patients and families right is incredibly fulfilling. And I think one of the things that I would say in response to your question is that every day in this role is a reminder of the fragility of life and the privilege it is to be entrusted with someone's care. And that's why I think it's one of the best professions. Like to think about someone that you don't even know, that is, putting their life in your hands. And talking to the families is one of the hardest things that I think I have to do, especially when the outcomes are not, you know, what you want them to be, and having to explain to a mother or father that their child that left that morning is never coming home again is the worst part of my job. But I have to do it right, and I have to disconnect the emotional aspect of what I have to do as a clinician to be able to get them to understand, and it's not easy. I think where my personal experience really plays an even more kind of profound role is in the patients that survive.
Dr. Joseph Sakran: [00:17:35] You know, I work at Johns Hopkins in East Baltimore. You know, most of the patients that I take care of don't look like me. And so a lot of times, the patients will look at me and they'll say, what does this guy know about being shot? And what's interesting is, you know, with the internet and, you know, social media, most patients look their doctor up. And what I can tell you is after they look me up and they see my story and see that I'm also a survivor, the rapport builds immediately. It is unbelievable because I go from being this guy wearing a white coat to someone that actually understands what they've been through. And I think, you know, specific to your question as it relates to the families, you know, maybe not in the acute kind of setting where they're trying to process what happened. But as you know, I continue to take care of them over the hospital course. A lot of these stories kind of come out, and I will sometimes, depending upon the scenario, share some of these with families to kind of, you know, let them know, like, hey, like I understand what you're going through. We're here for you. You know, this is not easy. And it's part of I think, you know, my ability not just to have the skills to treat the physical injuries, but also kind of the biopsychosocial impact of violence that we are seeing in cities like Baltimore.
Henry Bair: [00:19:09] Honestly, I don't know that many trauma surgeons, and maybe it's partly stereotyping, but I don't normally think of trauma surgeons as clinicians who focus so much on connecting with patients in the long term and trying to understand and empathize with the psycho and social dimensions of whatever is happening. So it's really fascinating to hear you say that. I'm curious to know, I mean, because truth be told, most physicians, I think I think most physicians haven't gone through the exact thing that they're treating their patients for. You know, I hope not. You know, but in reflection, are there things you can think of, ways that you talk to patients, a presence that you bring into those conversations that you feel like are valuable for building the kind of rapport even, you know, even for for clinicians who don't share the same situations as their patients.
Dr. Joseph Sakran: [00:20:09] Well, first of all, I'm going to I'm going to comment on your initial kind of framing of trauma surgeons or just maybe even surgeons in general. I think, you know, maybe historically and traditionally, you are correct. Like, you know, surgeons have not always been maybe known to be, you know, lovey dovey and like, you know, into thinking about, you know, beyond kind of coming down with the cold steel and focusing on maybe some of the both mental and emotional aspects of care. But I think also like medicine has changed a lot. And we understand, you know, there's less stigma on on mental health and there's less stigma on kind of really, truly understanding that it's more than just kind of the flesh wounds. Right? It's so much broader than that that impact our patients. And being able to provide, you know, trauma informed care in a way that is thoughtful is so important. But back to your question. You know, you're you're correct, right? Like, not everyone, you know, thankfully is going to have the experience that I had. And so how do you connect? How do you relate? I think part of it is trying to as much as possible. Have empathy. And I say that word specifically because that's very different than sympathy, right? Empathy, as I think probably, you know, you both know and and your listeners know is right.
Dr. Joseph Sakran: [00:21:35] Trying to put yourself in the shoes of that person. And I think if you truly try to do that right, you may not be able to 100% appreciate what they're experiencing. But I think it gives us a little bit of like, I think a different take where, you know, a lot of these people that are being injured, there's a lot of social and political determinants of health that exist that, you know, result in some of these potentially high risk behaviors that lead to a lot of the structural violence that we're seeing and understanding that, like, you know, it's not always easy for everyone to get a job or to ensure that there's food on the table or to figure out transportation to work. Being able to really empathize with our patients, whether it's in this scenario or many of the other kind of scenarios, I think is so critical. And I think a lot of times, you know, the other thing that is so important is really trying to listen with, you know, as Stephen Covey says, with the intent to understand. And I think that's important because a lot of times patients just want, you know, to bend someone's ear and they can always tell, you know, if you're the clinician, one hand on the door, ready to get out.
Dr. Joseph Sakran: [00:22:55] You know what happens when you do that. They just start asking more questions because they're nervous. Like, right. Like, oh, they're going to leave. What if I forget a question versus like, you know, truly like, you know, taking the time to understand and to connect with the person that is sitting or lying down in front of you. And I'm not saying, like, you know, I'll be the first to say, like, I don't always do it perfectly right. None of us do. And, you know, there's different scenarios that, you know, lend to, you know, the ability to kind of continue to learn from our experiences. But those, I think are some of the things, Henry, that I think are important. And then it's not just about the physician. Right. There's, you know, nurses or like in the violence work that we do, there's, you know, the hospital violence intervention programs, right, that help bring in people from the community to kind of connect with patients. So there's a lot of ways to do that where the burden is just not on the shoulders of any one individual.
Tyler Johnson: [00:23:51] So you alluded to this very briefly. I think you are one of the first, at least doctors. We've spoken recently with a couple of people who work in, like psychologists who work with trauma therapy and some sort of connected fields. But I think that you are maybe the first person, at least, who we have had any sort of an extended discussion with About specifically taking care of patients who are suffering not just from illness, but from the effects of violence. Right. And I have to imagine, and not always violence. Right. You also take care of patients who are in car crashes and other things. But but even then, even if you don't want to call that violence, but that's still often trauma involves another person having done something, whether it was inadvertent or purposeful. Right. I just have to imagine, for example, if you are, whether it's talking to a patient or whether it's talking to a patient's family members, that it just has to land differently. Like I think of myself, right? I'm a medical oncologist and so I deliver lots of bad news, right? That's one of the things that I do a lot in my job. But there's always kind of this understanding that cancer is this sort of, you know, the bad guy, so to speak, and that cancer arises from natural biological causes and that we wish we could prevent it. But we haven't figured out how yet. And there's this kind of a, you know, it's nobody's fault. It just is. Right. It's just sort of part of of being human. But I have to imagine that it lands differently if the paralysis comes because somebody else fired a gun at you, or even if the, you know, death comes because somebody ran a red light or somebody was driving while under the influence of alcohol or, you know, there was a fight or whatever. The thing is, can you just talk a little bit about what it is like to often be taking care of patients whose injuries and in some, in some cases, deaths or long term disabilities come because of another person's actions.
Dr. Joseph Sakran: [00:26:04] Yeah. I mean, it's simply put, it's tragic. You know, we are in America right? Facing this, you know what I call this uniquely American public health crisis. And you know, when you think about violence and specifically gun violence, right? Healthcare professionals are on the front lines of taking care of these patients. Were witnessing the devastating effects, right, that it has firsthand. And as such, we have this kind of unique, I think, peek behind the curtains and ability to play a I think a vital role in this conversation. I mean, if you think for a second, Tyler, who are the people, right, in America that are witness to the type of carnage that we see? It's the children that are in the schools that Are lucky enough to survive. You know, these terrible tragedies that we're seeing. It's the parents that have to identify the children, some of which are unidentifiable, as we saw in Uvalde. Right. And it's the front line workers, the medical examiners, law enforcement and clinicians like us who take care of these patients. And so we are absolutely, I think, devastated by having to see this happen day in and day out. That's the thing is, like, this is not a random one time thing. We often hear about the mass shootings. Right. But that comprises less than 2% of, you know, the overall public health problem that we're facing.
Dr. Joseph Sakran: [00:27:58] And every day in cities like Baltimore and Chicago and Philadelphia, you know, we are witnessing the slaughter of young brown and black men, right? We have mothers that are pregnant that are shot and killed. We have politicians, right? There's numerous examples that are shot. We just saw that potential assassination attempt right on the former president. So no one is immune. And to be able to really, I think, have to explain to a family that their loved one is never coming home again. Every time I do that, a piece of me dies. And how can you justify it? Right? And how can we just, you know, sit back and be okay with the status quo? I think Americans have become desensitized. I hear people massacre happens. They say, oh, another shooting, you know, that's where we've gone. And that's why every day we kind of, you know, the folks that are working on this issue day in and day out, are trying to do everything we can to tackle this public health problem. And there's no one solution, right? It requires a really robust, multifaceted approach to be able to tackle this issue in a way that's comprehensive. And I think that gets to the complexity of it.
Henry Bair: [00:29:26] What's really interesting is that I think regardless, I believe regardless of where one stands on the political spectrum, I think people recognize mass shootings, gun violence as a problem. I don't think anyone says that's okay. Let's keep it going as is. I think it's more so just people have drastically different solutions or drastically different ideas about the root causes of this kind of violence. You are an advocate for reducing these kinds of tragedies from happening. I'm wondering if you could just give us an overview of, in your mind, what would make the most sense in curbing this problem?
Dr. Joseph Sakran: [00:30:07] Well, I think just to kind of build off what I was saying, I think, you know, reducing gun violence requires a multifaceted approach. You know, there are public health strategies that have proven effective that include, you know, community based interventions such as violence interruption programs, which, you know, help address, of course, some of the root causes of violence. And I think additionally, right, like, you know, we always talk about the different policies, like expansion of the universal background checks, you know, safe storage laws that we talk about, extreme risk protection orders, right, that can help prevent guns from falling into the wrong hands. And education and outreach are also critical, right. Helping people understand the risks and promoting a culture of responsible gun ownership is so critical. Ultimately, it's about creating a safer environment for everyone. And people sometimes make it like, oh, you know, they're trying to take away the guns. That's not it at all. What we advocate for is for responsible gun ownership. And that's one of the things that we've always been advocating for. I'm the chair of the board for Brady and their chief medical officer. When we talk about this, you know, our motto is taking action, not sides.
Dr. Joseph Sakran: [00:31:26] And it's really about like, you know, ensuring that we are implementing and incorporating these safe practices across communities and across the nation. And I think, you know, just to build a little bit off, you know, what we saw just in this past couple of months where the Surgeon general, you know, released a report declaring that gun violence is a public health crisis. I think that was a very important report, one that we've been pushing for for a long time. And I think that continues to kind of peel back the layers for Americans to make people understand that depending upon the type of violence you're talking about, the solution may be different. Right. So if you're talking about suicide, which, you know, suicide is a violent act against one's self, or you're talking about intimate partner violence or you're talking about, you know, unintentional shootings at the home. Right. All of those. Right. Are part of this complex problem. And they all may require different solutions to be able to reduce that type of violence that we're seeing.
Tyler Johnson: [00:32:41] Yeah. You know, I have to say that I maybe this is my biases as a doctor coming through, I guess. But it has always struck me as puzzling and concerning. I mean, I sort of agree with Henry's point that, I mean, I'm sure that yes, if you just say, are mass shootings a problem, everyone will respond. Yes. Right. But it does also seem like we were talking with someone yesterday who pointed out that I think they said something like to govern is to choose. And I get that every potential gun policy, you know, requires choosing between things. Right. And so maybe you're choosing between giving a maximum amount of freedom to have firearms or whatever, versus reducing gun deaths, right, or reducing the deaths of especially children who are unarmed, those kinds of things. But it has always struck me as puzzling and concerning that there would even be anything on the other side of the ledger across from preventing violence, especially against children, that people would find to be morally compelling. Right. Like and I and I'm not even the surgeon who is in there taking care of them when the terrible things happen. I just have to imagine that it just everything else just seems like foam or something. Once you've taken care of even one such child.
Dr. Joseph Sakran: [00:33:57] Yeah. I mean, look, the leading cause of death in children and adolescents is gun violence. It's not cancer. It's not motor vehicle crashes. It's not poisoning. It's gun related injury. So I can't accept the idea that we're going to choose guns over our children. Like, that's just unacceptable to me.
Tyler Johnson: [00:34:19] So I am curious, though, you know, I've wandered into forays about this on social media occasionally. I don't really do much social media anymore. But, you know, in the era where Facebook was a place where people had really substantive discussions about things, I used to have substantive discussions, and this was one of those things where to the point that you just made the point felt so obvious to me that I almost didn't know how to argue it. Right? Because, like, I mean, like what? It's just sort of like children are dying and there are too many guns, and we need to change the fact that there and, and you know, you can put up the statistics about the number of deaths by gun violence in the United States versus virtually any other country in the world, and it's just not even close, right? And then the other thing that is also not even close is the number of guns per capita. But I guess I'm just wondering, as a person who is you mentioned your work with the Brady Campaign and other things, who is well versed in public policy. How do you make that argument in the face of a setting where it seems hard to me, almost to know how to even articulate an argument over something that just seems so obviously morally compelling?
Dr. Joseph Sakran: [00:35:29] Yeah, exactly. It is morally compelling. And this is why it blows my mind to see people that are elected and that are in office that make those type of decisions, especially, by the way, when the majority of Americans, including Republicans, including responsible gun owners, are in support of a lot of the common sense policies and programs that we talk about. And I think part of it, frankly, comes down to the way campaigns in America are run and the type of money that infiltrates these campaigns that I think, you know, get people to make decisions that are not always, you know, I think, in the best interest of their constituents. Sarah Brady used to say, if you can't change the law, change the lawmaker. And that's why, you know, healthcare professionals have been, you know, trying to have, I think, a voice beyond the bedside, as I call it. And I think that's that's so important. You know, we weren't necessarily trained to be in the policy realm or, you know, to delve our foot into politics, but we're part of the fabric of our communities. Right. And we have, I think, both the opportunity and the responsibility to use our voice as trusted, you know, health professionals to make people right. Leaders, policymakers and others understand what we are witnessing on the front lines. And I'm not saying everyone has to do it, but I think that there's a good portion of us, especially the next generation of healthcare leaders in America, that are interested in not just being competent clinicians, but also using their voice in a way that can impact populations and is scalable in a very kind of what I would say currently nontraditional manner.
Henry Bair: [00:37:41] I remember in 2018, the Annals of Internal Medicine published this research paper about the effects of gun violence, framing it as a public health issue, and then, of course, calling on Congress to allocate more funding for gun violence research, which I believe they aren't allowed to do, or at least there's like a like a cap to it. And of course, there was a lot of pushback from the NRA against the medical community because lots of doctors came out in support of that. I'm wondering what are the ways that clinicians can become more involved?
Dr. Joseph Sakran: [00:38:14] Yeah. Well, look, you know, I think when when that happened in 2018, you know, a lot of us were incensed because the audacity of an organization to come after the people that are actually taking care of the patients, the people that are talking to the families. Right. It's just ridiculous. And for any organization or frankly, individual to think that we're not part of the solution, they either don't understand the problem and the complexity of it, or they're not interested in actually moving the needle forward. I think there's a lot of different ways to be, you know, involved. I think my advice is always start in your own community and see who's doing the work that you want to do. It's not necessarily even about gun violence, right? Something that you may be interested in. There are people you know in your surrounding community that are doing a lot of this work. You have to be persistent. I think, you know, advocacy doesn't necessarily always have to mean leading a movement. It can be as simple as educating your patients or joining a professional organization that aligns with your values. I think, you know, you have to find an issue you're passionate about and look for ways to contribute and remember that your voice matters. As clinicians, we are trusted figures in society, and we have the power to influence change. We have to not be afraid to use that power to advocate for what we believe in. And I say that, and it might be an easy statement, but it's not always so easy, right? We've seen, you know, clinicians fired, you know, for statements that they have made. Right. We saw that during Covid. And and so it's not always easy. And sometimes there's serious repercussions. And I think that times are changing where people are starting to realize, like, yes, healthcare professionals are trained to provide competent care, but they have a potentially broader role.
Dr. Joseph Sakran: [00:40:06] And I think part of that is understanding how to communicate the data and science, because, you know, the data and science is critical. But as I always say, the data and science doesn't change the hearts and minds of people being able to understand how you tell those stories and how you communicate that message is so critical. You know, Marshall Ganz, who was when I was at the Kennedy School, a professor there, is probably the world leader in public narrative. He talks about going from value to action. And he says in order to go from value to action, right. Value is your purpose. It's done through emotion, meaning, you know, being able to tell that story to kind of really make people understand and get people to believe in what you believe in. And being able to tell that story effectively is much more powerful than coming out and telling people, oh, 40,000 people die a year of gun violence. And so those are like, you know, the things that if I was starting out, I would be thinking about, right? And it's not to downplay the importance of being, you know, I'm a very active clinician. I do elective general surgery, robotics, you know, emergency general surgery. So I'm very active as a clinician. But I also understand the power of my own story and each and every one of us, like we started off in the beginning talking, right, Tyler, we have a story to tell. And sometimes it takes time to figure out what that story is. And how do you package it up to make people understand why you're doing the work that you're doing?
Tyler Johnson: [00:41:41] Well, and I think the other thing that I have realized over time that that has really impacted my life is that there's this funny phenomenon that happens, I think, sometime in the third year of medical school, to some degree, and then especially during your residency fellowship, whatever your training is, which is that you become so accustomed to swimming in the waters of the hospital, and you are so constantly surrounded by other people who are swimming in those same waters, that you come to feel like everybody knows what it's like to be working with patients who are really sick or potentially dying or who have, you know, terminal cancer or who have terrible gunshot wounds or whatever the thing is. Right. And the stories that you see that you live every day become so commonplace to you that you forget that they are remarkable to most people and in fact, that most people otherwise have no exposure to them. Like most people, if you say, oh, a child suffered a gunshot wound. That's an abstraction, right? It's like a statistic. It's a number. But when you think about a child who has suffered from a gunshot wound, you have a thousand indelible images. I'm sure that flash across your brain of lives that have actually been brought up short or that have been altered in terrible and irreversible ways.
Tyler Johnson: [00:43:07] And so, for you, that moral compulsion to do something I would imagine can hardly help but be there, because behind your your moral force to act are those strong emotions that you were talking about. But all of that is to say that if you're just kind of sitting on your couch reading in the paper or whatever, and you read about the NRA said this, and this group of doctors said that, and it just sounds like one abstraction versus another abstraction. That's not very compelling. But when doctors share the stories that really only doctors are privy to. Then it makes it clear that what the NRA is talking about actually is an abstraction, if that. Whereas what doctors are talking about are actual human lives that are being interrupted and sometimes ended because of the promiscuous sale of guns of every type to anybody who wants them, no matter how many they want or in what form or how often or whatever else. And I think that that's just to say that I feel like doctors almost have a almost a moral obligation, certainly an opportunity and almost an obligation to tell their stories because they're the only ones that know what it's like to be in that position.
Dr. Joseph Sakran: [00:44:24] Yeah, very well said. I couldn't have said it better myself. I totally agree. I would say that not everyone is going to be comfortable doing that, and that's okay. But I think in the people that aren't, they should at least be supportive of kind of the idea that we have a role to play beyond the bedside.
Tyler Johnson: [00:44:45] And I would say that at the very least, it's worth asking yourself if there's more you can do and in some cases, maybe even something that would make you a little bit uncomfortable. Obviously, you know, every person is an individual and people have to make their own choices. But I'm just saying that I think asking yourself, is there something that I could do to share the stories that I'm privy to that might make the world a slightly better place? I think that's a worthy and helpful line of questioning for a lot of doctors.
Dr. Joseph Sakran: [00:45:16] Yeah, I think that's right. I mean, and sometimes it's like there's a lot of different ways to do that. Maybe some people, they don't want to be in front of the camera, but they like to write and they can write an opinion piece, right? I mean, maybe I mean, there's just a whole slew of kind of options that people have to do that. To your point.
Tyler Johnson: [00:45:32] Yeah, we want to Ask, and, you know, this is again, sort of a you're in a unique place, perhaps in answering this question. But if you were giving advice to people who are especially young in their training, maybe thinking about going into medicine just in medical school, somewhere in residency or fellowship, if you were going to offer advice to those people, what what would you say? What do you think is most important that people should remember as they come up through the years of training?
Dr. Joseph Sakran: [00:46:01] Well, I would say this. So I talked a little bit about, you know, Henry's question about some of the advice that I think people should do around advocacy. I think just general advice to your question, Tyler, is I want to share what I call kind of my four P's. Okay. It's purpose, passion, patience and perseverance. And I pretty much live by these four P's. And here's why this is important to have purpose in what you do is so critical. I've always tried to live, you know, a purpose driven life. The reality is all of us, right? As humans, ego is innate to being human. Some people have a little bit more ego than others, right? There's a whole spectrum. But if you live a life that is driven by purpose, you end up, I think, really being able to find a path that allows you to do the type of meaningful work and make the type of change that otherwise you couldn't really connect with. And that's where kind of the second P comes into play, which is passion. You got to be passionate about what you're doing. Now here's the problem, right. Most passionate people are not patient. And most patient people are not passionate. And that's why patience is the third key, and the reason you have to be patient is because all of us face adversity in our lives, and you got to be able to have the patience to persevere. Fourth P right. The adversity that we're all going to face, those, you know, kind of I don't know what you want to call them.
Dr. Joseph Sakran: [00:47:53] Principles values that I try to live by have allowed me to kind of carve out my own authentic path. When I finished fellowship, people had no idea what to do with me. They're like this guy. We don't we don't know how to mentor him. You know, like he's just so different. So it was a little bit of a struggle, and I didn't even realize I was doing something different until later on when people are like, hey, Joe, how did you get to the Kennedy School? Hey, how did you spend a year in the US Senate? Like they started asking these questions and I'm like, oh, I'm like, maybe, you know, there's other people that are interested in non what I call non traditional paths. And it's because I've always, you know, tried to be purposeful in what I've done. One of my mentors, doctor Mike rotunda, always says there's a lot of red, shiny lights out there. It doesn't mean you have to grab all of them. I think the point is, is like trying to think about what aligns with why you're doing the work that you're doing, and that takes a little bit of time to reflect, write about, like, why are you here? Why are you doing this work? And it's funny, like when I ask my medical students, I'm like, hey, why are you doing this work? You know? And there'd be like on the rotation with us and it's almost always, I'm on third.
Dr. Joseph Sakran: [00:49:04] Or I ask them like, you know, why? Why are you, you know, what are you doing here? Tell me a little bit about yourself. They'll say, oh, I'm a third year medical student on the surgery rotation, and I want to go into whatever. That's not your story, right? But that's like, you know, a little bit of your CV and currently what you're doing. So by the end of the rotation, though, if I've had the chance to work with them, their their response is very different because they've been able to kind of sit down and really take some time to reflect and to peel back some of those layers to think about, well, why did I go into medicine? And the last thing I'll just say is like, there's this game you can play, it's called the Nine Whys. And, you know, you ask someone like, okay, like, you know, I could ask, you know, Henry, what? You know, why'd you go into medicine? And I'll answer. And then the only thing I say nine times is why? And it sounds kind of cheesy, but what it does is it allows you to peel back those layers. So by the time you get to the end, you're like, oh, man, you've really had to reflect on how you got to where you are. So that would be my my advice. Tyler.
Henry Bair: [00:50:07] Thank you so much for sharing that. I've heard of the five whys in the context of like, business.
Tyler Johnson: [00:50:13] We're getting serious, Henry. None of this cut rate five whys stuff. We're going nine deep. This is trauma surgery. Why?
Dr. Joseph Sakran: [00:50:20] We're going nine, brother, I actually think I you know, I heard it during I was part of this Presidential Leadership Scholars program. I first did the exercise there, and I want to say it was a business minded, you know, individual that taught us that. So so maybe you're on to something.
Henry Bair: [00:50:38] Well, with that inspiring note, we want to thank you again, Joe, for taking the time to join us for sharing your powerful story. I work in an eye hospital, so I'm an ophthalmology resident. I have an interest in oculoplastic and reconstructive surgery. My hospital is based in downtown Philadelphia. We get a lot of patients coming in for trauma, violence related trauma, lots of shootings, stabbings, blunt trauma. And absolutely, I will be thinking about all the lessons you've shared the next time I join a surgical case related to one of these issues that you deal with on a daily basis. So thank you so much.
Dr. Joseph Sakran: [00:51:14] You're welcome. I did my fellowship at Penn, so I have a fond place in my heart for Philadelphia.
Tyler Johnson: [00:51:19] And retroactively, we're grateful to the two or 3 or 5 or whatever it was surgeons who were there on that night in Falls Church, Virginia, as well.
Dr. Joseph Sakran: [00:51:27] Thank you so much. Appreciate that, Tyler, and thank you both for having me on your podcast.
Tyler Johnson: [00:51:32] Thanks so much.
Henry Bair: [00:51:36] Thank you for joining our conversation on this week's episode of The Doctor's Art. You can find program notes and transcripts of all episodes at the Doctor's Art.com. If you enjoyed this episode, please subscribe, rate, and review our show, available for free on Spotify, Apple Podcasts, or wherever you get your podcasts.
Tyler Johnson: [00:51:55] We also encourage you to share the podcast with any friends or colleagues who you think might enjoy the program. And if you know of a doctor, patient, or anyone working in healthcare who would love to explore meaning in medicine with us on the show, feel free to leave a suggestion in the comments.
Henry Bair: [00:52:09] I'm Henry Bair
Tyler Johnson: [00:52:10] and I'm Tyler Johnson. We hope you can join us next time. Until then, be well.