Blog | Thursday, February 26, 2015

Guns, steel, grit, and grief


Michael Davidson, the cardiothoracic surgeon shot and killed in Brigham and Women's Hospital last week by the distraught son of a woman on whom he had operated some time ago and who died in November, was a medical student of mine at Yale back in the early 1990s.

Some few of my former students, including our newly minted surgeon general, Vivek Murthy, became friends of mine, and we stayed close over the years. I didn't know Dr. Davidson that well, but seeing his photo in the Boston Globe, I certainly remember his face. It's a good face.

I can't speak to Dr. Davidson's character corresponding to that good face, but others can, and have. According to colleagues, he was one of the greats, the kind of doctor every medical student wants to be, and the kind of doctor every patient wants to have. By all accounts, including those of patients, he was deeply caring. He was thoughtful, expressive, and clear. Peers credit him with the grit to wield the steel of scalpels in situations where other surgeons would balk, great surgical skill, the brilliance of innovation, and an extraordinary work ethic.

In addition, Dr. Davidson had a life outside the hospital. That life, according to the Boston Globe, included a wife, also a physician, and three children, with another on the way. That baby, of course, will now never meet his/her father.

The story line of this tragedy is almost unbearably heart rending.

And there's more. The shooter, who also took his own life, left behind a complicated legacy of love, anguish and disbelief. He had four grown children, and siblings, who say he was nothing but a good guy who was devastated by the death of his mother, with whom he was very close. Rightly or wrongly, he blamed his mother's death on an adverse reaction to medication, and rightly or wrongly, he apparently implicated Dr. Davidson in the use of that medication.

From the information available thus far, it could be that the medication had nothing to do with the patient's death, and that Dr. Davidson had nothing to do with prescribing the medication. Either way, there is nothing in the record to suggest any misstep in the treatment; just a bad outcome. Unfortunately, sick people die sometimes despite all that modern medicine can offer, and even when everything is done right.

Of course, sometimes patients die because something is done wrong, too.

But accuracy about who did what, when, and whether or not it was appropriate is not a priority in a moment of anguished passion. Passion clouds the mind, and tenses the muscles, including those of the finger, on the trigger.

Admittedly, Mr. Pasceri might have hurt, or even killed Dr. Davidson without a gun. And he might have killed himself without one, too. But both scenarios are a whole lot less likely. Try to remember the last time you heard about a murder/suicide involving, for instance, a knife.

I myself was stabbed long ago, on a train while traveling in Europe. I fought back with no weapon, and lived to tell the tale. If my assailant had used a gun instead, I suspect it would have been the end of the line for me.

There is a bitter irony underlying this dreadful story that has torn holes in two families at least. The shooting took place in the hospital where our new surgeon general worked, prior to his confirmation. That confirmation was held up for months and months because Dr. Murthy had stated publicly that guns were a public health issue. So here we are, in the immediate aftermath of that long forestalled confirmation, and a current colleague and former classmate of the surgeon general was shot dead with a gun also used to kill its owner, in a health care setting.

The irony is too thick to cut with a knife; you would have to shoot through it. Of course guns are a public health issue, if suicide is; if bleeding is; if emergency surgery is.

The public discussion about who has guns when, where, and for what obviously includes rights related to the use of such arms. But it cannot exclude the right to life, liberty, and the pursuit of happiness, all taken from Dr. Davidson. It cannot exclude the need to do what is right.

A finger on a trigger in a moment of acute grief is very unlikely to result in the right thing being done. In a moment of aggrieved passion, beastly and beatific look the same; it's a particularly bad time to pull a trigger.

That makes it a bad time to be holding a gun. That's where my sad ruminations on this tale take me. Guns and acute grief make for a very bad combination.

Whatever my own beliefs and preferences, I am not currently challenging any contentions about the right to bear arms, or the value of guns in self-defense. I am merely asserting this: if liberal gun policies mean more guns carried by more people more of the time, the likelihood of a gun in the hands of any given transiently, passionately aggrieved person goes up. This is a statement of statistical fact. Guns and such grief are a volatile mix.

Killing any other way requires real intimacy, and that's hard. Guns don't kill, people do, we are told. But guns allow those people an antiseptic, insulating distance. They make killing easier, and more efficient. One's hands need not even get dirty.

And in that way, they can convert the kind of emotional devastation we have all felt at one time or another into an irrevocable tragedy such as played out in Boston last week.

Guns and grief are a bad combination. Our judgment is clouded and undone in moments of aggrieved passion; we are least suited at such times to take on the roles of both jury and judge, leaving aside the illegality of such vigilantism. We may, in the throes of passion, misconstrue causes and misdirect blame. But we may hope to live through such moments, and see in a calmer, clarifying light.

First, though, we need to live through such moments at all. Guns in aggrieved hands make that tragically less likely.

David L. Katz, MD, FACP, MPH, FACPM, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care. He is a board certified specialist in both Internal Medicine, and Preventive Medicine/Public Health, and Associate Professor (adjunct) in Public Health Practice at the Yale University School of Medicine. He is the Director and founder (1998) of Yale University's Prevention Research Center; Director and founder of the Integrative Medicine Center at Griffin Hospital (2000) in Derby, Conn.; founder and president of the non-profit Turn the Tide Foundation; and formerly the Director of Medical Studies in Public Health at the Yale School of Medicine for eight years. This post originally appeared on his blog at The Huffington Post.