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Beyond the Number


The number alone is staggering. Twenty-four thousand five hundred and seventy-six deaths due to homicide in the United States in 2020, per the CDC estimate. This number, however, leaves out much of the toll of violence, a reality that became clear to me after an experience in clinic one afternoon.

As an internal medicine resident, I deal with the direct consequences of firearm injuries much less than my peers in emergency medicine or trauma surgery, so when I first saw a patient on my schedule with only “gunshot wound” listed under medical history, I was not sure what to expect. Several months earlier, he had sustained a single bullet wound, which required an exploratory laparotomy (an incredibly invasive sternum to pelvis abdominal incision) and removal of a fragment lodged in his spine. By many accounts he was incredibly lucky. He had survived, and the bullet had somehow avoided his vital organs.

But his story in clinic painted a much bleaker reality. A resulting nerve injury left him with severe pain and lasting weakness in one of his legs, preventing him from performing his previous job, and forcing him to rely on public assistance for both himself and his family, a situation he had never desired. The nerve damage also affected bladder and other functions, changing his daily life, potentially permanently. Apart from the clear physical injuries, my patient also faced lasting psychological pain from his trauma and resulting surgeries, and an embroiling legal battle likely to endure for months or even years to come.

As medicine has advanced, survival after firearm injuries and other traumas has improved in tandem. My patient, likely due to modern medicine, despite his life-changing pains and trials, will not count among the CDC’s total of annual homicide deaths after his gunshot wound. That number alone does not tell the full story of violence in the United States.

Beyond the number, the toll is even greater.

Alex Nusbickel
Gainesville, Florida


1 thought on “Beyond the Number”

  1. Sara Ann Conkling

    It’s so important that you raise the point that disability is frequently uncounted and/or not considered in estimating the impact of serious social problems. Most of those dear to me would rather die than suffer serious disability — and as we age, this becomes more of a topic of conversation. Related to this are concerns about the doctor-patient relationship when there is an illness or injury that cannot be fixed. I have my own strong feelings on this topic, from personal experience, that I will save for another day. In the meantime, I was impressed by your empathy for this patient and I’m sure it made a difference in his life, even if you couldn’t fix his injury.

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