By Eric Whitney for Colorado Public Radio and Kaiser Health News
In Colorado, where more people die from gunshots than car crashes, the victims have a profound effect on the physicians who treat them. For some of the doctors on the front lines, the experiences lead to a strong opposition to guns, questions about gun laws and even activism.
Dr. Chris Colwell, an emergency department physician in Denver, says he sees gun-violence victims on a weekly basis. And when those cases are fatal, they are hard to forget.
"These are the injuries that the [patients] will come in, and they'll look at me, and they'll talk to me, and then they'll die," says Colwell, who's been at Denver Health, the city's biggest public hospital, for 20 years.
Colwell also treated casualties from two of the deadliest mass shootings in American history. He responded to the scene during the 1999 massacre at Columbine High School where 15 people died. He also treated victims of last July's movie theater shooting in Aurora, where a dozen were killed and 58 wounded.
Often, Colwell will treat a shooting victim, and then treat the shooter after he or she has been caught by police. Colwell describes a case from a few months ago in which he treated a woman who later died -- and then her husband, who fired the gun.
"They had had a fight. He had caught her in what he felt was cheating, and he had lost his temper," he says. "He went and grabbed the pistol that he had for home defense at his bedside, and he made a snap decision." Now, he adds, "his life will never be the same, and hers was gone."
Colwell says it's remarkable how often people who pull the trigger are surprised at the consequences of their actions. And he's deeply disturbed by how easy guns are to get.
"I see patients every day that are right on the edge of being unstable. … They describe problems with access to medications; problems with access to psychiatric care or substance abuse care; problems with access to homes or to shelter," says Colwell. "But they don't describe problems with access to guns."
Dr. Katie Bakes, who has worked with Colwell in the emergency department for 10 years, also says it's the gunshot victims that she can't shake.
A few weeks ago she treated a three-year-old who'd been shot in the head. Her mother had shot each of her three children and then committed suicide. "Our patient was the only one who was a survivor," Bakes says.
Such experiences have made Bakes unequivocal in her opposition to guns.
"I hate guns. If I could snap my finger and get rid of all the guns I would. I think they're evil," Bakes says, "I don't really care what the other side of the argument is. I just don't want to see another 3-year-old come in and be shot in the head."
Bakes and Colwell say gun injuries feel much more deliberate than any other kind of trauma they see.
"It's so senseless," Bakes says. "You know, it's not an accident, somebody intentionally pulled the trigger for whatever reason."
But not all physicians share this perspective.
Dr. Jack Cletcher, a retired orthopedic surgeon, has treated his share of gunshot victims, too, from the streets of Chicago, and, decades ago, he took care of wounded soldiers just off the plane from Vietnam. He can sympathize with Bakes and Colwell, but he doesn't agree that laws need to change.
"This is the kind of emotional reaction that occurs with these horrible catastrophes that happen," Cletcher says. "The gun is only the instrument. It's not something that happens because the gun does it. There has to be somebody holding the gun to do it."
Cletcher is opposed to most of the new gun restrictions lawmakers are talking about in Denver and Washington.
"I don't think we need new laws, we just need to make the ones we have work better," says Cletcher, who would rather see lawmakers focus on better treatment for the mentally ill, and keeping guns out of their hands.
Recently, leaders of the Colorado Medical Society went to Washington to lobby for measures to help prevent gun violence. Strengthening mental health care was on their agenda, and they support President Barack Obama's executive action for increased research into gun violence.
Dr. John Bender, the organization's president-elect, showed Rep. Ed Perlmutter, D- Colo., the results of a recent survey of the medical society's members in which about two-thirds want to see gun regulations strengthened and about a third don't.
No similar survey exists for doctors nationwide, but a majority of AMA delegates have endorsed tighter restrictions on guns. Not all doctors agree, but among those calling for stricter gun control laws are the AMA and several groups of specialists, including the American College of Emergency Physicians, the American Academy of Family Physicians and the American Academy of Pediatrics.