I called into the morgue last Friday to find out what my day’s workload was going to be.
“One gunshot suicide and two other autopsies, probably natural.”
Not a busy day, by any means. It was part of a perfectly ordinary week working as a forensic pathologist in Oakland, California. A couple of days earlier, I had pulled out two 9mm bullets from the body of a middle-aged man. The previous week, it was a 30-something, shot in the back.
Right after I got off the phone, I saw a tweet from the National Rifle Association telling doctors to “stay in their lane” — their response to the American College of Physicians’ updated gun safety guidelines. That was just hours before a man with a handgun and a high-capacity magazine shot dead 12 people in a bar in Thousand Oaks, California, and less than two weeks after a man with an assault rifle shot dead 11 people in a Pittsburgh synagogue. Angered, I fired back a response, shut off my phone, and began my day.
Do you have any idea how many bullets I pull out of corpses weekly? This isn’t just my lane. It’s my fucking highway. https://t.co/48S9UIFaV2— Judy Melinek M.D. (@drjudymelinek) November 9, 2018
By the time I performed three autopsies and got out of the morgue, my tweet had gone viral, and I wasn’t alone. Doctors across specialties and across the nation were speaking up. After all, it’s our job to take bullets out of bodies every day — if anyone’s an expert on gunshot wound injury in this country, it’s us doctors.
Physicians like me understand the gun crisis in America intimately
The NRA’s original tweet was in response to new guidelines for doctors to protect their patients from firearm injury and death. The paper was issued by the American College of Physicians (ACP), a professional organization that represents internal medicine physicians. These guidelines urge doctors to ask their patients whether they have guns in their homes and to warn them about potential risks.
“We need to ask our patients about firearms, counsel them on safe firearm behaviors, and take further action when an imminent hazard is present,” wrote Dr. Garen J. Wintemute of the University of California Davis Medical Center for the ACP.
The document also encouraged a legislative response, such as strengthening laws that prevent domestic abusers from purchasing guns, and specifically acknowledged “that any such regulations must be consistent with the Supreme Court ruling establishing that individual ownership of firearms is a constitutional right under the Second Amendment of the Bill of Rights.”
I am a forensic pathologist who has investigated gun deaths for my entire career. I am the one who gets called out to the death scene at 2 am. I am the one who stands behind the cordon line, across the yellow tape from the shocked faces of the decedent’s neighbors, friends, next of kin. Sometimes their anger and frustration is directed at me and my team for taking so long, or not removing the body from public view while we document evidence at the scene. Sometimes they just want to see their loved one for the last time.
In 17 years on the job, I have performed more than 300 autopsies on gunshot wound victims. About half are homicides and the other half suicides, while a small number are accidents. One day I did five autopsies — an entire family — after a man shot his three children, his wife, and himself. In the course of another autopsy, of a man who was shot by the police after pointing his gun at them, I examined and documented 43 gunshot trajectories. That postmortem took me four days.
In my workplace, the county morgue, I seek to be professionally removed and scientifically dispassionate. I peel off the decedent’s clothing, document the bullet paths in the body, and collect projectiles and fragments. The bullets, shrapnel, and shotgun pellets are all evidence, of course. But the body itself is evidence, too. It breaks my heart to see tattoos of family names on the decedent, or the photos of their kids as I leaf through their blood-soaked wallet to document the personal property.
During the autopsy, I get to know my patient intimately. As a wife and a mother and a human being, it’s impossible for me not to grieve for their loved ones who will never again feel the warmth of that now-cold body.
I am also the one who reads the suicide notes. Sometimes the family knew their loved one was despondent, had long struggled with mental health troubles, or had talked about having no way out. But in many cases, the family had no inkling that this terrible thing would happen. The suicide was an impulsive act by someone who had a moment’s urge to self-destruct and easy access to a guaranteed lethal means.
Medical professionals need to speak up about gun regulations
Car crashes used to kill a lot more Americans before doctors, including my fellow forensic pathologists, advocated for government regulation of the auto industry, mandating the use of safety restraints and airbags. Those regulations save lives.
Lung cancer deaths used to be epidemic. Cigarettes are still the leading cause of preventable death in the United States, but our excess mortality rate from smoking has plummeted in the wake of legislation. It was doctors who spearheaded this effort to limit the exposure of teenagers to tobacco — legislation that has resulted in decreased smoking rates in every state where it has been implemented.
As scientists and caregivers, we doctors are in a unique position to understand the scale of human suffering caused by guns. We are driven both by data and by an intense feeling of personal responsibility toward those in our care. Gun deaths get the most media attention following a mass-fatality incident, such as in Parkland, Las Vegas, Pittsburgh, or Thousand Oaks. The daily carnage we witness in hospitals and morgues is often overlooked, but it happens everywhere, to every group of Americans, and leaves our patients and their families with an accumulation of broken bodies, coffins, and grief.
We have to do something. Doctors took on the auto industry and big tobacco on behalf of our patients. We didn’t choose this fight, but if we have to, we can take on the NRA.
Dr. Judy Melinek is a forensic pathologist in California and the CEO of PathologyExpert Inc. She is also the co-author with her husband, writer T.J. Mitchell, of the New York Times best-selling memoir Working Stiff: Two Years, 262 Bodies, and the Making of a Medical Examiner. Hanover Square Press will publish their debut detective novel, First Cut, in 2019. You can follow her on Twitter and Facebook.