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Healing the silence
  1. Arnav Mahajan1,2
  1. 1Department of Surgery, MetroHealth Medical Center, Cleveland, Ohio, USA
  2. 2Neurological Institute of Thailand, Bangkok, Thailand
  1. Correspondence to Dr Arnav Mahajan; arnavmahajan99{at}


This essay won the American Association for the Surgery of Trauma Diversity, Equity, and Inclusion essay contest for 2024.

  • wounds, gunshot

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In the sterile glow of the operating room, where life and death dance in a delicate balance, there lies a dissonant symphony of suffering and silence. Suffering for the victim of gun violence: their body torn through with a 0.45 caliber bullet, a mother wailing in the harrowed halls of the emergency room, and a family irreparably traumatized. But our silence, in knowing that beneath the surface of each patient’s struggle lies a dark underbelly of disparities, as if the very fabric of their stories had been woven with unequal threads.

This was Joseph (name changed for privacy). His story of gun violence was a stark departure from the narratives that continue to dominate our public discourse. In the wake of mass shootings that shatter our collective consciousness, the tales of trauma that emerge from the acute care wards often mirror the sensationalism of the headlines. But Joseph’s story bore the weight of a different kind of violence, one that lurked in the shadows of society, evading the spotlight of media attention.

As I stood by Joseph’s bedside, I could see the lingering scars etched across his body, tangible remnants of the pervasive gun violence that plagues marginalized communities. His wounds, inflicted by bullets, were not merely the results of chance encounters but were intimately entwined with the enduring legacy of institutionalized racism that stalked the neighborhood he grew up in. But while media outlets paint a one-dimensional portrait of gun violence, focusing on mass shootings and debates over constitutional rights, they overlooked the entrenched structural racism that kept communities like Joseph’s ensnared in a cycle of despair.

I believe the victims of gun violence are also the victims of a system that does not listen to their stories. When gun violence is not viewed as a social problem anymore, but instead is presented simply as a way of life for black and brown people, we have failed communities that need our help with our own biases. The truth was that Joseph’s story was a reflection of systemic injustice, where poverty, underfunded schools, and limited access to healthcare intersected to perpetuate a bleak reality. This reality was one where young lives were cut short, dreams eclipsed by the barrel of a gun, and acute care surgery became an unyielding battlefield against the forces that sought to extinguish hope.

The toll of death and disability is not the only problem. When being a witness to a shooting at school, at home, or in the community increases risk for depression, anxiety, engagement in criminal activity and substance abuse, our responsibility far exceeds the confines of the operating room. How news of gun violence is experienced across the country will always vary, but trauma surgeons will forever have a front-row seat to the vivid consequences that gun violence inflicts. We, more than most, bear witness to the complex web of factors contributing to gun violence in marginalized communities. But the solutions lay far beyond realms of political arguments; they demand a deep reckoning with the structural racism that had enabled this epidemic to flourish.

As media spotlight shines brightly on mass shootings, and amplifies narratives often centered around white communities, the poorly kept secret of our field is that stories of racialized gun violence like Joseph’s have become the norm rather than the exception. With every case like this since, I have become a fervent advocate for trauma-informed care that takes into account the unique experiences of patients like Joseph, integrating mental health support and community resources to address the deep-seated traumas they face.

Today, as I walk the corridors of the emergency department I carry with me the echoes of trauma that reverberate through marginalized communities. Stories like this remain etched in my heart as a haunting reminder that we cannot heal these wounds without acknowledging and challenging the institutionalized racism that perpetuates them. As I progress through the rest of my training, I hope to continue unveiling the untold tales of gun violence, advocating for meaningful changes, and striving to create a system that embraces every patient’s narrative, no matter how silenced it may be.

For some, silence is the ultimate demonstration of our unflinching professional stoicism that is both the armor and the mirror of our ability to move forward. For others, silence will never be an option.

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  • Contributors AM was a sole contributor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.