by Iain Overton
Medicine and surgical techniques have continued to keep up with modern warfare, and their benefits have been passed on to civilians. In 2013 a trauma centre at St Mary’s Hospital in London launched a new medical process based on a protocol developed at the British Army’s Camp Bastion in Afghanistan. It was a triage system to treat gunshot patients as quickly as possible, taking casualties straight to theatre to stem the bleeding.25
Other recent medical innovations in gunshot trauma include the drug Tranexamic acid. In 2010 a study into this drug, originally used to ease heavy menstrual flow, showed it could save the lives of haemorrhaging patients.26 The drug was quickly adopted by the British and US armies and is now seen in many American emergency departments. There has even been the development of syringes containing tiny sponges that can seal a gunshot wound in seconds.27 The reality of gunshot victims being placed in suspended animation, or ‘emergency preservation and resuscitation’, is also upon us. This involves replacing all of a patient’s blood with a cold saline solution, which rapidly cools the body and stops the majority of cellular activity, giving doctors time to treat the wounds methodically, without the tick-tock urgency of a dying patient on the table.28
But what all of these medical advances mean is that we cannot view the impact of guns solely in terms of the numbers killed by them. Given so many people are now being dragged back from the edges of death by the medic’s steady hand, we have to factor in the numbers wounded by them as well if we are truly to understand the gun’s impact.
The BBC foyer was filled with day-trippers. A coachload of excited, heavy-set tourists were down from the North, full of laughter, teasing each other gently. Some were having a go at being newsreaders in an ‘Interactive Newsroom’ corner. A huge poster of Annie Lennox dressed as an angel looked down. I sat down on a puce kidney-shaped sofa and thought about the person I was to meet: Frank Gardner, the broadcaster’s diplomatic correspondent.
Ten years earlier, Frank had been gunned down by six Al Qaeda thugs in Saudi Arabia. He had been shot a number of times – in the shoulder, leg and, at point-blank range, four times in the lower back. His colleague, the Irish cameraman Simon Cumbers, was killed beside him. Frank had lain there, in a spreading pool of blood, for the better part of an hour until he had been delivered, as minute seeped into agonised minute, into the capable care of a surgeon who had worked in the very South African hospital where I had seen those trauma victims. The training had, clearly, been of use, and Frank survived. Just. The bullets had missed his major organs. But one had clipped his spine and left him partly paralysed in the legs and dependent on a wheelchair. That was why I was there: because of his pain.
We are seduced by the idea of the wounded poet. The warrior hurt beyond hurt, yet a hero who, against the odds, rises through agony, overturns death and emerges, filled with knowledge, into the light. Perhaps I imagined Frank like this. After all, since the shooting, he had been given a medal by the Queen and written two bestselling books. Following fourteen operations, over half a year in hospital and months of rehabilitation he had also returned to reporting for the BBC. He was probably the most famous person alive who had been severely disabled by a bullet. It struck me that if I was to find a wounded poet, I’d find one in Frank.
The crush of excited tourists meant his approach was obscured by a line of standing figures. But he wheeled through the crowd and was apologetic for being late, shaking my hand firmly. Frank is one of those Englishmen who, in another era, would have been sent off to India to run a colonial province. He had a patrician kindness about him, with lean features and a keen mind. The way he took command of our meeting was fluid and understated – a lesson in leadership and diplomacy. He was, quite simply, charming.
I had hoped for something darker; the journalist in me wanted to paint a picture of arrogance or bitterness or something that would show ugly humanity. But Frank was none of these things.
We went into the building and, over coffee, he made one thing very clear. ‘The BBC have been unfailingly generous,’ he said. ‘And the NHS have been brilliant. I quickly learned that when you are really badly shot up, with multiple injuries, you need the care of a major NHS hospital. There, some of the treatment I had was pretty pricey, like the nutrients they had to feed me through a tube in my chest to keep me alive.’
His rehabilitation treatment was extensive. And that was an important thing to say, because the treatment of the wounded in a developed nation is not cheap. One US review estimated the care costs for regular gunshots victims at $18,000.29 This financial breakdown did not include complicated plastic or neuro-surgery, and other reviews have quoted much higher figures: $48,000 for treating people shot in the hand;30 over $100,000 for those shot in the face.31 Around the time Frank was shot, the daily cost of care for a spinal-cord gunshot victim in a US hospital was estimated at about $2,000 a day.32
It all adds up. The Pacific Institute for Research and Evaluation calculated that, in 2010, the financial burden of firearm injuries in the US came to $174 billion. They included things like work loss, medical care, mental-health fees, emergency transport provision, police time and insurance claims,33 a bill that was estimated to cost every American $564 a year.34 Just as the long-term pain that guns can bring is hidden, so too is the financial impact caused by them.
In some ways, if one is to see lightness where there is only dark, Frank was lucky. Sixty-two countries in the world do not have gun rehabilitation services of any kind; a shot to the spine would be the end for most.35 In 1994 it was estimated that gun-wound rehabilitation services in developing nations reached, at most, 3 per cent of victims.36 And today it’s only about 15 per cent of people with disabilities in such developing countries who can get devices like wheelchairs.37 The cost is huge, too – one report estimated that treating a gunshot wound in Kenya was twenty-seven times a person’s average monthly salary.38
But these are comparative statistics and figures that offer no comfort to a Westerner who, like Frank, still has to live their days in a wheelchair and in pain. For him the agony of nerves was constant. Some days . . . and his voice trailed off, and you know he’ll always be reminded that the past is real. That scar on his spine will always pull him back to a blood-soaked road and the roaring in his head.
‘No,’ he says, ‘it is there, the pain. Like someone has kicked me hard in the shin, or shoved a screwdriver up my backside.’
And the wounded-hero fantasy I had of him was transformed, because it was clear this man of intelligence and humility, despite showing no hatred for Islam or the Saudis, can never forget what those bullets took from him. Like playing with his children on a beach. Or skiing without a second thought. Or just walking. I wanted to ask him if he could still make love. But I did not, because he was a gentleman, and I felt ashamed at wanting to know these things. He did, though, talk about feelings; he had lived through some grim moments, particularly in hospital.
‘No,’ he said. ‘I can’t say that anything good has come out of it. That would be too much.’
A shadow passed across his face.
It is easy to forget the psychological injuries sustained through gun violence, I thought. We often just associate guns with physical harm, but it is clear that’s simply not the case. In one study, sixty gunshot patients admitted to a trauma centre were interviewed when at hospital, and interviewed again eight months after they were discharged. Over 80 per cent reported symptoms of post-traumatic stress disorder, or PTSD. Other studies support these findings, showing that gun-trauma patients have twice the odds of suffering PTSD than motor vehicle accident survivors.39
Frank had managed to find some semblance of balance again. He had the support of a major institution like the BBC, a loving family, an enviable job and a sharp mind. But he also had pain, legs that did not work, and all the secret humiliations this must bring. And his eyes were marked with it.
Perhaps that was what I took from meeting Frank. Not that being wounded by a gun brings pain; that is, perhaps, too
obvious. Not that the strength of a man’s character is based on whether he can turn a gunshot tragedy into triumph, because Frank saw no silver lining to what had happened. Rather, that the gun has no moral function. It does not question your worth, or your kindness, or your intelligence. It just does what it does, and that is to wound and to scar in ways that we will never truly know unless somebody shoots us – or we shoot ourselves.
4. THE SUICIDAL
The gun’s bitter role in suicide – a filmed moment of despair – a dark pilgrimage to the scene of a tragedy in New York, USA – talking to an American psychologist and learning from Sylvia Plath – Switzerland – meeting a suicide charity by the shores of Lake Geneva – and an unexpected discovery
According to the World Health Organization, over 800,000 die every year from suicide, in all of its despairing forms.1 This works out at about one person taking their life every forty seconds. What it means is that more people kill themselves each year than are killed by homicides and wars combined, and suicide is one of the leading causes of death among teenagers and adults under thirty-five.2
Of this mountain of dead, firearm suicides account for a huge number. Exact figures are hard to come by, but the general observation is that where guns are very common you often find a higher level of suicide deaths by that method. None more so than in the US, where more people shoot themselves than anywhere else in the world – 60 per cent of all suicides are by this method.3 It works out, on average, at about fifty gun suicides every day.4
Of course, there is no such thing as one ‘America’ when it comes to statistics; there are major regional differences. Alaska has a firearm suicide rate 700 per cent higher than New Jersey.5 But what we do know is that shooting yourself is becoming much more common there. The percentage of US gun suicides has increased from about 35 per cent of all suicides in the 1920s to over half today.6 And what shocks are the quiet lines in the US data. Like the cold figures that record there were ninety-two children under the age of fourteen who shot themselves in 2011.7
Comparing such figures to other developed nations highlights what an unaddressed problem the US has. In England and Wales gun suicides account for less than 2 per cent of all suicides.8 In Latin America and the Caribbean only 13 per cent of the 26,213 suicides in 2012 were with guns.9
Given the high level of firearm ownership there, this observation of the US as a gun suicide outlier is in line with the oft-stated link between rates of firearm ownership and suicides.10 In fact, so strong is this link that one way the Small Arms Survey establish levels of gun ownership in a country ‘is the proportion of suicides committed with firearms’.11 So it is no surprise that the US has a firearm-suicide rate almost six times higher than most developed nations.12
This was why, some months before I went to South Africa and on my way back from Honduras, I had stopped over in New York. There I had travelled deep into the heart of the city to visit a place that had stayed with me ever since I had begun researching the gun’s role in suicides: 1358 Washington Avenue.
The east coast wind pushed down the wide street, and clumps of fallen leaves danced in tight circles. Distant police sirens coughed out ugly staccatos across the city, and the winter sun bleached its low-covering sky. I parked my cheap rental car behind a scuffed brown Ford, a Dominican flag limply displayed in its stained rear window, and opened the door.
In front of me was a twenty-storey high, dull brown-brick tower. Bland and architecturally functional, this was one of the Projects, built in the mid 1960s to house some of the poor and the huddled masses of the greatest nation on earth. It was named after Governor Morris, a founding father by whose hand the American Constitution was written. And it was one of ten similar blocks, housing over 3,000 people, here in the Bronx. It was not the nice side of town.
Autumn had reached these streets weeks before, and the rough grass outside the building lay coated with curling leaves. A sweatshirt and a pair of tights draped the sparse limbs of skeletal trees and flapped in the wind like flags of poverty. Coffee cups scuttled around on gritty gusts, and squirrels darted up and down the encrusted bark of the trees.
Ten years ago, Paris Lane, a troubled twenty-two-year-old, had killed himself here in the foyer of this block. Paris had imagined himself alone, but a NYPD surveillance camera was the unblinking eye that saw him talking to – and, it was later to be said, being rejected by – his sixteen-year-old girlfriend, Krystin Simmons. It captured the wiping of tears from eyes and her hugging the young man with his lank hair braids and his black, dull puffer jacket.
And it saw what happened next.
Krystin walked into the lift and the metal doors closed. Paris then, with a casualness that belied what happened next, put a balled hand into his jacket pocket and pulled out a handgun. He put the pistol in his mouth.
A life was extinguished, and the CCTV camera carried on filming.
It would have ended there, but that grainy video was to find its way onto a website called Liveleak.com, one that specialises in videos of people dying, often killing themselves. Liveleak has videos of people jumping off buildings or stepping before trains. It has a few videos of men, and it is only men, even pulling the trigger. They had posted this particular film under the line ‘An Oldie but a Goodie’. So it was that over half a million people watched the ending of this man’s life, and I was one of them.
The watching of a suicide played out on video is a terrible and compelling thing. You see the sudden jerk of death as the bullet rips life away, then you rewind to the point of the last breath and you pause right at that moment when life is extinguished.
These things leave digital ghosts in our mind, the grandest and most terrible of gestures. And Paris’s death had haunted.
I think the seeming nonchalance with which he took his life was the thing that left its mark. The casual way he went from hugging his girlfriend to pulling out a gun. So I had travelled to this rundown district to see if I could put some meaning to his sudden end.
I walked up the path and entered the foyer. I had already been here, in a sense. It was the same, a decade on. The scuffed municipal floor, the grey metal light, the lift doors. A man in a tightly wound-down hooded top walked in. Did he know Paris? He did not answer me. Then a young African American woman came in, but she was also silent. This area had seen too much violence for people to start talking to a white guy with a notepad, so I walked back out into the wind.
School was breaking up, and, as I retraced my steps down the weed-ripped pathway, a fight broke out. The kids crowded around, screaming and jostling. A white teacher – all of the children were black – strode over, and there was a sharp bark of rebuke. The children dispersed, their laughing, pecking voices causing birds to take flight.
An older man, solid and confident, with a flat cap and tattoos, his poodle on a leash, walked past. I asked if he remembered the shooting.
‘Oh. That cat. Yeah, it was shocking,’ he said. ‘I had a friend who was downstairs when it happened – there was blood all over the floor. Like it was fake, you know. But the girl, the girl just carried on upstairs and didn’t know. It’s still being talked about.’
His name was Wayne Newton. He had lived here for forty years, ever since he was eight, and ran a barber shop down the way. It used to be crazy around here. A person like myself hanging around back then – and he pointed a finger at me and mimed pulling the trigger. I asked more about Paris.
‘Yeah. You hear about him even now. “Have you seen what’s on the internet? Some cat shot himself in the Projects.” They don’t realise he did this ten years ago.’
Paris had lived a hard life. His parents had both died of AIDS by the time he was twelve. He was an aspiring rapper who used the name Paradice. But Wayne did not know much more and so he shook my hand and told me he had a 9mm gun for himself because, hell, you needed it here once. Then his dog saw a squirrel and shivered with excitement and pulled at the leash, and Wayne was gone.
I walked the streets, around and aro
und, the apartment block at my centre, asking if people remembered the lonely death. But Wayne was the only one who had heard of this young man, or was saying he had, at least. The mothers in the children’s after-hours playgroup, each wall lined with rainbows, clicked their tongues and said they knew nothing. The police stood outside the school gates, guns on their hips and suspicion on their minds, and crossed their arms. They asked me why I was asking such questions, and I walked away from them as if guilty of something.
The woman at the housing association gave me the telephone number of a press officer on a slip of torn paper. I crunched it into a small ball and let it drop into a bin. Press officers don’t talk about such things. And I walked back out into the fading evening and watched the flight of lonely city birds as they sliced through the air in a solitary dance and realised that Paris’s name was long lost to these streets. His death was so famous and yet so forgotten in the very place where he died.
A slice of time can be a saving grace when it comes to thinking about suicide. One study of survivors of self-inflicted gunshot wounds in the US found 40 per cent had contemplated suicide for less than five minutes beforehand.13
Such a rapid shift in emotions means one thing: that the way someone chooses to end their life is important. If someone reaches for a gun, they usually don’t get a second chance. If they reach for pills, they often do. Over 99 per cent of people shooting themselves in the head die, whereas only 6 per cent of people slashing their wrists or popping pills end up killing themselves.14 And it’s been shown, repeatedly, that those who survive a suicide attempt usually don’t later die by suicide.
This link between the availability of means of killing yourself and the chances of a successful suicide is powerfully illustrated in the way that the American-born poet Sylvia Plath ended her life in the UK. Sylvia, despairing of the lifelong depression that had hounded her for thirty years, which she called ‘owl’s talons clenching my heart’, killed herself in 1963. In the velvet quiet of the morning she had taken sheets of tin foil and handfuls of wetted tea towels and lined the doors and windows of her kitchen, so as to protect her sleeping children next door. Then she put her head in the oven and turned on the gas. By 4.40 a.m. Sylvia Plath had escaped the weight of her darkness.