Crisis

Yesterday was.

There are two reasons not to talk about gun control in the immediate aftermath of the Newtown atrocity, and opposition by the NRA and its adherents is neither of them.

The first is that addressing gun control right after innocents are shot might in some way seem exploitative. The second is that no imaginable degree of stringent gun control could fully exclude the possibility of an unhinged adult shooting a kindergartener.

But both of these objections are as porous as the sands of our shores battered by Hurricane Sandy. And a consideration of those shores readily reveals why.

With regard to exploitation, there was no thought of it as post-Sandy ruminations turned to how we might best prevent or at least mitigate the next such catastrophe. It was not exploitative to look around the world at strategies used to interrupt storm surges, divert floodwaters, or defend infrastructure. Those reflections continue.

Similarly, it’s not exploitative when my clinical colleagues and I speak to our patients in the aftermath of a heart attack or stroke about what it will take to prevent another one. In fact, these exchanges have a well-established designation in preventive medicine: the teachable moment.

It is opportunistic, but in a positive way: There is an opportunity to do what needs to be done. Admittedly, it’s better to talk about preventing heart disease, or the drowning of Staten Island, or of New Orleans, or the shooting of children, before ever these things happen. But the trouble tends to be: Nobody is listening then.

We are constitutionally better at crisis response than crisis prevention.

We’ll get back to the Constitution shortly.

Continue reading “Now Is Not the Time to Talk About Gun Control”

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My summer job before I left for college in 1965 was the night admitting clerk in the emergency room in the Huntsville, Alabama county hospital – a facility built to support a few thousand in a small rural community but now taxed with serving hundreds of thousands, brought to town by the new Apollo missile program.  Saturday nights in the small emergency room were often pure chaos, with auto wreck victims lined up on gurneys in the hallway. Those shifts passed the quickest for me, and I slept the best, afterwards.

Crisis promotes a kind of serenity. Why do people commonly tend get into their “zone” then? It’s because of what the situation demands: appropriate engagement. Think about the last time you were in such a circumstance. What were the fundamental components of your experience and behavior? Immediate integration of potentially meaningful inputs; clear definition of desired outcomes; trust in your intuitive judgment; decisions about specific next actions and physical movement on the most critical; consistent recalibration of all factors as required; acceptance of what can’t and needn’t be done at that moment. Those are all core elements of triage, and, actually, appropriate engagement with anything. Put together they’ll get you into your “zone.”

Continue reading “What’s the Real Emergency Room?”

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