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Dr. Najma Ahmed remembers the first few times she treated patients with gunshot wounds. One of them was a victim of domestic violence who had been trying to leave her partner.

“We weren’t able to save her,” says Ahmed, a trauma physician and Surgeon-In-Chief at St. Michael’s Hospital, a site of Unity Health Toronto. “That really stayed with me.”

Ahmed has been openly advocating for gun reform for years, and received widespread media attention after treating patients of the tragic Danforth shooting in 2018. She will be leading the Canadian Academy of Health Sciences’ 2023 Forum in September, with the theme this year of “gun violence as a public health issue.”

The conference is intended to help people understand the epidemiology and repercussions of gun violence and to offer guidance to clinicians on how to have conversations about firearms and safety with patients, families and communities.

Ahmed stresses that the way gun violence is depicted in the media – an ambulance racing down the street, a stretcher being carried into a hospital, the sense of calm that descends as the sliding doors close and the patient is ushered into the hands of the people who save lives – is very different from the reality. 

“People are often shocked by how much damage bullets can do to bodies,” says Ahmed. “In serious situations we often have to drain the blood bank to keep the patient alive. If you’re shot in the spine you’re likely to be paralyzed. You will probably have damage to organs. Guns are meant to kill people – that’s what they’re supposed to do. It’s like a war down there in the trauma room.”

Patients who are shot and survive are never the same. Some have to spend months in the hospital and endure repeated surgeries; others are attached to ventilators or life support. They may not be able to go back to work or school long-term. Their families and communities are permanently altered too.

“In medical school we learn how to talk to patients about things like drinking alcohol and eating healthy, but we don’t learn how to have those kinds of discussions about gun violence,” says Ahmed. “Just sewing up the wounds won’t change the societal problem.”

When and if her patients recover, Ahmed will often go to their bedside and speak frankly with them about what’s happened. She helps to connect women experiencing domestic violence with social workers and resources for safely exiting.

The conference is also intended to correct misconceptions about firearm use and it’s epidemiology. For example, the leading cause of gun-related death in Canada isn’t mass or accidental shootings or gang violence, but instead suicide.

“These things are preventable,” says Ahmed. “Many of the people we lose to gun violence are young and healthy and should have had long lives. The presence of a gun makes it easier for people to behave impulsively.”

Ahmed says that since she began her advocacy things have gotten both better and worse. Conversation and public dialogue has become more widespread, but the gun lobby in Canada has doubled down and the proliferation of both legal and illegal firearms has continued. Ahmed has seen an increase not only in the number of patients, but in the severity of injuries and the number of patients per incident. The strain on the health care system is tangible: gunshot patients need a lot of blood, tend to have long hospital stays, and need to be in the operating room many times.

The stigma and politicization around gun violence – even for victims – can make it difficult to speak about openly.

Ahmed, who chose trauma as a specialty because she believed it was where she could save and turn around lives, says that she was told during training that to learn about gunshot injuries she’d need to go to the United States. That is no longer true.

The conversation around gun reform has involved many stakeholders, including the government and the police. Physicians, who see the aftermath of gun violence in a way not many other do, need to be equipped to talk about it as well.

“It’s time for Canadians to have these conversations.”   

By: Olivia Lavery

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