WEBVTT - Guns Part 4: Moral Hazard 0:00:15.356 --> 0:00:24.916 Pushkin Midnight, June fifth, nineteen sixty eight. Robert F. Kennedy 0:00:25.196 --> 0:00:28.676 is running for the Democratic presidential nomination. He's just been 0:00:28.676 --> 0:00:31.836 declared the winner of the California primary. He's now the 0:00:31.836 --> 0:00:35.116 front runner. The White House is in his sights. 0:00:35.796 --> 0:00:41.996 I want to express my gratitude to my dog, Freckles, 0:00:41.996 --> 0:00:45.676 who has been the line. I don't care what they 0:00:45.676 --> 0:00:47.756 say about me, but when they start to attack my dog. 0:00:50.236 --> 0:00:52.756 And I'm not doing this in the order of importance, 0:00:52.756 --> 0:00:54.836 but I also want to thank my wife, Beth full. 0:01:11.316 --> 0:01:15.116 And her patience during this whole effort is. 0:01:16.796 --> 0:01:21.836 Fantastic. Thank you very much. The Freckles has. 0:01:21.796 --> 0:01:22.556 Gone home to bed. 0:01:23.596 --> 0:01:25.676 He thought very early that we were going to win, 0:01:25.796 --> 0:01:26.596 so he retired. 0:01:27.916 --> 0:01:30.676 You can hear the supporters packing the room despite the 0:01:30.796 --> 0:01:32.476 hour and the sweltering heat. 0:01:34.036 --> 0:01:37.156 Hey, hey, hey, I want. 0:01:36.996 --> 0:01:37.916 To hear really loud. 0:01:38.116 --> 0:01:40.556 Boom's gonna be the next president of United States. 0:01:48.676 --> 0:01:49.796 Hey, here's a bad lessen. 0:01:54.116 --> 0:01:57.236 He leaves the stage out to the kitchen, pauses to 0:01:57.236 --> 0:02:00.236 shake the hand of a bus boy, and out of nowhere, 0:02:00.396 --> 0:02:03.636 a young man emerges holding a twenty two caliber revolver 0:02:04.116 --> 0:02:09.596 eight shots. Boom boom, boom, boom, boom boom, boom boom. 0:02:09.596 --> 0:02:12.796 It's chaos. You can hear it, can't you. There's a 0:02:12.836 --> 0:02:16.236 photograph of this moment. Kennedy sprawled on the ground, the 0:02:16.316 --> 0:02:19.396 bus boy crouched by his side, his face turned to 0:02:19.436 --> 0:02:23.476 the camera, picture of anguish. 0:02:23.916 --> 0:02:26.276 I don't know, I can't what happened to you know, 0:02:26.596 --> 0:02:27.236 nobody might. 0:02:27.196 --> 0:02:29.916 Have been shown. 0:02:30.596 --> 0:02:41.916 I'm not Jimmy plugged in. Jimmy plugged in. Please day back, 0:02:42.036 --> 0:02:44.716 everybody else, just please day back. Just a doctor come 0:02:44.796 --> 0:02:45.236 right here. 0:02:45.676 --> 0:02:48.196 Let's roll some videotape on this sat here for him. 0:02:48.236 --> 0:02:56.196 Some reason, would a doctor come right here? A doctor here, 0:02:56.356 --> 0:02:57.156 doctor right here. 0:02:57.316 --> 0:03:02.196 I'm not calling pay the video. My name is Malcolm Gobwell. 0:03:02.316 --> 0:03:06.156 You're listening to Revisionist History, my podcast about things overlooked 0:03:06.316 --> 0:03:11.196 and misunderstood. This episode is part four of our investigation 0:03:11.476 --> 0:03:14.836 of the messed up way Americans talk about guns. The 0:03:14.876 --> 0:03:17.836 Supreme Court just issued one of the most important gun 0:03:17.916 --> 0:03:21.316 rights cases in its history, and devoted pages to the 0:03:21.316 --> 0:03:26.396 fourteenth century, the seventeenth century, the eighteenth century, the nineteenth century, 0:03:26.596 --> 0:03:30.916 the Civil War, reconstruction, the Constitutional Convention, and an obscure 0:03:31.156 --> 0:03:36.236 disputatious merchant from Bristol, But nothing about the present day, 0:03:36.836 --> 0:03:39.476 as if the crisis of gun violence on our streets 0:03:39.556 --> 0:03:43.236 is beside the point. We get our ideas about guns 0:03:43.316 --> 0:03:47.116 from a television western written by screenwriters from Hollywood whose 0:03:47.236 --> 0:03:50.916 understanding of the American frontier is one hundred percent backwards. 0:03:51.636 --> 0:03:55.956 It's all a little weird, and in this episode, I 0:03:56.036 --> 0:03:59.916 want to offer an explanation for how things got so weird. 0:04:00.556 --> 0:04:03.716 One I think gets missed, that is, except by the 0:04:03.716 --> 0:04:11.356 people who treat gunshots for a living. Oh I see, okay, okay, 0:04:11.636 --> 0:04:15.596 So let's walk through what happens. Sir He Sir hen 0:04:16.556 --> 0:04:21.956 Is comes up to Kennedy backstage at the Ambassador Hotel 0:04:22.676 --> 0:04:26.596 and fires eight shots from a twenty two caliber revolver, 0:04:27.156 --> 0:04:33.476 three of which hit Senator Kennedy, right, that's our understanding, Yes, 0:04:33.756 --> 0:04:38.876 Jordan commisero trauma surgeon at Duke University. Where so where 0:04:38.916 --> 0:04:39.916 do those bullets go? 0:04:40.836 --> 0:04:45.636 So the bullet that that struck him in the head 0:04:46.036 --> 0:04:51.436 hit right behind his right ear sort of if you 0:04:51.516 --> 0:04:54.316 feel everyone has like a little bit of a bony prominence, 0:04:54.796 --> 0:04:59.836 so roughly around there, and the other two struck him 0:05:00.076 --> 0:05:04.276 in the axilla, and they think the chest. Although it 0:05:05.316 --> 0:05:08.636 would seem that from the accounts of the thoracic surgeons 0:05:08.636 --> 0:05:14.996 as they really laid them, those were of minimal consequence. 0:05:15.356 --> 0:05:19.556 Yeah, it's really the headshot that we're concerned with. Yes, 0:05:20.036 --> 0:05:25.596 and have you in your experience? Have you ever We'll 0:05:25.596 --> 0:05:27.556 come back to this, but I'm just curious whether you 0:05:27.636 --> 0:05:30.436 ever treated an analogous gunshot wound. 0:05:30.276 --> 0:05:30.676 To the head. 0:05:30.996 --> 0:05:34.676 Yes, you have. Yes, When a bullet strikes you behind 0:05:34.716 --> 0:05:36.356 the ear, what happens. 0:05:38.956 --> 0:05:41.756 Largely these are mostly fatal injuries. 0:05:42.876 --> 0:05:46.836 By the next morning, Kennedy was dead. I want you 0:05:46.916 --> 0:05:50.876 to imagine what would happen if Kennedy were shot today. 0:05:52.756 --> 0:05:55.116 One of the iron laws of medicine is that the 0:05:55.156 --> 0:05:57.436 more you treat a condition, the better you get it 0:05:57.556 --> 0:06:01.996 curing it. Practice makes perfect, You develop your skills, you 0:06:02.076 --> 0:06:05.956 start to anticipate anomalies and variations. You're more motivated to 0:06:05.956 --> 0:06:10.836 try new ideas, introduce new techniques, develop new technologies. And 0:06:10.876 --> 0:06:13.676 nowhere is that iron law more in evidence in the 0:06:13.756 --> 0:06:16.636 United States than when it comes to the treatment of 0:06:16.716 --> 0:06:20.516 gunshot wounds. If you're an American trauma surgeon, you get 0:06:20.556 --> 0:06:26.436 a lot of practice. World War One, World War Two, Korea, Vietnam, Iraq, 0:06:26.476 --> 0:06:31.036 on Iraq to Afghanistan. Every generation of trauma surgeon got 0:06:31.036 --> 0:06:33.916 a war of their own, the best kind of crash course. 0:06:34.676 --> 0:06:37.116 Then they come home to the other war, the one 0:06:37.156 --> 0:06:42.356 in the streets. This is an area of genuine American expertise. 0:06:44.356 --> 0:06:46.996 I was curious about this, so I went to see 0:06:47.036 --> 0:06:49.476 a man named Edward Cornwell. Third. 0:06:50.316 --> 0:06:55.996 I got to Hopkins in nineteen ninety eight as the 0:06:56.076 --> 0:07:01.476 chief of Trauma, and my experience had been nine years 0:07:01.476 --> 0:07:04.716 at La County Hospital, which was among the busiest trauma 0:07:04.756 --> 0:07:07.676 centers in the country, five as a surgical. 0:07:07.316 --> 0:07:11.156 Resident around and everyone told me that if you ever 0:07:11.196 --> 0:07:13.956 got shot, Eddie Cornwall was your best hope for coming 0:07:13.956 --> 0:07:17.436 out in one piece. Mid sixties fit a little hint 0:07:17.436 --> 0:07:20.396 of Patrician about him. He grew up in Washington, d c. 0:07:21.036 --> 0:07:23.516 Trained at USC Medical School, and worked there in the 0:07:23.596 --> 0:07:27.036 nineties South Central in the middle of the crack epidemic. 0:07:27.396 --> 0:07:30.276 He opened the trauma center at Johns Hopkins University in 0:07:30.356 --> 0:07:34.436 nineteen ninety eight. Other American cities had seen a decline 0:07:34.476 --> 0:07:37.356 in a murder rate by that point, but not Baltimore. 0:07:37.556 --> 0:07:40.116 We have a protected conference that takes place every Department 0:07:40.116 --> 0:07:43.956 of surgery does so called morbidity immortality conference. We talked 0:07:43.956 --> 0:07:46.116 about every patient that died or had a complication in 0:07:46.156 --> 0:07:50.876 the prior week, and I showed that a table where 0:07:50.876 --> 0:07:54.116 we have five consecutive days on our trauma service, where 0:07:54.196 --> 0:07:57.356 every single day a twenty year old died gunshot to 0:07:57.396 --> 0:08:00.316 the chess dead on arrival, gunshot to the chess, dead 0:08:00.356 --> 0:08:03.716 on arrival, stab wounto the chess erthor ecademy. You need 0:08:03.756 --> 0:08:05.796 to have time to go to the operating rooms, literally 0:08:05.836 --> 0:08:09.316 opened their chests in the emergency department, declared dead. Five 0:08:09.316 --> 0:08:12.916 different surgeons, including myself. One day, a whole basketball team 0:08:12.916 --> 0:08:16.276 of twenty year olds essentially dead in the emergency department, 0:08:16.836 --> 0:08:21.116 prompting us to identify that we had this dramatic increase 0:08:21.236 --> 0:08:24.436 in the brazen nature of gunshot wounds more to the 0:08:24.476 --> 0:08:26.116 head or the chest or both. 0:08:27.076 --> 0:08:30.156 Then Cornwall came home to DC, once known as the 0:08:30.276 --> 0:08:33.236 murder capital of the United States, to head the trauma 0:08:33.276 --> 0:08:34.436 center at Howard. 0:08:35.556 --> 0:08:39.516 It's interesting I did my residency at La County Hospital, 0:08:39.676 --> 0:08:43.076 this huge eighteen story structure. I had a fifteen floor 0:08:43.116 --> 0:08:47.156 elevator ride from the er to the operating room in 0:08:47.276 --> 0:08:50.916 La County, and I was glad for it sometimes because 0:08:50.916 --> 0:08:53.236 I'm think should I go on the right chest, should 0:08:53.276 --> 0:08:54.356 I go on the left chest? Should I go on 0:08:54.396 --> 0:08:56.716 his abdomen? Then I get the Hopkins I had a 0:08:56.756 --> 0:09:00.196 seven floor elevator ride, shorter timeframe. I'm here, I have 0:09:00.236 --> 0:09:02.476 two floor elevator rights. So the more expert I was, 0:09:02.716 --> 0:09:04.996 the shorter the elevator ride. I was glad I had 0:09:04.996 --> 0:09:06.556 a fifteen floor elevator R. But by the time I 0:09:06.596 --> 0:09:09.116 get to Hopkins, I'd seen it all, so I didn't 0:09:09.116 --> 0:09:11.516 he need a fifteen seven floors is fine. I had 0:09:11.556 --> 0:09:12.436 two floors. 0:09:12.076 --> 0:09:18.676 Here South Central East Baltimore, Central Washington. I mean I 0:09:18.716 --> 0:09:20.836 spent a morning with him at the hospital with a 0:09:20.876 --> 0:09:24.036 colleague of his, a next Army surgeon named Mallory Williams. 0:09:24.636 --> 0:09:27.756 It was a Tuesday. He'd worked the weekend and operated 0:09:27.796 --> 0:09:30.396 on two kids, nineteen and twenty who'd been in a 0:09:30.436 --> 0:09:31.036 gun battle. 0:09:31.756 --> 0:09:33.516 I take the nineteen year old to the operating room. 0:09:33.516 --> 0:09:36.956 He's clearly tender, he clearly has evidence of contamination. To 0:09:37.036 --> 0:09:38.716 go to the operating room, spend three and a half 0:09:38.796 --> 0:09:40.956 hours doing the things that I mentioned, the liver, the stomach, 0:09:41.036 --> 0:09:43.956 small and testain coal in the record, but let's still 0:09:43.996 --> 0:09:46.076 lease that out well, let me just say one last 0:09:46.076 --> 0:09:49.676 thing about him, because it's like wild wild West. In retrospect, 0:09:49.676 --> 0:09:53.556 it becomes obvious to me that one bullet enters here 0:09:53.836 --> 0:09:56.836 and goes through his stomach his liver is large intestine, 0:09:56.876 --> 0:10:00.436 and goes out here. Another bullet enters in his upper 0:10:01.356 --> 0:10:04.876 gluteus buttocks and goes across the ouven and hits some 0:10:04.956 --> 0:10:08.276 small intestinal injuries, bounce off the pelvic That bullet is 0:10:08.356 --> 0:10:10.716 deformed and lodge's abdominal wall. 0:10:11.316 --> 0:10:14.156 But while he's treating the nineteen year old, he's worrying 0:10:14.196 --> 0:10:16.596 about the twenty year old because there must be something 0:10:16.636 --> 0:10:19.156 going on between the two of them, right, And now 0:10:19.156 --> 0:10:21.196 the two of them are in the same hospital. 0:10:22.076 --> 0:10:24.156 I made sure that the other kid doesn't go to 0:10:24.156 --> 0:10:26.556 the IC where which typically put these patients, because I 0:10:26.556 --> 0:10:28.276 don't want the two families down there. 0:10:28.436 --> 0:10:30.996 You know, I see you. 0:10:30.076 --> 0:10:30.236 You know. 0:10:30.316 --> 0:10:33.076 So we have them remote locations in the hospital from 0:10:33.116 --> 0:10:33.516 each other. 0:10:34.276 --> 0:10:36.916 Do that for forty years and learn from all the 0:10:36.956 --> 0:10:39.356 other trauma surgeons around the country who are doing the 0:10:39.396 --> 0:10:44.156 same thing, and you get good. Yeah, what's what flaw 0:10:44.156 --> 0:10:49.036 a medical standpoint? What would you looking forward? What is 0:10:49.076 --> 0:10:53.116 the hypothetically if I gave you if I was a 0:10:53.436 --> 0:10:56.756 if I gave you a wish, I said you could, 0:10:57.196 --> 0:11:00.476 you could, you could solve one problem in your field 0:11:00.636 --> 0:11:01.356 that would. 0:11:01.916 --> 0:11:03.716 Well reduce gun gun deaths. 0:11:03.796 --> 0:11:07.036 No, no, I mean what's in your Yeah, they would 0:11:07.036 --> 0:11:11.476 reduce gundest So what medically speaking, what is one one 0:11:11.796 --> 0:11:15.516 medical trick that you could I could give you that 0:11:15.556 --> 0:11:17.516 would have the biggest impact on how many people die 0:11:17.556 --> 0:11:18.276 from a gun shoggler? 0:11:18.636 --> 0:11:22.596 My trick wouldn't be medical. Yeah, it's not medical for me. 0:11:22.876 --> 0:11:25.716 It would be two parents in every home. That almost 0:11:25.756 --> 0:11:28.716 sounds today to say that today it sounds you might. 0:11:30.996 --> 0:11:36.556 Say that you think we have progressed as far as 0:11:38.116 --> 0:11:40.796 you think we're We've done most. We've got most of 0:11:40.796 --> 0:11:43.156 the low hanging flute in terms of how to save 0:11:43.236 --> 0:11:44.196 somebody once they arrive. 0:11:44.516 --> 0:11:46.876 Yeah, I got some slize of share there, but I 0:11:48.196 --> 0:11:51.156 don't think we have another peak in my lifetime. So 0:11:51.276 --> 0:11:53.636 once you get to ninety five percent, there aren't any 0:11:54.316 --> 0:11:56.956 The fruit is high up on the tree, right. 0:11:59.316 --> 0:12:02.276 That's how good trauma surgeons are now. They're looking for 0:12:02.356 --> 0:12:07.436 solutions outside the hospital. Now, think about the implications of 0:12:07.476 --> 0:12:10.636 that in a place like Washington, DC. In the last 0:12:10.636 --> 0:12:13.716 thirty years, the number of homicides in Washington in a 0:12:13.756 --> 0:12:17.196 typical year has been cut in half. People look at 0:12:17.196 --> 0:12:20.356 that statistic and say, oh, the city's gotten a lot safer, 0:12:20.996 --> 0:12:24.396 But isn't some part of that decline simply that Eddie 0:12:24.436 --> 0:12:27.676 Cornwall and Malory Williams and all the other trauma surgeons 0:12:27.676 --> 0:12:31.236 of Washington, DC are now saving lives that were once lost. 0:12:32.396 --> 0:12:35.196 A city's murder rate is not a measure of the 0:12:35.276 --> 0:12:39.876 number of people victimized by potentially lethal violence. No, it's 0:12:39.916 --> 0:12:43.316 a measure of the number of people victimized by potentially 0:12:43.476 --> 0:12:47.676 lethal violence minus how good a job doctors do at 0:12:47.756 --> 0:12:50.636 saving that person's life once they get to the hospital. 0:12:51.596 --> 0:12:54.076 So how important is the second half of that equation? 0:12:54.756 --> 0:12:58.396 Do people like Eddie Cornwall move the needle on homicide 0:12:58.436 --> 0:13:02.836 rates a lot or just a little? Which is why 0:13:02.876 --> 0:13:06.316 when I got back from DC, I called up Jordan Commissera, 0:13:06.676 --> 0:13:10.316 trauma surgeon at Duke University, to talk about the assassination 0:13:10.356 --> 0:13:14.236 of Robert Kennedy, because it seemed like looking at Kennedy's 0:13:14.276 --> 0:13:17.116 injuries through the lens of the present day would be 0:13:17.156 --> 0:13:29.996 a good way to try and answer this question. There 0:13:30.076 --> 0:13:34.396 is a long tradition among trauma surgeons of speculating about 0:13:34.436 --> 0:13:37.396 which famous shooting of a political figure would have turned 0:13:37.396 --> 0:13:41.716 out differently given today's medical nohow. If you flip through 0:13:41.756 --> 0:13:45.316 trauma surgery journals, you can find all kinds of examples. 0:13:45.836 --> 0:13:48.116 By the way, you can't play this game if you're 0:13:48.156 --> 0:13:51.476 a trauma surgeon in Canada because they've never had any 0:13:51.516 --> 0:13:55.756 of their leaders assassinated, or England because they've had just one. 0:13:55.916 --> 0:13:59.036 France had one president's stab to death in eighteen ninety four, 0:13:59.516 --> 0:14:02.716 and in nineteen thirty two, President Paul Dumaer was gonned 0:14:02.716 --> 0:14:06.756 down by a Russian anarchist. Germany not really no one 0:14:06.836 --> 0:14:08.876 major unless you want to count the killing of the 0:14:08.916 --> 0:14:11.716 Form Minister in nineteen twenty two. But in the United 0:14:11.756 --> 0:14:16.236 States you can play this game for days. You've got 0:14:16.276 --> 0:14:19.596 Abraham Lincoln in eighteen sixty five, shot to the head 0:14:19.796 --> 0:14:22.716 from a forty four derringer pistol. Does he live today? 0:14:23.396 --> 0:14:25.836 A couple of years ago, a group of neurosurgeons at 0:14:25.836 --> 0:14:29.436 Brigham and Women's Hospital in Boston re examined his autopsy 0:14:29.476 --> 0:14:33.276 records and concluded, probably not. It was the worst kind 0:14:33.316 --> 0:14:36.756 of head injury. What about James Garfield twentieth President of 0:14:36.796 --> 0:14:40.196 the United States, shot twice. The second bullet hit him 0:14:40.196 --> 0:14:43.156 in the back, missing the spinal cord and embedding itself 0:14:43.196 --> 0:14:46.356 behind his pancreas. He's rushed to the hospital. It's a 0:14:46.356 --> 0:14:49.396 minor injury, but they get obsessed with taking out the 0:14:49.436 --> 0:14:53.076 bullet and that contaminates the wound. He's shot in June. 0:14:53.356 --> 0:14:56.876 He dies in September because of a sepsis infection. He 0:14:56.956 --> 0:15:02.116 survives today easy. William mc kinley is next September sixth, 0:15:02.236 --> 0:15:06.436 nineteen oh one, shot twice in the abdomen. He lives today. 0:15:07.236 --> 0:15:14.636 JFK no. He's dead on arrival at the hospital, but go. 0:15:14.676 --> 0:15:17.796 To nineteen eighty. Ronald Reagan a sixty nine year old 0:15:17.836 --> 0:15:21.636 man with a gunshot wound to the left chest. He 0:15:21.676 --> 0:15:24.916 doesn't survive. In nineteen hundred, he doesn't survive in nineteen twenty. 0:15:25.876 --> 0:15:29.556 He might have survived in nineteen forty whose blood transfusion 0:15:29.556 --> 0:15:33.476 he needed blood. I am nineteen sixty, but certainly a 0:15:33.516 --> 0:15:36.076 sixty nine year old gunshot womb. The chess were the 0:15:36.076 --> 0:15:39.236 first one hundred plus years of our history would largely 0:15:39.316 --> 0:15:40.596 be largely be fatal. 0:15:42.316 --> 0:15:45.516 If Ronald Reagan had died of his wounds. The way Lincoln, 0:15:45.716 --> 0:15:49.396 McKinley and Garfield did, the world would have been very different. 0:15:50.076 --> 0:15:53.316 He shot in March nineteen eighty one. He's just two 0:15:53.316 --> 0:15:57.156 months into one of the most consequential presidencies in American history. 0:15:57.796 --> 0:16:00.876 Does the Berlin Wall fall in nineteen eighty nine without 0:16:00.916 --> 0:16:05.876 Reagan in office? Maybe, but maybe not. History is shaped 0:16:06.036 --> 0:16:09.556 not just by assassin's bullets, but also by the ability 0:16:09.556 --> 0:16:13.156 of doctors to treat the damage done by assassin's bullets. 0:16:13.876 --> 0:16:16.996 It's the Robert Kennedy case though, that caught my eye. 0:16:18.276 --> 0:16:21.196 I wanted just to start, how did you come to 0:16:21.236 --> 0:16:25.596 be interested in revisiting the assassination of Robert Kennedy? 0:16:25.796 --> 0:16:27.796 So I was walking through the hallway one day came 0:16:27.836 --> 0:16:30.876 across Ted Pappis, who's one of our general surgeons, and 0:16:30.956 --> 0:16:38.156 he had done a series of historical works, and he said, 0:16:38.596 --> 0:16:41.116 you know, have you ever heard about Robert Kennedy? And 0:16:41.196 --> 0:16:43.716 which seems like kind of an odd question because everyone's 0:16:43.836 --> 0:16:46.556 I would think I heard about Robert Kennedy. And he said, well, 0:16:46.556 --> 0:16:48.156 I think I may have gotten a hold of some 0:16:48.196 --> 0:16:52.036 of the original documents related to his assassination. Would you 0:16:52.116 --> 0:16:53.916 be interested in combing through them with me? 0:16:55.236 --> 0:16:58.356 So Commsero sits down with his colleagues. It goes through 0:16:58.356 --> 0:17:02.756 what papus has found, autopsy reports, testimony from the surgeons 0:17:02.796 --> 0:17:07.676 who treated Kennedy, and they reconstruct the case. So walk 0:17:07.716 --> 0:17:09.716 me through what happens to him at he shot. 0:17:11.356 --> 0:17:14.796 Yeah, so you know, I've always sort of envisioned this 0:17:14.876 --> 0:17:18.236 chaotic scene where you know, his limited security and his 0:17:18.356 --> 0:17:22.916 chief of staff went and saw sought the available the 0:17:22.956 --> 0:17:25.116 assistance of the available physicians. 0:17:26.036 --> 0:17:27.836 He's lying on the ground in the kitchen of the 0:17:27.876 --> 0:17:33.196 Ambassador Hotel. Today they would be Secret Service protection, contingency plans, 0:17:33.476 --> 0:17:36.116 an ambulance on call. There was nothing like that in 0:17:36.196 --> 0:17:40.236 nineteen sixty eight. For bodyguards. Kennedy has two celebrity athletes, 0:17:40.596 --> 0:17:43.716 the football player Rosie Grier and the Olympic gold medal 0:17:43.796 --> 0:17:47.196 decathlete Ray for Johnson. No one is prepared for this 0:17:47.316 --> 0:17:48.196 kind of emergency. 0:17:48.916 --> 0:17:55.476 And then this is sort of where the Senator then 0:17:55.476 --> 0:17:58.196 gets on lucky and where a lot of victims get 0:17:58.196 --> 0:18:01.636 on lucky. Is he is taken to sort of the 0:18:01.676 --> 0:18:06.916 closest hospital, but not necessarily the facility that's best equipped 0:18:06.956 --> 0:18:08.756 to care for someone who had been shot in the head. 0:18:09.396 --> 0:18:13.116 Kennedy gets taken to Central Receiving Hospital on sixth Street, 0:18:13.476 --> 0:18:16.636 just west of downtown. They stabilize him there, but they 0:18:16.636 --> 0:18:20.116 don't have a neurosurgeon, so he has to be retransported 0:18:20.356 --> 0:18:24.276 to Good Samaritan Hospital just stuff Wilshire. And what did 0:18:24.356 --> 0:18:27.356 that that mistake cost him? How much time. 0:18:28.716 --> 0:18:31.596 I calculated in the paper and let me double check. 0:18:37.756 --> 0:18:40.476 So he got to the operating room a Good Samaritan 0:18:40.756 --> 0:18:42.956 two and a half hours after the shooting. 0:18:43.276 --> 0:18:45.676 Two and a half hours. In your world, two and 0:18:45.716 --> 0:18:47.916 a half hours is a long time, is. 0:18:47.876 --> 0:18:48.716 A very long time. 0:18:49.996 --> 0:18:53.476 Yeah, So he gets he gets to Good Samaritan to 0:18:53.556 --> 0:18:54.076 what happens. 0:18:54.556 --> 0:18:59.756 So they finish stabilizing him, they inspect for his other runds, 0:18:59.796 --> 0:19:02.676 and then they decide pretty quickly to take him to surgery. 0:19:03.356 --> 0:19:08.876 And they they wound up removing you know, roughly about 0:19:08.876 --> 0:19:11.796 a five centimeter two and a half inch piece of 0:19:11.876 --> 0:19:14.676 bone surrounding where he was shot in the back of 0:19:14.716 --> 0:19:20.316 the head, right behind the ear, and to breed which 0:19:20.396 --> 0:19:22.716 was the standard of the day, sort of everything that 0:19:22.756 --> 0:19:28.596 looked abnormal along the bullet track, tried to remove fragments 0:19:28.596 --> 0:19:32.756 of his skull and then brought him back to the 0:19:32.796 --> 0:19:35.956 intensive care unit where they tried to cool him, which 0:19:36.036 --> 0:19:39.196 was a sort of common practice at the time, to 0:19:39.236 --> 0:19:43.316 reduce swelling in the brain. They gave him medications, specifically 0:19:43.356 --> 0:19:47.476 steroids in something called manitol, which is a diuretic. Both 0:19:47.516 --> 0:19:49.876 of those are aimed at reducing swelling of the brain, 0:19:50.516 --> 0:19:54.116 one of which manatol, is still very commonly used today. 0:19:55.116 --> 0:19:57.876 Dexamethasone is no longer used for this type of injury, 0:19:57.996 --> 0:20:03.196 based upon data from large clinical trials that occurred long 0:20:03.236 --> 0:20:03.636 after this. 0:20:03.716 --> 0:20:07.796 Of course, he was in a coma. He never came 0:20:07.836 --> 0:20:11.156 out of it. He was pronounced dead at one forty 0:20:11.156 --> 0:20:16.116 four am the next morning. So now let's redo this. 0:20:16.596 --> 0:20:19.796 But it's twenty twenty three. There's no delay today. Right today, 0:20:19.836 --> 0:20:22.436 he's if you're shot in the Ambassador Hotel in La today, 0:20:22.436 --> 0:20:24.356 where do you go? Where's the nearest trauma center? 0:20:26.876 --> 0:20:30.876 I believe the closest Level ones trauma center is probably 0:20:31.036 --> 0:20:33.516 USC But yes, you would go straight to a Level 0:20:33.556 --> 0:20:34.396 one trauma center. 0:20:35.036 --> 0:20:38.516 A Level one trauma center is a recent invention, a 0:20:38.596 --> 0:20:42.316 high tech, on demand medical unit attached to a traditional 0:20:42.356 --> 0:20:46.436 hospital with every kind of specialist on call twenty four 0:20:46.476 --> 0:20:49.476 hours a day, and you would get there, I. 0:20:49.436 --> 0:20:50.796 Mean today, rather rapidly. 0:20:50.876 --> 0:20:52.956 Today he gets So he arrives at at a level 0:20:52.996 --> 0:20:55.476 one trauma center. Let's just say for the sake of argument, 0:20:55.516 --> 0:21:00.636 it's fifteen minutes. Yeah, the and in your so the 0:21:00.676 --> 0:21:02.956 difference between two and a half hours and fifteen minutes 0:21:03.036 --> 0:21:03.556 in your. 0:21:03.396 --> 0:21:07.476 World is might as well be a year. 0:21:07.956 --> 0:21:13.596 Yeah, yeah, And when he gets there, he's treated very differently. 0:21:14.956 --> 0:21:20.516 So at Duke, the neurosurgery team that's in the hospital, 0:21:20.956 --> 0:21:24.916 which is for us always a resident and potentially always 0:21:24.916 --> 0:21:27.436 a faculty member. The rest of the trauma team would 0:21:27.436 --> 0:21:30.756 be paged ahead of time and waiting for the patient 0:21:31.636 --> 0:21:32.476 when they arrived. 0:21:32.556 --> 0:21:36.196 In the resuscitation day, Kennedy got an X ray once 0:21:36.236 --> 0:21:39.396 he arrived, a one dimensional image that made it hard 0:21:39.396 --> 0:21:43.076 for the surgeons to know exactly where his bullet was. Today, 0:21:43.436 --> 0:21:47.476 he'd get an immediate CT scan in three D, an 0:21:47.516 --> 0:21:49.596 extraordinarily detailed image. 0:21:50.396 --> 0:21:53.676 In most trauma centers, including Duke, there is a CT 0:21:53.796 --> 0:21:56.396 scanner that is about ten feet from where the patients 0:21:56.436 --> 0:22:00.196 first arrive, so there's very little care, very little delay. 0:22:00.956 --> 0:22:04.676 You finish the CT scan, you're how many how many 0:22:04.756 --> 0:22:06.796 minutes in are you from the moment the patient has 0:22:06.876 --> 0:22:08.316 arrived at the hospital. 0:22:09.196 --> 0:22:13.236 Unless the patient was so unstable in terms of their 0:22:13.236 --> 0:22:16.156 blood pressure or heart rate that that required additional stabilization 0:22:16.236 --> 0:22:18.476 that should be occurring within ten or fifteen minutes. 0:22:19.556 --> 0:22:22.716 Commasaro began to talk through the difference between how a 0:22:22.756 --> 0:22:26.236 brain injury like Kennedy's was treated in nineteen sixty eight 0:22:26.876 --> 0:22:29.756 versus today. He gave me close to an hour of 0:22:29.836 --> 0:22:36.476 technical description, step by step. So in sixty eight, given 0:22:36.556 --> 0:22:39.636 standard of care and the extent of his injuries, he 0:22:39.756 --> 0:22:42.316 has zero chance of survival. 0:22:43.156 --> 0:22:45.076 About as close to zero as you can get. 0:22:45.236 --> 0:22:48.876 Yeah, what's what's his percent survival chance today? He's not 0:22:48.996 --> 0:22:51.916 dying at two forty five the next morning under this protocol? 0:22:52.676 --> 0:22:54.596 I think it is far less likely he is dying 0:22:54.636 --> 0:22:56.276 at two forty five the next forty Yeah. 0:22:56.356 --> 0:22:56.796 Yeah. 0:22:57.076 --> 0:23:01.276 Listening to you describe the differences between sixty eight and 0:23:01.356 --> 0:23:05.156 the present day, it sounds like night and day. You 0:23:05.236 --> 0:23:08.116 have the same intention today as they did in sixty eight, 0:23:09.276 --> 0:23:12.876 reduced to swelling in the brain, repair, stop the bleeding, 0:23:13.396 --> 0:23:15.916 but the ways in which you're going out about doing 0:23:15.956 --> 0:23:20.956 that are markedly different, totally, markedly different. How do I 0:23:21.036 --> 0:23:23.716 describe the leap that's been made between then and now? 0:23:24.236 --> 0:23:26.956 What's it like. Is it like I've driven in a 0:23:27.036 --> 0:23:29.756 car from nineteen sixty eight. It doesn't seem like it 0:23:29.796 --> 0:23:34.396 belongs to a different paradigm than a car today. 0:23:35.116 --> 0:23:39.956 It's the difference between a bicycle and an electric car. 0:23:40.516 --> 0:23:46.876 Oh okay, yeah, that makes a lot of sense. Oh 0:23:46.916 --> 0:23:51.916 that's huge. So what does commasarows? What if on the 0:23:51.956 --> 0:23:57.916 Kennedy assassination tell us that medicines contribution to falling homicide 0:23:57.996 --> 0:24:02.956 rates is a very big deal bicycles to electric cars. 0:24:03.796 --> 0:24:06.836 Here's a back of the envelope calculation on how big 0:24:06.876 --> 0:24:11.476 this effect is from the University of Massachusetts in two 0:24:11.556 --> 0:24:15.916 thousand and two. Estimated improvements in traumacare probably lower the 0:24:15.916 --> 0:24:18.836 death rate from serious injury about two point five to 0:24:18.876 --> 0:24:23.676 four percent a year. So if nothing else changes, if 0:24:23.716 --> 0:24:26.876 there's still just as many would be murderers walking around, 0:24:27.396 --> 0:24:29.396 that's how much your murder rate is going to fall 0:24:29.436 --> 0:24:32.556 every year on its own. Let me quote to you 0:24:32.596 --> 0:24:36.996 from their conclusion. Compared to nineteen sixty, the year our 0:24:37.036 --> 0:24:42.076 analysis begins, we estimate that without these developments in medical technology, 0:24:42.556 --> 0:24:46.356 there would have been between forty five thousand and seventy 0:24:46.556 --> 0:24:50.996 thousand homicides annually. The past five years instead of an 0:24:51.116 --> 0:24:56.956