WEBVTT - Guns Part 5: The Footnote 0:00:15.356 --> 0:00:15.796 Pushkin. 0:00:20.236 --> 0:00:24.556 I read footnotes. I always have. Perhaps it seems like 0:00:24.596 --> 0:00:27.156 good manners to read everything someone else has written for you, 0:00:27.756 --> 0:00:32.116 like cleaning your plate when you're a kid. Or maybe 0:00:32.156 --> 0:00:34.436 it's because a footnote is where you put the bit 0:00:34.476 --> 0:00:38.116 of information that doesn't quite fit the main story, but 0:00:38.196 --> 0:00:40.636 at the same time is too important to leave out. 0:00:41.916 --> 0:00:44.956 And to my mind, the thing that is important and 0:00:45.036 --> 0:00:48.716 doesn't fit is often the most important thing of all. 0:00:49.996 --> 0:00:53.956 So I read footnotes, and occasionally that leads me somewhere 0:00:54.116 --> 0:00:58.796 entirely unexpected, like the footnote at the very end of 0:00:58.836 --> 0:01:02.836 a paper in the Journal of Criminal Justice entitled Damned 0:01:02.916 --> 0:01:07.396 upon Arrival, volume twenty three, number four, pages three thirteen 0:01:07.716 --> 0:01:13.276 to three, twenty three, nineteen ninety five. Lead author Penelope J. Hanke, 0:01:13.996 --> 0:01:19.876 Second author James H. Goodluck. It made me go all 0:01:19.916 --> 0:01:22.596 the way to a little town in Alabama to have 0:01:22.676 --> 0:01:25.476 the man who wrote the footnote explained to me thirty 0:01:25.556 --> 0:01:31.236 years later, just what it meant. Could you do me 0:01:31.236 --> 0:01:31.596 a favorite? 0:01:31.636 --> 0:01:33.876 Can you read that? Read the footnote for me? 0:01:36.676 --> 0:01:43.596 Small print At three or two am on September the 0:01:43.636 --> 0:01:47.596 twenty third, nineteen ninety four, a little over a month 0:01:47.676 --> 0:01:51.276 after doctor Hanche and I submitted this article to the 0:01:51.276 --> 0:01:56.196 Ejournal of Criminal Justice. A death following the pattern described 0:01:56.196 --> 0:02:02.716 in this article little Stuckholm Jay Brandon Young, age seventeen 0:02:02.796 --> 0:02:05.196 were shot in the back with a twelve gay shotgun 0:02:05.276 --> 0:02:09.996 and killed in my house and a predominantly black part 0:02:09.996 --> 0:02:15.276 of rue Macon County, Alabama. 0:02:15.996 --> 0:02:19.356 My name is Malcolm Gladwell. You're listening to Revisionist History, 0:02:19.596 --> 0:02:26.076 my podcast about things overlooked and misunderstood. This episode is 0:02:26.116 --> 0:02:42.436 about the death of Brandon Young. James Gunlock lives in Shorter, Alabama, 0:02:42.716 --> 0:02:46.156 a little town just south of Tuskegee along I eighty five. 0:02:46.836 --> 0:02:50.156 Some parts of Alabama are wild and hilly. This is 0:02:50.196 --> 0:02:54.116 the other side of the state, flat swampy pine trees. 0:02:54.516 --> 0:02:57.756 Macon County one of the eighteen counties that make up 0:02:57.796 --> 0:03:01.156 the Black Belt of Alabama, where the cotton plantations were 0:03:01.396 --> 0:03:05.196 in the days before the Civil War. Gundlock lives with 0:03:05.276 --> 0:03:09.396 his wife in an eighteen forties plantation house, a doctress house. 0:03:10.036 --> 0:03:13.196 The old slave quarters are in the basement directly below 0:03:13.236 --> 0:03:15.996 the old surgery, so the slave stove could heat the 0:03:15.996 --> 0:03:20.636 doctor's offices during the winter. Two enormous Anatolian shepherds pat 0:03:20.676 --> 0:03:25.236 around presenting their giant heads for attention. The house looks 0:03:25.356 --> 0:03:28.756 untouched from the nineteenth century. There's an abandoned truck in 0:03:28.796 --> 0:03:29.396 the backyard. 0:03:31.836 --> 0:03:32.836 I grew up tough. 0:03:35.156 --> 0:03:39.596 I was a World War two baby, and my father 0:03:39.716 --> 0:03:42.076 came back from the war mentally messed up, and he 0:03:42.156 --> 0:03:47.556 became an alcoholic. And we lived on a farm, and 0:03:48.356 --> 0:03:51.036 he would take off on a drinking branch, taking my 0:03:51.116 --> 0:03:53.396 mother with him, and be gone for days. 0:03:54.676 --> 0:03:59.356 Gun Luck is tall, stooped, wisps of white hair. He 0:03:59.436 --> 0:04:00.756 moves and talks slowly. 0:04:01.796 --> 0:04:06.636 That continued on. When I was eleven, we ran out 0:04:06.676 --> 0:04:12.836 of the food and I saw this flock of blackbirds crows, 0:04:14.796 --> 0:04:17.756 and so I took the twelve gate shotgun and my 0:04:17.876 --> 0:04:20.076 brother and I we went up and stuck up on him. 0:04:20.356 --> 0:04:22.516 And as soon as I started flying, I went I 0:04:22.556 --> 0:04:25.756 got two shots off, and that's I was talking to you. 0:04:25.796 --> 0:04:30.196 My brother, reminiscing about this, said, yeah, if you said, 0:04:30.236 --> 0:04:32.596 your whope shoulder hurts so much, you may may go 0:04:32.676 --> 0:04:37.836 pick up all the dead birds. But we sat there, 0:04:37.996 --> 0:04:40.516 started the fire, stripped and dressed out the birds, and 0:04:40.556 --> 0:04:43.156 all the roasted them just to be able to have food. 0:04:46.916 --> 0:04:50.036 He escaped home by enrolling in the Army, went to college, 0:04:50.396 --> 0:04:54.276 then graduate school, then to Alabama and taught sociology at 0:04:54.316 --> 0:04:58.036 Auburn University. One time he caught a huge cheating ring 0:04:58.236 --> 0:05:01.476 going on with teachers in this department and football players, 0:05:01.636 --> 0:05:04.516 and blew the whistle. Made the New York Times in 0:05:04.556 --> 0:05:06.836 one of the most football crazed states in the country. 0:05:07.516 --> 0:05:08.676 He went, after football. 0:05:09.676 --> 0:05:12.156 Today's the twenty eighth day of my eighty first year. 0:05:12.476 --> 0:05:17.716 So I'm on the old side. And six months after 0:05:17.756 --> 0:05:20.796 I retired, I had an encephalitis infection to the brain. 0:05:22.396 --> 0:05:27.436 And I survived that when I was sixty six, which 0:05:27.476 --> 0:05:31.636 is quite rare. But when I came to from it 0:05:31.716 --> 0:05:37.836 in the hospital, I had company, but I couldn't think 0:05:38.076 --> 0:05:41.636 of I couldn't take the words to say what I 0:05:41.636 --> 0:05:43.516 wanted to say. 0:05:43.636 --> 0:05:47.236 He forced himself to go through the alphabet A to Z, 0:05:47.756 --> 0:05:50.076 counting all the words he knew that began with each letter. 0:05:50.356 --> 0:05:52.396 He came up with one hundred and ninety six. 0:05:53.236 --> 0:05:56.196 My first conclusion was that I was essentially brain dead. 0:05:56.196 --> 0:06:00.396 I might as well put myself down. Then after I 0:06:00.436 --> 0:06:02.756 thought of it, I thought, well, the way I measured 0:06:02.796 --> 0:06:05.556 it meant that I'm not completely brain dead. So I 0:06:05.796 --> 0:06:08.396 just decided to gets the suicide. 0:06:09.396 --> 0:06:12.956 Slowly he recovered built himself back up. He was working 0:06:12.956 --> 0:06:15.596 on a new paper when we spoke, an analysis of 0:06:15.596 --> 0:06:19.156 health insurance status and mortality rates. By the way, you 0:06:19.196 --> 0:06:21.716 will hear all kinds of strange noises in the background 0:06:21.876 --> 0:06:23.356 as you listen to Gundlock talking. 0:06:24.556 --> 0:06:27.316 Let me go turn that thing off. Okay, my wife 0:06:27.316 --> 0:06:30.036 always leaves it unbalanced and it makes it a lot 0:06:30.076 --> 0:06:34.436 of noise. And if I'm going off on tangents that 0:06:34.556 --> 0:06:36.476 you're not interested in, but. 0:06:36.436 --> 0:06:37.516 What actually. 0:06:38.636 --> 0:06:40.556 Some of what you're talking about now feeds into what 0:06:40.636 --> 0:06:42.916 I want to speak to. So sure, why don't we 0:06:42.956 --> 0:06:46.156 start with the stuff that was interested me the most, 0:06:46.196 --> 0:06:49.716 which was I read that damned on a rival paper 0:06:51.116 --> 0:06:56.516 and I just thought it was fascinating and I wanted 0:06:56.516 --> 0:06:58.756 to kind of talk to you a little bit about that, 0:06:58.796 --> 0:07:00.236 and that'd be a good place to start. 0:07:00.396 --> 0:07:00.716 Okay. 0:07:01.516 --> 0:07:03.836 We talked a little about the paper, and then James 0:07:03.876 --> 0:07:06.996 Gunlock went off on what seemed like one of his tangents, 0:07:07.316 --> 0:07:10.556 although as I found out, it wasn't really a tangent 0:07:10.596 --> 0:07:14.436 at all. It was about the time back in the 0:07:14.476 --> 0:07:16.836 early nineteen nineties when he got a call from his 0:07:16.916 --> 0:07:19.716 brother his brother's daughter had run away. 0:07:20.596 --> 0:07:22.836 The police called him and ask him why he hadn't 0:07:22.876 --> 0:07:28.236 canceled the missing child. He said, well, she's not back home, 0:07:28.316 --> 0:07:32.156 and they said, Welching's never missed school. She worked out 0:07:32.196 --> 0:07:34.996 a system by where she was just staying with friends 0:07:35.276 --> 0:07:41.236 overnight in sequence and just avoiding going home by living 0:07:42.036 --> 0:07:44.076 out in the world and still going to school. 0:07:44.996 --> 0:07:47.916 Gun Luck took his niece in. She was about fourteen, 0:07:48.476 --> 0:07:51.516 so is his daughter. Now he had two teenagers under 0:07:51.516 --> 0:07:51.916 his roof. 0:07:52.676 --> 0:07:56.796 She eventually decided that we were such good parents that 0:07:56.876 --> 0:07:59.876 she found a couple of street boys had been thrown 0:07:59.876 --> 0:08:02.156 out of their own homes, and we ended up taking 0:08:02.196 --> 0:08:02.476 them in. 0:08:03.916 --> 0:08:06.236 They were living in Montgomery then, and parts of the 0:08:06.276 --> 0:08:10.236 city were full of gangs, the bloods, the grips, the disciples. 0:08:10.596 --> 0:08:12.796 Word got out that the Gunlux house was a place 0:08:12.836 --> 0:08:13.636 of refuge. 0:08:14.276 --> 0:08:19.596 One time, we had this big lizard, and the lizard 0:08:19.636 --> 0:08:22.636 got out, so I was going around looking for it, 0:08:23.556 --> 0:08:26.676 and I looked under the bed and there was this boy. 0:08:28.636 --> 0:08:31.556 And I looked at him and he said, I guess 0:08:31.596 --> 0:08:38.236 you want to know why I'm here. And he was 0:08:38.316 --> 0:08:42.276 just kind of a temporary close eye street kid. He 0:08:42.476 --> 0:08:44.756 was sort of staying in our house to be out 0:08:44.996 --> 0:08:49.836 off the street and stuff without having contact with adults 0:08:49.876 --> 0:08:50.356 in the house. 0:08:53.476 --> 0:08:56.356 I sat in a small chair next to gunlux desk 0:08:56.716 --> 0:08:59.276 as he talked about the kids he took in, boys 0:08:59.276 --> 0:09:02.156 and gangs, boys living off the street, who stole car 0:09:02.236 --> 0:09:04.716 radios to stay alive and drank cheap liquor to stay 0:09:04.756 --> 0:09:07.636 warm at night. What is it about you do you 0:09:07.676 --> 0:09:10.596 think that led you to take in so many of 0:09:10.596 --> 0:09:11.156 these kids. 0:09:11.596 --> 0:09:15.396 Well, I think it was ruined in the time that 0:09:15.476 --> 0:09:20.676 our parents left us alone on the farm. That I 0:09:20.796 --> 0:09:27.836 can really relate to kids not having parental support and 0:09:28.076 --> 0:09:30.596 subsistence support and other kinds of things. 0:09:32.316 --> 0:09:34.236 One of the kids they took in came from a 0:09:34.236 --> 0:09:37.076 little town called Valley in the northern part of the state, 0:09:37.436 --> 0:09:41.396 an old textile town. He was seventeen. He was involved 0:09:41.476 --> 0:09:44.156 in one of Montgomery's many gangs, but he was looking 0:09:44.156 --> 0:09:48.236 for a way out. His name was Brandon Young. How 0:09:48.276 --> 0:09:49.636 long did Brandon live with you? 0:09:52.836 --> 0:09:54.636 Probably only about six months. 0:09:54.836 --> 0:10:00.196 Yeah, but you got to know him, well, oh yeah, 0:10:00.356 --> 0:10:05.236 at first he was very you know, reserved and suspicious 0:10:05.276 --> 0:10:06.476 and other things. 0:10:06.516 --> 0:10:08.556 But you know, as we got to know him and 0:10:08.636 --> 0:10:11.276 stuff opened up and we talked about time she. 0:10:12.116 --> 0:10:15.396 And then James Gunlock started talking again about the paper 0:10:15.476 --> 0:10:50.956 he wrote with Penealty Hanky damned upon arrival. The number 0:10:50.956 --> 0:10:54.396 of homicides in any community is a combination of two 0:10:54.476 --> 0:10:58.796 completely unrelated variables. The number of people victimized by acts 0:10:58.836 --> 0:11:01.876 of violence minus how good a job the medical system 0:11:01.956 --> 0:11:05.236 does at saving the lives of those victims. And a 0:11:05.276 --> 0:11:07.996 lot of times, what a murder rate really tells you 0:11:08.476 --> 0:11:11.036 is how good you're doctors are, and not how safe 0:11:11.036 --> 0:11:14.236 your streets are. This is the idea we explored in 0:11:14.276 --> 0:11:18.716 the previous episode. But there's a twist on that observation, 0:11:19.156 --> 0:11:22.716 a really important twist which the people who treat gunshots 0:11:22.756 --> 0:11:25.876 for a living have known about for a long time. 0:11:26.836 --> 0:11:30.116 So I'm assuming over the course of your career you 0:11:30.196 --> 0:11:33.516 have treated innumerable gunshot wounds. 0:11:34.236 --> 0:11:36.036 Unfortunately true. 0:11:36.036 --> 0:11:40.236 This is doctor Babach Serrani. He's a trauma surgeon at 0:11:40.276 --> 0:11:44.316 George Washington University Hospital in Washington, d C. If you 0:11:44.356 --> 0:11:46.916 get seriously injured by a bullet, you get taken to 0:11:46.956 --> 0:11:50.756 a trauma center, more specifically a Level one trauma center, 0:11:51.036 --> 0:11:54.596 which is a self contained, twenty four hour facility equipped 0:11:54.596 --> 0:12:01.316 with everything necessary to treat traumatic injury, general surgeons, orthopedic surgeons, neurosurgeons, 0:12:01.316 --> 0:12:06.116 plastic surgeons, and the caesiologists, er docs, radiologists, nurses with 0:12:06.156 --> 0:12:11.076 the right qualifications on and on. Trauma centers cost hundreds 0:12:11.116 --> 0:12:14.596 of millions of dollars to build and operate. They're relatively rare. 0:12:14.956 --> 0:12:18.876 DC has thirteen hospitals, but only four level ones. One 0:12:18.916 --> 0:12:22.356 of those is at George Washington. Serrani is the chief 0:12:22.436 --> 0:12:26.236 trauma sursion there. Do you know how many, roughly. 0:12:25.996 --> 0:12:31.556 Speaking, Oh, my goodness, I would think probably by now 0:12:32.276 --> 0:12:34.636 the number of gunshrare victims I've seen personally. I've been 0:12:34.636 --> 0:12:39.116 in practice since two thousand and five, I would venture 0:12:39.316 --> 0:12:41.396 miss Bladwell five hundred plus. 0:12:41.636 --> 0:12:41.996 Wow. 0:12:42.556 --> 0:12:46.756 Yeah, And you weren't even there during DC's darkest years. 0:12:46.756 --> 0:12:48.036 Correct, yeah, correct. 0:12:48.676 --> 0:12:52.716 I wanted to talk to Serrani about time because trauma 0:12:52.716 --> 0:12:56.356 sursions are obsessed with time. There's a phrase common in 0:12:56.396 --> 0:12:59.956 their world, the golden hour. If you get shot, they 0:12:59.996 --> 0:13:02.396 really want to have you on the operating table as 0:13:02.436 --> 0:13:05.796 soon as possible. That's why we pull over for ambulances. 0:13:06.796 --> 0:13:09.556 Talk a little to me about time. You said, tends 0:13:09.556 --> 0:13:11.116 to get there within ten minutes, and you tend to 0:13:11.116 --> 0:13:13.996 get to the trauma center between twenty and forty five. 0:13:14.876 --> 0:13:18.036 What's the difference between twenty and forty five. What happens 0:13:18.076 --> 0:13:21.516 in that extra period of time that would diminish someone's 0:13:21.596 --> 0:13:22.476 chances of survival? 0:13:22.596 --> 0:13:25.396 Yeah, I think it depends on where the injury is. 0:13:25.476 --> 0:13:27.236 You know, if you've been injured in the abdomen and 0:13:27.236 --> 0:13:29.956 it hits your intestine, honestly, nothing will happen between twenty 0:13:29.996 --> 0:13:32.836 and forty five minutes. That's plenty of time. But if 0:13:32.836 --> 0:13:36.796 you're bleeding, specifically speaking, if you're bleeding, then every minute 0:13:36.836 --> 0:13:39.276 that goes by is you know, the value of that 0:13:39.436 --> 0:13:40.156 is plutonium. 0:13:41.116 --> 0:13:43.756 Like, for example, if you take a bullet to your liver, 0:13:44.396 --> 0:13:46.796 the liver is a maze of blood vessels. 0:13:47.476 --> 0:13:51.636 Making the liver, of all things, stop bleeding is exceedingly difficult. 0:13:51.956 --> 0:13:53.916 You know, kidney, I can take it out, you have 0:13:53.956 --> 0:13:56.396 two kidneys, spleen, I can take it out. You don't 0:13:56.396 --> 0:13:58.636 need a spleen. I cannot take out your liver that 0:13:58.716 --> 0:14:01.436 you need a liver to live, and so I'm obligated 0:14:01.476 --> 0:14:03.636 to try to repair it while it just continues to bleed. 0:14:04.276 --> 0:14:07.316 When we spoke, Surrouni had just treated someone who had 0:14:07.316 --> 0:14:08.836 taken a rifle shot to the liver. 0:14:09.596 --> 0:14:11.956 The reason he's alive, and I will take some credit 0:14:11.996 --> 0:14:14.356 at George Washington, but honestly, one of the bigger reasons 0:14:14.356 --> 0:14:17.996 he's alive is the paramedics. They completely scooped and ran 0:14:18.036 --> 0:14:20.556 with this guy. I think their entire scene time was 0:14:20.676 --> 0:14:24.116 like ten or twelve minutes, and they just high tailed 0:14:24.116 --> 0:14:26.156 it to the trauma center. When he showed up on 0:14:26.196 --> 0:14:29.756 our doorstep. You figure by now it's been twenty twenty 0:14:30.116 --> 0:14:32.276 five minutes of the most from the moment of wounding 0:14:32.396 --> 0:14:37.356 to arrival to the trauma center. He was probably five 0:14:37.396 --> 0:14:39.676 to ten minutes away from dying. He was the extreme 0:14:39.836 --> 0:14:40.556 end stages of. 0:14:40.516 --> 0:14:44.236 Shock or what about a bullet to the lungs? 0:14:44.636 --> 0:14:46.796 A paramedic can actually treat a gunshot win to the lung. 0:14:46.796 --> 0:14:48.636 They can temporize that person very nicely. 0:14:48.996 --> 0:14:49.476 So do that. 0:14:49.556 --> 0:14:52.596 How do you temporize someone who's had a gunshot win 0:14:52.676 --> 0:14:53.156 to the lung? 0:14:53.836 --> 0:14:56.276 So, when you have a gunshot to the lung, assuming 0:14:56.276 --> 0:14:58.556 it has not hit a blood vessel, assuming you're not bleeding, 0:14:58.596 --> 0:15:00.636 all you have is a gunshot to the lung, which 0:15:00.636 --> 0:15:05.436 is I believe or not really really common. The problem 0:15:05.556 --> 0:15:08.036 is you have air leaking from your lung and that 0:15:08.116 --> 0:15:12.196 air is accumul inside the chest. As that air collects 0:15:12.236 --> 0:15:13.916 more and more inside the chest because it's leaking out 0:15:13.916 --> 0:15:16.076 of lung, it'll create a lot of pressure in the 0:15:16.156 --> 0:15:19.636 chest and it'll cause it'll alter the blood flow to 0:15:19.716 --> 0:15:23.076 your body. So the paramedic can simply put a needle 0:15:23.276 --> 0:15:25.436 inside your chest, believe it or not, just like literally 0:15:25.476 --> 0:15:27.636 in sort of needle through your skin into your chest 0:15:28.076 --> 0:15:30.596 and it's like popping a balloon. It'll allow that air 0:15:30.636 --> 0:15:33.596 that's accumulating to decompress and that's all you have to do. 0:15:34.276 --> 0:15:37.996 That will buy the person then tens of minutes if 0:15:38.036 --> 0:15:41.076 not more, to get to the trauma center to allow 0:15:41.156 --> 0:15:44.356 us to then fix the issue at hand. But that's 0:15:44.396 --> 0:15:45.276 a paramedic. 0:15:44.916 --> 0:15:50.156 Skill absince that intervention that would be a fatal event. Correct, 0:15:50.836 --> 0:15:53.516 Just to deling on this time question for a moment. 0:15:53.916 --> 0:15:56.876 So if I have a gunshot wound to the chest 0:15:56.916 --> 0:16:00.596 and I have exactly happening to me what you just described, 0:16:01.116 --> 0:16:03.796 how much time do I have without an AMS's intervention? 0:16:04.036 --> 0:16:04.556 Half an hour? 0:16:04.956 --> 0:16:06.556 Yeah, probably about half an hour or so, I mean 0:16:06.556 --> 0:16:08.356 plus minus, But yes, I would think. 0:16:08.236 --> 0:16:13.796 So, So let's think through the logic of this, a 0:16:13.836 --> 0:16:17.636 city or country's homicide rate is heavily dependent on how 0:16:17.676 --> 0:16:22.236 good its medical system is at treating gunshot ones. And 0:16:22.276 --> 0:16:25.316 what determines how good a medical system is a treating 0:16:25.316 --> 0:16:28.796 gunshot ones, at least in part, it's how quickly a 0:16:28.796 --> 0:16:33.356 gunshot victim can get to a Level one trauma center. Okay, 0:16:33.516 --> 0:16:37.356 second question, and in this case let's use Chicago as 0:16:37.396 --> 0:16:42.796 our example, classic big American city. Chicago absolutely confirms the 0:16:42.796 --> 0:16:46.956 theory that proximity to a trauma center matters. According to 0:16:46.996 --> 0:16:49.076 a big study done a couple years ago by the 0:16:49.076 --> 0:16:52.916 epidemiologist Marie Crandall, if you live more than five miles 0:16:52.956 --> 0:16:55.636 from a Level one trauma center in Chicago, you had 0:16:55.676 --> 0:16:58.956 a thirty five percent higher chance of dying from your 0:16:58.996 --> 0:17:02.116 wounds than if you were shot less than five miles 0:17:02.156 --> 0:17:06.516 from a level one. So here's the second question. What 0:17:06.716 --> 0:17:10.396 determines how quickly you get too trauma center in Chicago? 0:17:11.196 --> 0:17:14.076 Is it a random fact like whether there's an ambulance 0:17:14.116 --> 0:17:16.556 nearby when you get shot, or how bad the traffic 0:17:16.636 --> 0:17:19.156 is that day on the way to the hospital, or 0:17:19.596 --> 0:17:22.836 is there a pattern to who lives within five miles 0:17:22.836 --> 0:17:26.356 of a level one, and who doesn't. A physician at 0:17:26.396 --> 0:17:30.156 the University of Chicago named Elizabeth Tongue set out to 0:17:30.196 --> 0:17:34.116 answer that question a few years ago, what do you 0:17:34.116 --> 0:17:35.116 find in Chicago? 0:17:36.076 --> 0:17:39.156 And so we found that black majority census tracks were 0:17:39.156 --> 0:17:41.276 disproportionately in these trauma deserts. 0:17:41.716 --> 0:17:44.356 A trauma desert, by the way, is what er docs 0:17:44.396 --> 0:17:47.036 call places that are a long way from a level one. 0:17:47.796 --> 0:17:55.476 That racial disparity was essentially very large, approximately a sevenfold 0:17:55.556 --> 0:17:58.956 increase on the South Side in black communities. 0:17:59.116 --> 0:18:02.476 Wait to explain the sevenfold the racial disparity between what 0:18:02.596 --> 0:18:03.916 and what is sevenfold higher. 0:18:04.156 --> 0:18:07.676 The racial disparity between black majority census tracks and white 0:18:07.676 --> 0:18:13.236 majority census tracks is an x sevenfold sevenfold wow. 0:18:15.476 --> 0:18:18.396 For a period of thirty years between nineteen ninety one 0:18:18.756 --> 0:18:22.316 and twenty eighteen, the south side of Chicago didn't even 0:18:22.476 --> 0:18:25.196 have a Level one trauma center. So if you got 0:18:25.196 --> 0:18:27.196 shot on the south Side, and by the way, the 0:18:27.236 --> 0:18:29.876 south Side is the area of Chicago where you're most 0:18:29.956 --> 0:18:32.756 likely to get shot, the ambulance had to take you 0:18:32.996 --> 0:18:36.236 all the way across the city uptown to Northwestern or 0:18:36.276 --> 0:18:42.156 Cook County or west to advocate Christ Medical Center miles away. Now, 0:18:42.316 --> 0:18:44.596 why did the South Side go so long without a 0:18:44.596 --> 0:18:48.156 trauma center because it makes no sense for any hospital 0:18:48.356 --> 0:18:51.836 to open one on the south Side. Treating gunshot wounds 0:18:52.156 --> 0:18:57.156 serious ones is incredibly expensive, and the typical gunshot victim 0:18:57.196 --> 0:19:00.076 in Chicago is a young black man from a poor neighborhood, 0:19:00.156 --> 0:19:02.956 and young black men living in poor neighborhoods in Chicago 0:19:03.316 --> 0:19:07.076 typically don't have health insurance or they're on Medicaid, which 0:19:07.116 --> 0:19:11.636 reimburses at a fraction of what private insurance does. The 0:19:11.676 --> 0:19:16.036 euphemism used in the healthcare world is payer mix, which 0:19:16.036 --> 0:19:18.316 refers to how many of your patients come to you 0:19:18.436 --> 0:19:22.196 blessed with private coverage. Opening a trauma center in a 0:19:22.236 --> 0:19:27.396 bad neighborhood messes with your payer mix deeply, which is 0:19:27.436 --> 0:19:31.236 a paradox. Right. The point of a trauma center is 0:19:31.276 --> 0:19:33.956 to be closest to the places where people are getting shot. 0:19:34.356 --> 0:19:36.516 But if you put your trauma center close to the 0:19:36.556 --> 0:19:39.836 places where people get shot, your payer mix will go 0:19:39.916 --> 0:19:43.076 to hell in a handbasket and you won't be able 0:19:43.116 --> 0:19:46.476 to afford to run your trauma center. So you put 0:19:46.476 --> 0:19:50.276 your trauma center as far away as possible from the 0:19:50.276 --> 0:19:54.516 people who most need your trauma center. As I said, 0:19:54.636 --> 0:19:57.716 at the very beginning of this series, the way America 0:19:57.756 --> 0:20:07.836 deals with gun violence is bonkers. We have a misaligned 0:20:07.836 --> 0:20:11.076 healthcare system. Yeah, what's the simplest way to realign it. 0:20:11.836 --> 0:20:14.236 I mean, I think the simplest way to realign it 0:20:14.316 --> 0:20:15.596 is nationalized healthcare. 0:20:16.636 --> 0:20:19.156 What she's saying is that if everyone has the same 0:20:19.196 --> 0:20:22.916 insurance like they do in Canada or Europe, then hospitals 0:20:22.996 --> 0:20:25.996 don't have to worry about payamics. You can put your 0:20:26.036 --> 0:20:28.676 trauma center where your trauma center makes the most sense 0:20:28.956 --> 0:20:31.116 and not worry about how much your patients will pay you. 0:20:32.116 --> 0:20:36.916 It's funny you say this. So I'm not someone in 0:20:36.956 --> 0:20:40.596 the medical world. Yeah, but I'm certainly sort of familiar 0:20:40.596 --> 0:20:43.676 with arguments around national health care. It had never occurred 0:20:43.716 --> 0:20:46.956 to me until just now listening to you that if 0:20:47.156 --> 0:20:49.996 one of the consequences of national health insurance is that 0:20:50.116 --> 0:20:54.156 hospitals would look different, would do different things, and would 0:20:54.196 --> 0:20:55.236 be in different places. 0:20:56.276 --> 0:20:58.956 Yeah, I mean, the idea would be that under a 0:20:59.036 --> 0:21:01.396 nationalized healthcare system, we could be a little bit more 0:21:01.436 --> 0:21:04.556 thought out in the planning of health care. We're essentially 0:21:04.556 --> 0:21:07.076 taking the market forces out of that and we're saying, 0:21:07.356 --> 0:21:11.996 let's plan this that it should be planned, and let's incentivate. 0:21:12.436 --> 0:21:17.156 Let's incentivize hospitals appropriately to essentially be able to care 0:21:17.276 --> 0:21:19.116 for their patients at the level of care they need 0:21:19.156 --> 0:21:19.596 to be cared. 0:21:19.716 --> 0:21:23.836 Yeah, or let's not penalize people who want to serve 0:21:23.876 --> 0:21:26.756 the sickest population exactly, which is what we're talking about. 0:21:26.916 --> 0:21:30.556 Yeah, exactly. Hospitals aren't even just not getting incentivized, they're 0:21:30.556 --> 0:21:34.556 actually getting penalized. And so that's the problem in terms 0:21:34.596 --> 0:21:36.716 of our healthcare financing system. 0:21:36.956 --> 0:21:40.076 Yeah, yeah, it is. Yeah, such a kind of like, 0:21:41.396 --> 0:21:45.316 it's so weird that you would penalize somebody for essentially 0:21:45.356 --> 0:21:47.676 for doing the job in the best way. 0:21:48.396 --> 0:21:48.556 Right. 0:21:48.636 --> 0:21:52.836 The whole reason people go into medicine is to help 0:21:52.916 --> 0:21:57.036 the sickest people. Absolutely, but the system is set up 0:21:57.116 --> 0:22:01.396 such that if doctors do what they went into medicine 0:22:01.436 --> 0:22:04.916 to do, the institutions they work for are penalized. 0:22:05.756 --> 0:22:09.676 Yeah, yeah, absolutely, and so they're actually has been a 0:22:09.676 --> 0:22:12.676 lot written recently about the moral injury of our healthcare 0:22:12.796 --> 0:22:16.476 financing system and how it really does make a lot 0:22:16.476 --> 0:22:21.756 of healthcare workers feel incredibly demoralized at the end of 0:22:21.796 --> 0:22:26.276 the day. And you know, I mean, that's just that's 0:22:26.316 --> 0:22:27.196 not good for anyone. 0:22:28.516 --> 0:22:32.596 Final question, and here we come to the twist that 0:22:32.636 --> 0:22:36.516 the people who treat gunshot wounds think about all the time. Ay, 0:22:37.356 --> 0:22:40.036 it really matters how close you are to a trauma center. 0:22:40.516 --> 0:22:43.916 B In a place like Chicago, black people for years 0:22:44.036 --> 0:22:47.716 were really, really far from a trauma center. See. So, 0:22:47.796 --> 0:22:49.996 how much of the reason that black people have such 0:22:49.996 --> 0:22:52.636 a high homicide rate is just a function of the 0:22:52.676 --> 0:22:55.316 fact that we're not doing a terribly good job of 0:22:55.356 --> 0:22:58.756 saving the lives of black people after they've been shot. 0:23:00.356 --> 0:23:04.276 It's an uncomfortable question, and one of the very first 0:23:04.276 --> 0:23:08.636 scholars to venture down this path were Penelope Hanky and 0:23:08.716 --> 0:23:13.156 James Gundlock in the Journal of Criminal Justice, Volume twenty three, 0:23:13.476 --> 0:23:20.796 number four, nineteen ninety five, Damned upon arrival. The idea 0:23:20.836 --> 0:23:25.716 behind the paper was ingenious. A sociologist at Auburn named 0:23:25.756 --> 0:23:30.036 Alan Shields had assembled a database of homicide offenders from 0:23:30.156 --> 0:23:34.236 Tutwiler Prison, the all women's prison just north of Montgomery. 0:23:34.676 --> 0:23:39.316 Not an especially nice place. Tutwiler's primary distinction was that 0:23:39.396 --> 0:23:41.916 it was once named to the ten Worst Prisons in 0:23:41.996 --> 0:23:45.916 America list. So Gundlock and Hankey looked at all the 0:23:46.036 --> 0:23:50.916 murderers in Tutwiler and divided them by race. First, the 0:23:50.956 --> 0:23:55.316 white murders. There were forty seven people victimized by white 0:23:55.356 --> 0:23:59.076 women who died instantly no amount of medical attention would 0:23:59.076 --> 0:24:02.476 have saved them head shots, bulled to the heart, and 0:24:02.556 --> 0:24:05.996 a roughly equal number who were dead on arrival those 0:24:06.196 --> 0:24:09.316 who could at least theoretically have lived if they had 0:24:09.356 --> 0:24:13.876 gotten medical attention sooner. The ratio of killed instantly to 0:24:13.956 --> 0:24:18.596 dead on arrival was essentially one to one. Then Gundluck 0:24:18.756 --> 0:24:22.556 and Hankey looked at the victims of black murderers. What 0:24:22.716 --> 0:24:26.156 was their ratio? It wasn't one to one. It was 0:24:26.356 --> 0:24:29.356 way out of whack. There were many, many more victims 0:24:29.436 --> 0:24:31.716