Margaret McNamara stood outside the intensive care unit, dreading the moment to come, the diagnosis she was about to disclose: Her teenage patient had been rendered a quadriplegic, victim of a gang shooting.
The young doctor, not long out of medical school, steeled herself to face the disconsolate teen, to answer his grim questions.A year later, she treated a preschool patient, a little girl whose jumping on a bed at her home accidentally discharged a loaded gun stored nearby.
"She had a spinal cord injury, she had a lot of digestive and urinary problems, she was left permanently disabled," McNamara recalls. "Her family was horribly traumatized."
The two patients helped galvanize McNamara, now chief of pediatrics at University of California-San Francisco's Mount Zion Medical Center.
She has become part of a group of physicians and health educators across the nation who are trying to make the epidemic of gun violence an urgent public health issue.
No longer content to patch up wounded patients and then discharge them to the streets, more and more physicians and public health practitioners, from trauma surgeons and emergency room residents to policy analysts and prevention researchers, are confronting firearms manufacturers, organizing gun exchanges, counseling families on everything from aggressive behavior in children to the dangers of junk guns.
Their goal: To stop the violence contamination at the source.
Some fight the weapons war within the confines of medical offices, diplomatically questioning patients about their ownership and storage of handguns, quietly warning them of the hazards and pleading for prudence around children.
Others in the health community are taking the cause to the larger policy level, lobbying for crackdowns on Saturday Night Specials, for safety devices on weapons, for federal funding to study why someone pulls a trigger.
To them, gun violence, with its crippling societal fallout and billion-dollar medical toll, is as great a public health concern as AIDS, cancer and heart disease. Violence prevention, they believe, has become a tragic necessity in the 1990s, as indispensable to a doctor's black bag as penicillin.