Chana Sacks, MD: Solving the Problem of Gun Violence

Q: Gun violence kills more than 35,000 Americans annually— about the same amount as sepsis and liver disease. And yet, millions of research dollars are spent annually to understand and prevent those diseases, while funding for gun violence prevention research is hard to come by, and as such, only a handful of researchers across the country focus on this area. Gun violence has become a public health crisis in America, and yet doctors are not taught how to approach the issue with their patients.

For Mass General internist Dr. Chana Sacks, gun violence became a very personal reality on December 14th, 2012, when her cousin’s 7-year-old son Daniel was killed in Sandy Hook. The profound impact of those events on her family spurred Chana to take action and get involved in the uniquely American problem of gun violence. She is the co-founder of the Mass General Gun Violence Prevention Coalition and has become a vocal advocate for new research to help develop innovative solutions to what she sees as a solvable problem. So welcome Chana.

A: Thanks for having me.

Q: Excited to have you. And I know that the topic of gun violence is something that got very personal for you very quickly. So I'm wondering if we can start out by talking a little bit about that?

A: Absolutely. December 14th is coming up and that's the six year anniversary, which is really hard to believe six years already has passed and I think in some ways it’s hard to believe because just the factual statement of what happened that day is so unbelievable. I mean, my cousin’s son, Daniel, was murdered in his first grade classroom along with 19 other little kids and six educators. And that sentence makes no more rational sense to me today than it did almost six years ago.

And I think back, especially with the anniversary coming up, I think back on that week, on that day, so much. And some parts of it are a blur and some parts of it, some moments of that day, of that week, are vividly seared in my mind. Being at the funeral, someone heard somewhere that Daniel wanted to be a firefighter when he grew up, so the entire path from leaving the church to the cemetery was just an honor guard of firefighters for-- felt like miles we were driving. And I’ll never forget that sight.

I come from a big family, and my younger brother’s 16 now, he was 10 then. And you know in the chaos of everybody dropping everything and get to Connecticut, he flew up from Florida, where he was with my parents at the time. And he left his dress shoes at home. And I’ll never forget this image of him as this 10-year-old at this funeral wearing a really nice suit and these big white sneakers.
Standing at the funeral, I’ll never forget sort of-- I was staring at the grave that had been dug, and there shouldn’t be graves that small, ever. And somebody tapped me on the shoulder and told me to turn the other way, and I realized I was looking at the grave for the next kid whose funeral came after.

And just being struck in that second by just the cataclysmic enormity of what just happened and what we were bearing witness to and what somehow was going to come to define my cousin’s life and all of us in some way. It’s just something unimaginable, except imagined it a lot.

And then the what comes next? You know, I’ll never forget driving home. I was a second year resident at the time. And coming back to residency and my residency community, my colleagues and my friends really supporting me like family. I always knew that about what residency at MGH was, but I’d never felt it like that. I’d never felt that sense of community in that way.

And then figuring out what I was going to do about it, or how I was going to interact with this. Certainly that wasn't a given at that point, but that process started soon after.

Q: It seems to me when something like that happens, you can go kind of one of two ways. And one way is to hole up and go inward, and one way is to look outward. How did you get yourself in that direction?

A: I think there's probably two answers to that. One is that I followed my cousin’s lead, in a lot of ways. That my cousin Mark, Daniel’s dad, spends a lot of his time working on this issue in a real way. And fundamentally, I thought if he could do it, I have to do something here.

But probably the second is that as doctors, this is what we do a little bit, this sort of intellectualization. When you find out somebody related to you has a disease or is going through something, you just learn everything you can about it. I started reading about this problem, I started thinking about this problem, which I had known something about. You know, I was a medical student at the University of Chicago, and you don’t train on the south side of Chicago without having some understanding of this issue. But once it became personal, it was really transformative for me.

Once I started reading about it, you're trained in this program to be very good at reading about disease processes and understanding the research field. And I couldn’t believe how bad the research was in this space. You know, there were a couple of names that kept popping up as doing study after study, and that was it. And for a problem of this magnitude, it felt unprecedented for everything that I was learning about. Gun violence kills 35,000 people a year and it’s the same, as you mentioned, as liver disease. And the number of lectures I had about how to manage that problem from the epidemiology to the prevention to the treatment, and I had never heard anything about gun violence in a professional capacity at all.

Then I realized that a tiny community like that means there's about five researchers in the country that were doing anything on this space and some of the best ones in the world were right across town at the Harvard School of Public Health. And David Hemenway, who’s one of the eminent researchers in this field, put up with me as I popped over to his office to chat about this issue. He did not know me, and welcomed me in and sort of just listened to me talk. And then helped me write.

It took me a little while. The first piece that I ever published in this space, my goal was to write a piece that was not controversial. Not because I'm afraid of controversy, but really because the issue as I was experiencing it with my family, the issue that I was seeing what gun violence meant, had nothing to do with the superficial conversation that was masquerading as a discussion of gun violence in America. I mean, you listen to what gets played about, talked about on the news and it felt like an entirely different thing that people were talking about.

You know, people who don’t know what they're talking about debating 18th century law as if that's the core of the problem that we're talking about. And to just convey here's my experience, here's my experience as a resident, as a trainee, when I'm learning about a public health problem, this is the approach, this is what we do as a medical community. And in this space, we've entirely abdicated.

And just to sort of draw those parallels. The first piece I wrote was sort of describing here's what a research problem looks like in heart disease. I was in the cardiac intensive care unit at the time that all this happened, and this is what we do in that setting. And this is what we've done here. And there's no reason that that has to be the reality. This is a solvable problem. Not initially an easily solvable problem, but so few in medicine and public health are.

But there's an approach that we're generally pretty good at. And to be in this place and to have that platform and to know I could write and to really believe that I had something to say, to try to get people to think about this differently. Felt like I had to try.

Q: I think people might be surprised to hear you describe gun violence as a public health issue. Can you talk a little bit about why should we think of it as a public health issue?

A: Yeah, I think fundamentally, I've heard someone say if it’s not a public health issue, why is it killing so many people? I mean, fundamentally, it’s a complex problem. That we, in so many ways as clinicians have this obligation to try to tackle the causes of morbidity and mortality that face our patients. And as this number, which is more than 35,000 gun deaths a year, probably more than double that in terms of nonfatal gunshot wounds.

But the crazy truth of that is nobody really knows what that number is because we don’t study it, because we don’t look at it. And to not use that lens of here's a problem that's affecting the health and the lives of the people that we take care of, the communities that we serve, that's fundamentally what we do. And why we've allowed this issue to become so other, that's the problem. Not that we have to justify why it’s a health issue.
Anything that's taken the lives of this many people, this many young people in this country, in this world, needs to be something that we focus on. To me, that's the given. That's the starting point.

Q: I hadn’t even thought about that, that 35,000 is a shocking number. But there's this whole other piece that doesn’t get captured in that number.

A: It doesn't get captured in even the nonfatal gunshot wounds, the people who survive that, that number doesn’t get captured. But even that number, if you had that, which is probably estimates have about twice the number that are killed, even that number is a huge underestimate. You know, we had an event here at Mass General the year after the Pulse Nightclub shooting. It was right before the one-year anniversary.

And we invited a group of survivors up here who were coming up and they were going to march in Boston Pride the day after they met with us. And they came and we had a packed room. And had really just an intense conversation about gun violence and their experience. And what really struck me that day was there were maybe 30 survivors from that shooting and a couple, a couple, had been physically injured. And 30 survivors one year later, every single one of their lives was totally transformed.

And I remember walking into that room really thinking that one is just how intense that conversation was when you bring that group of people who've experienced and then people started sharing their experiences. And you realize that it’s getting rarer and rarer for anyone not to have been touched by this issue in this country. But really, that none of those people, except the ones who’d been physically injured, would show up on any stat sheet from that night. We think about it as a shooting that left 49 people dead and injured about 50. But I had just talked to dozens of people that had no physical wounds from that night, but were all really traumatized in a very real way.

And we as a society, we as a medical community, don’t really know as much as we need to about how to prevent PTSD, for example, in that patient population. How to prepare primary care doctors who are the ones who are going to be taking those patients in the days, weeks, years ahead. And this is a very real part of who they are.

And those people don’t show up on the stat sheet anywhere. Again, we talk about that now with school shootings, it’s not just the number. We have this almost perverse way of comparing all shootings based on the number of people that died. But you look at the ripple effect. It’s not just the number of students who died at Parkland, for example, but 3,000 people went to that school and their lives are all different and they're affected by it. And so are every one of their family members. For every one of them who knew somebody, everyone thinks about things a little differently.

And to suggest that we should try to reduce that kind of suffering? That seems like it’s one of the least controversial statements you can make.

Q: I think about that a lot, especially being a young person. If violence happens in your school, you have to go back to that school. I can't imagine.

A: More and more young people in this country are having to imagine it, or even having to experience what it might be like because we're forcing people to do that. You know, 70% of school districts in this country now have active shooter training. And we should be aware. We have no evidence that people being more prepared in that setting is going to improve outcomes, and we're probably traumatizing a lot of students without any evidence that it’s really going to work or make them safer.

And I think we need to be very, very careful about that and really letting the policies that we start enacting outpace the evidence and the research base of what works here. Because we can cause a lot of harm by just trying to throw solutions at this without thinking about it more.

Q: It seems to me, too, that part of the challenge with the whole topic is, I think, two pieces. It’s gotten very politicized. And a lot of people are very uncomfortable talking about gun violence, whether you've experienced it or not. So, how do you approach it and how do you go about mitigating those things?

A: I think that second point that you get at a lot is just people’s discomfort with this issue and that is teachable. And I tell any doctor who feels uncomfortable talking to their patients about access to guns at home, those same doctors felt very uncomfortable the first time they tried to take a sexual history, and they got very good at that, too. And if this a real cause of morbidity and mortality and a risk factor that we can modify, we have to do that, no matter what it is.

And the truth is once we start having those conversations with patients, it starts to feel so far from this political conversation that other people seem to be having. I said that earlier, is that the reality of what we're talking about is so far from what you see on cable news being batted back and forth. By that, I mean of the 35,000 gun deaths that happen every year, almost two-thirds of those are due to suicide. That's arguably the least discussed. People try to push that fact down when they're talking about it.

And what could be more medical? What could be more in the space of something that we need to try to take on and do something about than suicide prevention among our patients?

I think the vast majority of Americans agree on this issue so much more than they disagree. I had the opportunity after Parkland to meet with David Hogg and Emma Gonzalez. And David Hogg and I wrote an op ed in the Boston Globe making that point, that Americans agree on this issue. They might not know it yet. And the vast majority of people, gun owners and non-gun owners, think things like universal background checks should be law. The vast majority of people, think that if somebody has a restraining order against them for domestic violence, they shouldn’t have access to a gun.

Some of these things that are basic and fundamental that people really do agree on, I think there's so much common ground here to unite people. They’ll think we should study this problem like we do any other epidemic or any other process that's taken this many lives. Those things are not controversial.

Q: It seems so simple when you say it, but there's so many layers of complication.

A: Yeah, there absolutely are, but I think for far too long that complexity has become an excuse for inaction. And I think that’s something we're really, really trying to combat at this point. You know, people talk all the time about restoring federal funding. Absolutely, I think that should be done. Having said that, at the peak of federal funding. It was a few million dollars a year that was dedicated specifically to this problem.

A problem of this magnitude needs much more funding than that. So instead of using that lack of that funding as an excuse for inaction. There are certain things CDC can do better than any private enterprise, absolutely. But that can't be an excuse for inaction anymore.

Q: How do we get people to see the common ground and sort of clear the extra?

A: Part of it is by doing the work. And I think as people were starting to come back into this space from a research standpoint, there were a couple of years of so many studies showing how there weren't enough studies. There were so many studies showing that we need more funding and that there's underfunding. That's actually necessary to show and it’s staggering to show when you look at the money that is dedicated every year towards sepsis or liver disease, claiming the same number of lives and where gun violence falls.

So that work is important, no doubt about it.

But we need to move beyond that of what should clinicians do. And that's something at MGH in our Gun Violence Prevention Coalition, in our group and our research group, that we're really trying to work on. What are the tangible things that I want clinicians doing tomorrow?

So our group joined with Maura Healey, the Massachusetts Attorney General’s office, the Mass Medical Society, and worked on developing clinical guidance, some gun ownership 101. What are basic Massachusetts laws? What do gun locks look like? Where can you get them? How much do they cost? Some basic information that's now available on our intranet.

4.7 million kids in this country are living in homes with guns that are unlocked and loaded; 4.7 million. To say that that shouldn’t be, that's noncontroversial. And we're starting a pilot program now of handing out free gun locks in our primary care clinics so that can no longer be an excuse for why that's happening.

And you start to have conversations with patients about those things. Again, it just doesn't feel personal or political. It feels like the same way we talk to patients about other issues about home safety and smoke detectors and seat belts that we got very good at asking, very comfortable at asking. And that's what we have to do here.

Q: Do you find that as you start having these conversations with patients and with the community, are people generally receptive, or has there been any pushback?

A: Yeah, absolutely. I won't say that everything is roses and easy conversations, and absolutely some people bring up, “Why are you asking me that?” And like anything else, the more comfortable a clinician is talking about something, the better received that that is.

Having said that, the vast majority of interactions are as if we're talking about any other safety issue. And sometimes, they start really interesting conversations, and important conversations, about-- for people who have firearms, maybe because they're trying to protect themselves, asking what they're afraid of and who they're afraid of. And you start to understand what people’s lives are like and what their neighborhoods are like and what their own safety concerns are.

I work mostly clinically on the inpatient side and I have a rule with all my resident teams. When they're examining a patient, you got to know where every scar comes from. And that in and to itself starts some really interesting conversations. You start to find and then hear a lot of stories when you ask those questions about a lot of gunshot wounds and a lot of bullet wounds and a lot of childhood and adolescent and other trauma that may or may not be directly relevant to that exact admission at that second. But, it may be and you don’t know if you don’t ask.

And like anything else, I think so much about medicine is about eliciting people’s stories and hearing about those pieces and trying to put it all together. And for a lot of people, this is a big part.

Q: And treating that whole patient.

A: Absolutely, and what they’ve been through and what they're afraid of and what they’ve experienced and what their past interactions with the medical system have been. And I think, again, for every person you find a wound on, many, many more people have guns at home and that's a reality that we need to talk about.

There are more guns than people in the U.S. They're here, and to me that's just a reality. And an abstinence only approach is going to work about as well as an abstinence only approach has ever worked with any medical problem. So it’s time to roll up our sleeves and dig in and figure out how to make things safer.

Q: Absolutely. I'm wondering, I suspect a lot of people maybe think of gun violence as an urban problem or it’s in certain neighborhoods. Is that an accurate perception?

A: I think almost anybody’s one-liner thought about this issue is way oversimplified. And the reason I say that is because I don't think of gun violence as one problem; I think of it as four complicated problems.

Yes, there's the violence that you're describing, and homicides and assaults. There are the mass shootings like the one that affected my family, the one that gripped the national consciousness in a profound way. And even though they do that, they account for less than one percent of all shooting deaths in the U.S., even though it’s the vast majority of what we talk about.

There's accidental shootings where little kids are stumbling across, an unlocked and loaded gun and tragically using it to kill a sibling or a neighbor or a parent. We're hearing more and more of those stories. And those are the three we hear a lot about. And then there are suicides, as I mentioned, which are almost 2/3 of all gun deaths, by far the most of any of those categories and certainly the least talked about.

So, in terms of demographics, each one’s different and each one has different root causes, different opportunities for intervention. The way that we talk about as a nation that really once you dive into the data and try to understand this problem, it’s so much more complex and multifaceted and there's so many different areas for intervention and approaches that we need to start down that path.

Q: It strikes me, too, as you're talking that there's this role of stigma. For each of those kinds of gun violence, that stigma impacts the way that is perceived.

A: Absolutely. And I think about that every time that I hear people try to press down suicide and throw that out as if that's not a form of gun violence. I mean, that's absolutely a form of gun violence and very potentially really preventable form of gun violence that we need to talk about. And I think that, sometimes takes people a while to understand.

You know, there's a common myth out there which is just that, a myth, that if somebody wants to kill themselves they're going to find a way. And what we know by some really strong research that has been done in this space is that access to a gun really is an independent risk factor for completing suicide.

If somebody’s in a moment of crisis, which is often what a suicide attempt is, it’s an impulsive moment of crisis, it is not a longstanding thought-out decision that gets made. If in that moment of crisis somebody has access to a gun, they're going to complete that suicide and die more than 90% of the time.

If they don’t have that access to a gun, if in that potential period of crisis, someone thought to, or knew, to remove the gun from that house just for that period of time and instead, for example, they reach for pills, which is the most common method of suicide attempt in the U.S., the completion rate, the death rate is about 2%. Without changing anything about that individual, just changing the means they have access to, we have the opportunity to save lives in that moment.

And more than nine out of ten people who survive a suicide attempt do not go on to die by suicide. So it’s not about postponing the inevitable, it’s about making sure that that person survives, that they have an opportunity to become connected with care. And again, the only way that we know that, the only way that we can counter that sort of gestalt that people had, which that myth-- it’s not the most unreasonable to think about-- is really good research and the really good evidence base that has been built.

There are really a lot of public health successes in that way. And that's a big part of the public health approach in so many ways. We're not always very good at changing individual behavior in any one moment, but we can shape the environment in a way that changes potentially the consequences of that behavior in that moment.

Q: So you're talking about research and learning more about this problem. But often, what actually impacts change is advocacy and people speaking out. So, how do you view the relationship between research and advocacy?

A: I think it’s a critical question, and I think it’s incredibly important that they are distinct. Sometimes, good research fuels advocacy and can definitely have an impact on policies that have a much better chance of working because we've studied them. And sometimes, research is done to evaluate policies that exist to understand what works and what doesn’t. But in some ways, there should be, and there needs to be, a firewall between those two. Where it gets, I guess, a little murky sometimes is when you're advocating for research funding, for example, which I don’t see that should be a sort of partisan issue.

But, I think research-- the goal and the focus in research, unapologetically, is yes to reduce morbidity and mortality from this cause of death. The same way I think if you were talking to any researcher who spends their time in heart disease, she would say the same thing. The goal here is to reduce morbidity and mortality from heart disease. That's not an advocacy lens to want to do that.

To get the bias out of it and to go into it with an open mind is absolutely critical. And to follow the data where they lead is absolutely critical.

Building a research foundation really offers a potential to have approaches that make sense, potential policies that make sense, and to evaluate those policies so that we can understand what worked and what didn’t. And I don't think that's an advocacy lens. I think that's a health lens that I think any researcher in any area really takes.

Q: You mentioned we have this lack of research currently and we need to build it up. So as that's happening, are there other fields that you're looking to for reference or that can inform?

A: That's a great point. You know, we have the models in this country of how we've confronted other epidemics, so I think we have absolutely a lot of models. And I think about smoking and lung cancer. It’s another field that I really look to and think about the evolution over time.

You know, if you look through advertisements of any newspaper, any magazine from the 1920s to the 1950s, it’s doctors. You know, doctors smoke Camel cigarettes. It’s doctors who are the advertisers for those things. And to think about the transformation that has really happened over the last 50 to 60 years in that space.

And again, that's without anybody discussing whether or not anybody has the right to smoke a cigarette. I don't think there's many people out there that would say you don’t have the right to go do that. But, how to keep it necessarily out of the public space and out of restaurants and away from people who don’t necessarily want to be impacted by that is an approach that that field has taken and seen a lot of successes with. And that's a field I definitely look to.

Q: I want to go back to something you mentioned earlier. You have become the cofounder of the Mass General Gun Violence Prevention Coalition. Can you talk a little bit about that group?

A: Yeah, absolutely. I think that group, we started out as a ragtag dedicated bunch, was really me and a pulmonary critical care doctor and a pediatric trauma surgeon and one of our nursing colleagues, started as sort of the four of us meeting once every few weeks ad hoc trying to decide what we could do. And from that, I would just say we've grown to maybe 100 people or more.

And the first thing it does is brings a space for people to come together and talk about this issue, which I think is already really important. One of my favorite things about it is it’s one of the most multidisciplinary groups I've ever been part of at Mass General. It is a group of us doctors at both the attending and training level, it’s nurses. We have physical therapists, we have MGH police and security come, we have social workers that are incredibly involved. Students from many sites, and people from sort of every discipline, almost, of medicine. And that in and of itself is just an incredible community to bring together and to have the opportunity to work with.

And we're sort of dividing our efforts in a few spaces. One is an education piece, and that's the group, for example, that was helping develop the clinical guidance documents. That's a group that's going on a speaking tour of showing up in primary care clinics and trying to raise awareness about the existence of these guidance documents, answering questions, sort of getting at trying to have an opportunity for people to discuss their concerns about having these conversations with patients.

Been doing a lot of really important education work. For example, we have a new program under way where every single trainee that comes into MGH next year in June will go through, during their orientation, as part of the simulation curriculum, there's going to be a case involved in gun violence prevention.

We have a research group that's doing some of the work that we've talked about; doing a lot of work using our own electronic medical records, trying to understand how often we're screening about guns or even asking those questions to any patients. A lot of really interesting work looking at the cost of, as we've talked about, of nonfatal gunshot wounds, which is really overlooked.

And we have a community engagement mission and group of people that are trying to really understand from the communities that we serve across Boston. What people in those communities feel like they need and how we can engage and trying to be even more visible, showing up, for example, Mother’s Day, there's a march every year and we joined last year, I think, for the first year that MGH was part of it. And to be out in communities and really trying to bridge that gap.

Q: What are you hearing from the communities?

A: This is a huge issue. You know, what you said before of people have an impression of what this issue is, and for different people that we talk to, everybody has a story and it’s been really a wonderful opportunity for us to really partner with other groups and to listen. Just to be a member of this community and be in it and be part of the conversation and solution here, I think are really an important part of what we do.

Q: I'm wondering to hear from you, you're a doctor leading this movement. I know there's been some conflict lately between the NRA and doctors.

A: Yeah, you noticed-- you saw that.

Q: Yeah, who have spoken out. There was the hashtag, #stayinyourlane, and sort of butting of heads. What's your perspective on that?

A: Yeah, I think it was really just interesting to watch unfold. And I think the overwhelming response that you saw to that sort of bizarre and such off-based suggestion that this has nothing to do with clinicians, sort of woke a sleeping giant in some ways. You just had this response of people-- couldn’t even see the point of view that it’s not absolutely what we do every day. And it lent itself to some powerful photos and responses of physicians describing what gun violence has meant to their patients, to their families in their careers.

And I think to watch all of our colleagues from across the country really take a public, vocal stand, again, was a sign to me of, one, how doctors aren’t going to step by and let this be seen as a partisan football anymore. Because, two, fundamentally it’s just not that partisan issue. You know, I think that became so obvious when people were talking about what it’s like to talk to parents of kids who've died from this and to tell them that their child is dead. And people who go home, leave the emergency room at the end of a shift covered in the blood of their patient.

And the idea that people were trying to turn that into something else, I think really woke a lot of people up and I think physicians took a real stand and it’s going to be our job to follow it up with substance now of what we really want to do and what we're really going to be able to do in this space.

Q: When you talk about collaborators, are you finding collaborators around the country? Is that growing?

A: Absolutely. And I think it’s growing some opportunities. There are more potential philanthropy funders that are interested in doing things. And I think those networks are going to continue to form and to grow and to be really important here. I also think when you're trying to build something and get something off the ground, really starting local in our hospital and our community is also a really important approach.

Part of the space that we're trying to fill is what do you want clinicians to change tomorrow? What resources do we need to make available for our patients tomorrow?

Q: I'm surprised to hear you say tomorrow. Does it feel that close to you, that we can make an impact tomorrow?

A: You know, it already is bit by bit, which is, again, a really gratifying and rewarding part of being in this space. That seven years ago, I wasn't asking patients these questions and I do now and hopefully the medical students and residents that I have the opportunity to work with, they're thinking about this more. Whether it's giving grand rounds around this hospital in different departments or around the city or around the state, it feels like each of those conversations is a potential to make a difference.

But trying to get clinicians to take ownership in this space and to step up, I think we're seeing that. And that, as physicians stay up and declare that this is our lane, we're also good at admitting what we don’t know and saying, “I need more training in this.” And part of what we see our role as is being there with the substance behind that effort and the resources and the education that we can really make a difference.

I mean, it feels like a real step that every trainee that comes into our residency programs next year is going to go through some of this training. And you can really build a culture and make changes in that way. And I think we have those really big opportunities and I think we're trying to make a dent and take a swing every place we can.

Q: I'm really struck to hear you talk about this. You seem to have such a sense of hope, and I think a lot of people right now, every week there's a new mass shooting. Every week, something new and terrible happens. So, how do you maintain that hope?

A: There's no question-- I mean, for example, I did my medicine sub-internship at Mercy Hospital in Chicago where that shooting took place. And there's no way to see that happen and to hear the details of that and not feel devastated. So, I don’t minimize that for even a second.

But part of it is that now, it’s, unbelievably, been almost six years that I've been working in this space in some way, and the change that we're seeing is different. And it really is moving, even if that's not readily apparent when you look at the news stories of the week.

But that was never going to change overnight. A few months after Daniel died, after Newtown, my cousin Mark introduced President Obama in the Rose Garden right after that background check legislation that 95% or something of Americans agreed with, that everybody sort of expected to pass after that failed. And I re-watched that introduction that he gave, and he was standing there and his two kids and his wife, and he was so shell shocked. This idea that this unimaginable thing had happened and even this, which everybody agrees on, even that couldn’t get through was just such a sign of how broken things are.

And I think there was maybe a moment there, sort of this despair. But it was this realization that there's been no other side moving with a positive vision of what we want to replace the status quo with. And you don’t build that overnight. That takes time. And it was very clear that that was going to be a five to ten year effort at the least. Maybe we're at year six of this, but things are changing, and people are engaged in this issue in a way that I have not seen before.

You can't go to any statehouse in any state in this country and not see people in those red Moms Demand Action shirts that are there, knowledgeable about what their legislators are doing. I think a lot of people feel like they're in the fight of their lives, and too many people literally feel like that.

And then watching students and young people really step up and lead and make a difference. And I think the March for our Lives group of students has been so effective. Again, not to say anything controversial, for the most part. But really saying we can probably lower this number. We can probably do better than 35,000 dead people.

And the support. It’s why I love working in a place like this. I have not been, whether it’s the chief of medicine whose office I've been in, or the president of this hospital, not one time have I gone in looking for support on this and-- not one time have I gotten any pushback even for half a second about the mission here. I've gotten support and help with logistics and building on our vision. But there's a commitment here to moving this forward and an understanding of the platform that we have to try to do something here. And that's a pretty amazing opportunity and something I come to work every day and to be part of.

Q: Yeah. It’s, as I said, humbling and inspiring to hear so much hope in the face of this huge problem.

A: Join us. We need all the help we can get. Everybody has something to add in this space. And watching people come together in this way and be committed and try to move forward, it’s a really energizing group to be part of because this is not work you can do alone.

But I think the goal and what we try to do for each other is keep each other motivated and engaged and focused and believing each other.

Q: You mentioned that everybody has a role to play. You're coming at it from a clinical perspective. What about the rest of us who don’t have medical specialization? What's your advice to people who are sitting at home, watching what's happening and want to get involved or want to effect change?

A: Absolutely. I really do believe there's a role for everybody here. And there's organizations that are out there, whether it’s Moms Demand or others, that there's a role for people to get involved in their community. That number that I said at the beginning of 4.7 million kids who are living in homes with unlocked and loaded guns, we all have a role to play in reducing that. Asking our neighbors before our kids go over to play whether or not there are guns at home.

Making this part of a culture of something that we can talk about. We're bringing responsible gun owners to the forefront of this conversation. It’s about a third of households in America have guns. This is not an us against them approach. Everybody has something to add here, and I have learned the most in this space from people who are very competent and are safe gun owners. And I grew up in central Florida. This is not a new issue to me at all. And I think everybody has their angle to tell their stories, to listen to other people’s stories and to really get off the sidelines on this one and to get involved.

Q: Great. Well, that concludes our conversation. But before you go, I have my final five questions.

A: Yes, all right.

Q: So number one, what's the best advice you've ever gotten?

A: Probably said in about a thousand different ways is to go for it. I think any time you're trying to carve out a career or a pathway within academic medicine in not maybe the most traditional or typical path, it sometimes feels really daunting, and I've had a lot of support from a lot of people pushing me to go for it. And I think that is, in so many ways, to try to remember why we're doing this and to keep patients and communities at the center of what we do and to move forward.

Q: The name of this podcast is Charged. What does that word mean to you?

A: Things that get us charged or get us amped up, probably, the motivations that keep us going.

Q: How do you recharge?

A: By being around the people I love and people I work with. I think as a researcher, I spend a lot of my time sitting at my desk, staring at data sets typing away. And I think every time I need to recharge, it’s coming back together with people who I love out of the hospital and in the hospital to move forward together.

Q: When and where are you happiest?

A: Around the people that I love working with. I feel happiest when I feel like we're moving forward, when we're really-- when we're really making a difference here. It’s fun.

Q: And lastly, what rituals help you have a successful day?

A: Great question. Rituals, I'm not a coffee drinker at all, which I would bet is a common answer. I make smoothies every morning. I think that's probably a big part of the start to the day. A Vitamix was my first purchase when I became an attending. Still, a refurbished one because those are expensive. But I start every day pretty much with one of those smoothies, and it gets me going.

Q: And what's in a smoothie?

A: Total mix. My entire freezer is all frozen fruit because then you don’t have to use ice. But it’s usually some mixture of either spinach and kale and frozen fruit and almond milk. A little peanut butter if it’s feeling like an indulgent day. Really can fit the mood, which is very important.

Q: Well, thank you so much. It’s been an absolute pleasure and we loved having you.

A: Amy, thanks so much.