They looked at me plainly, waiting for the question, waiting for clarification of why I was alarmed.

Now we were all confused. They were stumped by my concern, and I was puzzled by their untroubled stance.

We all went into the room to join Gabriel, who looked up at his parents.

“Miss,” his mother said to me, “if he has to defend himself, he has to defend himself.”

I paused. The statement was deceptively plain. I was horrified that his parent normalized what sounded like retaliation. It hadn’t taken long in my career for me to learn that violence often begets more violence. Each trauma alert, each young person we pronounced, each patient who, if lucky, left the hospital with a colostomy bag, tracheostomy, or wheelchair proved this point. I also knew firsthand that self-defense could make the difference between being memorialized or graduating, and that no child should ever be put in the position to have to make that choice. “Um, okay. This is a very dangerous situation. Anytime we receive information about potential gun violence, we have to get Social Work involved, to ensure everyone is safe,” is what came out.

“What are you saying, miss? Are you going to take our son from us?” the mother asked with the first hint of concern I perceived in her voice. The father slumped back in his chair, propped his head against the wall, and sighed, closing his eyes. Gabriel sat up in the stretcher. For the first time during this discussion with his parents, he looked me squarely in the face. His eyes were glassy with disbelief, the way I had looked at the two DC police officers who came to our door and said they would arrest my brother, too, after I had summoned them to stop my father’s violence. That night, they had communicated to my family that we were all implicated somehow, so all of us would have to pay.

Now, as I stood there looking down at this child, I knew how he felt. I knew that there wasn’t anything I could say or do to make him feel otherwise. We were all in this mess together, and none of us would leave feeling vindicated or clean.

“No, that is not the aim here. No one wants to take you away from your family. That will not happen here,” I stated, in a desperate attempt to clarify my intentions. As I stood there waiting for the social worker to arrive, I wondered why, in all my growing-up years, no physician had ever spoken to me alone, to ask if I was safe. Neither had a teacher, mentor, or other family member, for that matter. I wondered what might have transpired if they had. I imagine that I, too, would have felt reluctant and scared. I did know that it would have taught me a valuable lesson, one I would have carried with me for the rest of my life: There are adults who will protect another human being. This was something I had to learn later, on my own, once I finally left that house.

The ER social worker, Aisha, arrived and took her report. Aisha was as conscientious as she was fabulously accessorized. While she was undoubtedly a phenomenal social worker, she could have been a notable fashion blogger, too. Each day, she sported her pixie cut with a different selection of dangly earrings depending on her ensemble. How she adroitly walked the hospital halls during her entire shift in four-inch heels as if they were sneakers is still a mystery to me.

When she completed her consultation with the family, she pulled me aside to summarize her findings. She told me that these were hardworking parents who were doing the best they could. Mom worked full time at a grocery store, typically doing overtime to make ends meet. Dad was a janitor, working all hours of the night and day while doing contractor work on the side. They lived in a violent neighborhood riddled with crime. Drugs were sold on every corner, and you tuned out gunshots the way suburbanites tune out the crickets’ chorus at dusk.

Aisha placed her hand on my arm. Her tone was kind but resigned. She didn’t break a sweat, and her brow was unfurrowed. Clearly, this was a conversation she had with newbies like me all the time.

“Michele, when you’re at war, the rules are different. The members of this family, they’re soldiers in a way. They’re fighting for their families. The frame of reference in war is different. The atrocities of a war zone are a normal part of life, and you do what you have to do to survive, to make it out, to make it home.” She sighed. “You know these are really good people. None of this is right. Gabriel shouldn’t think it’s okay to use a gun. There are other ways, of course. And he shouldn’t feel he has to have a gun to feel safe at school. Schools should be safe. There are other ways for that, too.”

She sighed again, this time even more heavily.

“Oh, child,” she said, shaking her head. “Anyway, there’s no proof that this kid really has access to a gun. No one in his family has one, either. I’ll write up my report, and we’ll check on the family. There’s nothing else to do here.” She shook her head again and smiled. “Unless the ER can give these people jobs that are actually living wage and safe places to live.” She picked up her clipboard and began to walk away, and then turned to me and asked, “Can we do that, Doc? Lord knows, I wish we could do that. Have a nice day. You know how to reach me!” She waved, turning to see the next patient down the hall.

That was years ago now. I never found out what happened to Gabriel and his family. Yet his story, their story, haunts me.

Now I stood in the trauma bay at Montefiore, waiting to receive the latest trauma notification—all of us robed, gloved, and ready. The call had come in: two young men shot, one in the head, the other in an extremity. When trauma alerts like this one came in, I often thought about how the patient could be Gabriel or so many others like him. It was the beginning of my shift, so I would be taking the more seriously injured one. It’s common practice for the fresher doctor to handle any new critical patient. The other doc would head up the less serious injury, in Trauma Room 2, while my team and I were in Trauma 1. We figured the incident was gang-related, but then, that was almost a given.

As I stood at the head of the bed, I checked my suction and laryngoscope blade one last time. One tech was at the foot of the bed with trauma shears, to cut off all clothing for full exposure, so we could check for wounds. Another pulled out a C-collar, a rigid neck brace used to stabilize the cervical spine in any trauma patient where neck injury hasn’t been ruled out—just in case EMS didn’t have time to place one in the field. One nurse was on either side of the bed, each with an IV setup. The nurse to my right had fluids hanging, the one on my left had monitor leads and the code cart. There were two med students in the room, whispering to each other in eager anticipation. This was their first shift in the emergency room, and they probably already felt like they were in the middle of a popular ER reality show episode.

“Please, just let them get here,” I implored. Standing there in the Trauma Room, I could practically feel the charts building up in the main ER. With a groan, I pinched the top of my mask snug to the bridge of my nose to prevent condensation on my face shield. I stood there thinking about all the things that could go wrong and how I could address them. What if the GSW was to the mouth, and I couldn’t intubate? What if it was to the neck, and I couldn’t even manage a tracheotomy? There are times, too, when the EMS notification is completely wrong. There was the time a GSW to the chest was called in that was actually a flesh wound to the arm. Who knows? Maybe the guy coming in was only grazed on his scalp.

Nurse Ramirez walked through the Trauma Room doors with an update. “Just a heads-up that y’all will only get the GSW to the head. The other male was diverted to Episcopal, since they’re in opposing gangs. The less craziness we have here, the better! They should be here any second.”

“Thanks, Chief,” Brian, one of the techs, replied.

We heard thunderous rattling at the ambulance entrance. Then EMS appeared, pushing in a gurney with two enormous black sneakers hanging off the edge, kicking in twisting movements. The legs were clad in jeans streaked crimson. Then a torso emerged—a striped shirt with blood dripping down the right side and bits of fleshy matter about the chest. Blood leaking from a pressure dressing to his scalp streaked the floor.

“Sorry, this was a scoop-and-run,” one medic announced, beginning his report. “Twenty-something-year-old man. GSW to head. GCS anywhere from thirteen to fifteen. It’s hard to tell because he’s agitated. Blood pressure one-ten over seventy, heart rate one-forty, saturating ninety-five percent on room air. We couldn’t get IVs. We couldn’t tube him in the field.”