Cedric Dark believes violence is a disease. Sometimes it manifests in quiet, private ways; other times, it’s public and deafening. As a mosquito transports malaria, a gun delivers violence, Dark says—making death an all too likely prognosis.
For Dark, a bookish and unflappable 45-year-old, this isn’t just a matter of semantics. Like millions of Americans, he’s lost a loved one to gun violence. But it’s his job, as an emergency medicine physician in Houston, at one of the state’s top level I trauma centers, that gives him a close-up view of what a bullet does to the human body. Nearly every day, he and his colleagues dig their hands into the wounds of gunshot victims to try to stop the bleeding and prevent vital organs from shutting down. “Orchestrating chaos is the hardest part of this job,” Dark says.
ER docs and trauma surgeons throughout the country pull off heroic feats—sometimes literally bringing patients back from the dead—but even with the best care, gunshot wounds are often lethal. Firearm violence is the number one killer of kids in America, taking 4,603 young lives in 2022. Such statistics can feel abstract and numbing. Even after the most egregious mass shootings, policy proposals fizzle out, and, as groups funded by gun manufacturers successfully lobby against meaningful reforms, so does public engagement with the topic.
For all his immersion in the gruesome details of gun violence in America, Dark isn’t particularly polemical on the topic. “We’re not anti-gun,” he says of himself and like-minded colleagues, “we’re anti–bullet hole.” When we talked, he cited stats that show that keeping a gun at home makes the owner significantly more likely to be shot. Still, Dark nevertheless owns a 12-gauge shotgun and a .40-caliber pistol. He takes them from his house to the shooting range, pulls the trigger, feels the kick, and takes pride as his aim improves.
What Dark and many of his fellow emergency physicians can’t abide is the notion that there’s nothing to be done about gun violence. In recent months the topic has seen renewed scrutiny. In June, the U.S. surgeon general issued an advisory that labeled firearm violence a national public health crisis. In July, a gunman tried to assassinate former president Donald Trump, and though it’s not clear whether that will spur policy changes, past political assassination attempts have been catalysts for reform. This week, in the wake of those developments, Dark published his new book, Under the Gun: An ER Doctor’s Cure for America’s Gun Epidemic, coauthored with physician and writer Seema Yasmin. It offers a series of narratives from the ER that are woven together in support of practical, incremental policies aimed at harm reduction. Dark says these small measures will keep many Americans out of the trauma bay.
Dark grew up in Prince George’s County, Maryland, a predominantly Black community near Washington, D.C. When he was a “nerdy, four-eyed teenager,” his cousin, a newspaper reporter in North Carolina, was shot and killed with his own gun during an altercation with another man over a woman he’d been dating. Dark writes about how his family members bottled up the pain. They felt helpless in the face of such devastation. Dark never once heard his uncle speak of the son he’d lost.
Around that time, Dark, who liked studying science and working with his hands and knew he wanted to help people, began charting a path to become a doctor. After attending Morehouse College, Atlanta’s prominent historically Black liberal arts institution, he moved to Manhattan to attend medical school at New York University. Like many of his classmates, he wasn’t sure what kind of medicine he wanted to practice.
The pay in emergency medicine lags well behind that in other medical specialties, and the work is often tragic and exhausting. Although millions of Americans can’t afford health insurance, most emergency departments accept anyone in need of care, so ER doctors treat all manner of maladies. Most medical students choose different paths. But shortly after Dark arrived in New York, he watched the Twin Towers fall and determined he wanted to be where the action was. “That day, September 11, 2001, I chose to dedicate my life to emergency medicine,” Dark writes in his book. He wanted to “learn how to piece together broken things.” And he sought “to be useful in that moment when everything else was falling apart.”
After graduating, he worked as a medical resident in Washington, D.C. In 2013, Dark’s wife, a fellow emergency physician, persuaded him to move back to her hometown, Houston. In addition to working ER shifts at the county hospital, Dark now teaches at Baylor College of Medicine.
Two events in 2018 inspired him to write Under the Gun. On November 7 of that year, the National Rifle Association tweeted out a response to an article in which a group of physicians had proposed measures to reduce firearm violence. “Someone should tell self-important anti-gun doctors to stay in their lane,” read the NRA’s post. Less than two weeks later, emergency physician Tamara O’Neal was shot to death by her ex-fiancé in the parking lot of a Chicago hospital, after completing a shift in the ER. O’Neal had treated gunshot victims and had long been troubled by the epidemic of gun violence in America, but the NRA sought to discount the perspective she and her colleagues held.
Dark’s book argues forcefully against the NRA’s logic. He writes that “addressing gun violence is within our lane as health care workers.” Drawing on interviews with physicians around the country, Dark paints a picture of a nation in crisis. One chapter focuses on mental health through the lens of a Colorado emergency doctor, who saw countless suicidal patients at the hospital and became an advocate for suicide prevention after her uncle and cousin both took their lives with guns. Another tells the story of an ER physician and epidemiologist in Virginia who grew up hunting in the hollows of rural Tennessee but lost his zeal for shooting after studying how firearms in the home could be risk factor for violent death. The doctors Dark interviews come from across the political spectrum, but they all agree that something has to be done about how this country addresses gun violence.
Instead, as Dark lays out in Under the Gun, not only has the NRA stood in the way of meaningful gun regulation, but industry lobbyists also, in 1996, got Congress to gut federal funding for research on gun violence. That measure took away one of the most important tools at doctors’ disposal: solid medical research on how to reduce risk when guns inevitably do wind up in the wrong hands. (In 2018 lawmakers lifted the ban, approving funds for agencies such as the National Institutes of Health and the Centers for Disease Control and Prevention to once again study firearm-injury prevention.)
Given the lack of long-term federally funded studies, Dark draws conclusions from what data is available, including research conducted by nonprofits. He makes the case for strong laws to block children from accessing guns, including by making it a crime to negligently store firearms. He supports a brief waiting period between when a buyer purchases a gun and when he gets access to it; extended background checks and licensing procedures; and keeping guns out of the hands of those under domestic violence restraining orders. Some of these reforms are already in place in a patchwork of states. All have been proposed at the federal level and have failed to draw enough support in Congress. Notably, Dark writes about the destructive potential of assault weapons but says the existing research doesn’t provide enough evidence that a ban on such firearms would save lives.
Most of Dark’s proposed measures enjoy broad public support. Polling suggests a majority of Americans approve of stricter gun-sale regulations, and some reforms have nearly unanimous support. For instance, more than 90 percent of those polled by Gallup support requiring background checks for all gun buyers. “We already know the policies that should be put into effect to limit the loss of life in this country,” Dark says. The question is: “Are we going to have the political will to make it happen?”
The recent surgeon general’s advisory, which was released after Dark’s book went to press, proposes many of the same measures Dark supports, and Dark hopes that—like the surgeon general’s advisory on smoking in the sixties—it eventually takes some of heated rhetoric and misinformation out of the discussion. “Hopefully, it changes the conversation from being pro-gun–anti-gun to evidence-informed policymaking.”
Dark also points to the recent assassination attempt on Donald Trump and notes that some of the most substantive changes to the country’s gun policies have come after similar attacks. The fatal shooting of John F. Kennedy spurred the Gun Control Act of 1968, a law that, among other provisions, required a federal license to deal in firearms and restricted interstate transportation of guns. In the wake of the 1981 attempt on Ronald Reagan’s life, lawmakers passed the Brady Bill, which instituted background checks on buyers who purchase their firearms from licensed dealers. “So the real question,” Dark says “is, in the wake of this assassination attempt, what is going to come as a consequence?”
Texas is home to more medically uninsured residents than any other state, and though we rank twenty-seventh in firearm fatalities per capita, due to the state’s sizable population, more Americans die by guns here than anywhere else in the country. Someone who survives a gunshot wound will often need follow-up care, but unlike in the emergency room, patients who can’t afford to pay for that care—like the millions of uninsured Texans—can be turned away. Dark says he also worries about the vast rural swaths of the state whose medical facilities don’t have the resources of his level I trauma center in Houston.
In Dark’s view, gun laws in Texas are a mixed bag. He argues that our embrace of concealed carry without a permit will cost lives, but he also notes that the statutes requiring that guns be kept away from children are strong relative to those of other states.
The horrific school shooting in Uvalde—which saw hundreds of armed law enforcement officials stand by as 21 children and teachers were gunned down by a former student—undercut the argument that the only thing that can stop a bad guy with a gun is a good guy with one. A couple of months after the massacre, a publication for emergency physicians, for which Dark serves as medical editor in chief, ran a story on what happened in Uvalde based on an interview with Gilberto Arbelaez, the only local ER doctor on duty that day. Arbelaez recalled the frantic preparation that followed the first report of a shooting, the uneasy tension as he waited for patients to arrive, and the harrowing states many of the kids were in as they were rolled through the hospital’s doors.
“We like to fix things,” Arbelaez said, referring to ER doctors like himself. “It’s just kind of the way we’ve been trained and sort of our personalities.” But his experience that day left him bewildered. “I just don’t know why we can’t fix this problem. We’re the most advanced country in the world, and we can’t get out of this hole.”
Dark writes in the book that “gun violence consumes my life.” Many doctors can momentarily compartmentalize their emotions, not letting the weight of the outcome get in the way of the work. But after Dark loses a patient to a gunshot wound, it often falls to him to take off his gloves, dispose of his bloody gown, and stride down the hall to a waiting room, where he delivers the news to his patient’s loved ones. “That’s where it gets you,” he told me. If his book can preclude just one of those tragic conversations, Dark says, writing it will have been worth it.
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