Pushkin.

Pushkin.

I read footnotes. I always have. Perhaps it seems like good manners to read everything someone else has written for you, like cleaning your plate when you're a kid. Or maybe it's because a footnote is where you put the bit of information that doesn't quite fit the main story, but at the same time is too important to leave out. And to my mind, the thing that is important and doesn't fit is often the most important thing of all. So I read footnotes, and occasionally that leads me somewhere entirely unexpected, like the footnote at the very end of a paper in the Journal of Criminal Justice entitled Damned upon Arrival, volume twenty three, number four, pages three thirteen to three, twenty three, nineteen ninety five. Lead author Penelope J. Hanke, Second author James H. Goodluck. It made me go all the way to a little town in Alabama to have the man who wrote the footnote explained to me thirty years later, just what it meant. Could you do me a favorite?

I read footnotes. I always have. Perhaps it seems like good manners to read everything someone else has written for you, like cleaning your plate when you're a kid. Or maybe it's because a footnote is where you put the bit of information that doesn't quite fit the main story, but at the same time is too important to leave out. And to my mind, the thing that is important and doesn't fit is often the most important thing of all. So I read footnotes, and occasionally that leads me somewhere entirely unexpected, like the footnote at the very end of a paper in the Journal of Criminal Justice entitled Damned upon Arrival, volume twenty three, number four, pages three thirteen to three, twenty three, nineteen ninety five. Lead author Penelope J. Hanke, Second author James H. Goodluck. It made me go all the way to a little town in Alabama to have the man who wrote the footnote explained to me thirty years later, just what it meant. Could you do me a favorite?

Can you read that? Read the footnote for me?

Can you read that? Read the footnote for me?

Small print At three or two am on September the twenty third, nineteen ninety four, a little over a month after doctor Hanche and I submitted this article to the Ejournal of Criminal Justice. A death following the pattern described in this article little Stuckholm Jay Brandon Young, age seventeen were shot in the back with a twelve gay shotgun and killed in my house and a predominantly black part of rue Macon County, Alabama.

Small print At three or two am on September the twenty third, nineteen ninety four, a little over a month after doctor Hanche and I submitted this article to the Ejournal of Criminal Justice. A death following the pattern described in this article little Stuckholm Jay Brandon Young, age seventeen were shot in the back with a twelve gay shotgun and killed in my house and a predominantly black part of rue Macon County, Alabama.

My name is Malcolm Gladwell. You're listening to Revisionist History, my podcast about things overlooked and misunderstood. This episode is about the death of Brandon Young. James Gunlock lives in Shorter, Alabama, a little town just south of Tuskegee along I eighty five. Some parts of Alabama are wild and hilly. This is the other side of the state, flat swampy pine trees. Macon County one of the eighteen counties that make up the Black Belt of Alabama, where the cotton plantations were in the days before the Civil War. Gundlock lives with his wife in an eighteen forties plantation house, a doctress house. The old slave quarters are in the basement directly below the old surgery, so the slave stove could heat the doctor's offices during the winter. Two enormous Anatolian shepherds pat around presenting their giant heads for attention. The house looks untouched from the nineteenth century. There's an abandoned truck in the backyard.

My name is Malcolm Gladwell. You're listening to Revisionist History, my podcast about things overlooked and misunderstood. This episode is about the death of Brandon Young. James Gunlock lives in Shorter, Alabama, a little town just south of Tuskegee along I eighty five. Some parts of Alabama are wild and hilly. This is the other side of the state, flat swampy pine trees. Macon County one of the eighteen counties that make up the Black Belt of Alabama, where the cotton plantations were in the days before the Civil War. Gundlock lives with his wife in an eighteen forties plantation house, a doctress house. The old slave quarters are in the basement directly below the old surgery, so the slave stove could heat the doctor's offices during the winter. Two enormous Anatolian shepherds pat around presenting their giant heads for attention. The house looks untouched from the nineteenth century. There's an abandoned truck in the backyard.

I grew up tough.

I grew up tough.

I was a World War two baby, and my father came back from the war mentally messed up, and he became an alcoholic. And we lived on a farm, and he would take off on a drinking branch, taking my mother with him, and be gone for days.

I was a World War two baby, and my father came back from the war mentally messed up, and he became an alcoholic. And we lived on a farm, and he would take off on a drinking branch, taking my mother with him, and be gone for days.

Gun Luck is tall, stooped, wisps of white hair. He moves and talks slowly.

Gun Luck is tall, stooped, wisps of white hair. He moves and talks slowly.

That continued on. When I was eleven, we ran out of the food and I saw this flock of blackbirds crows, and so I took the twelve gate shotgun and my brother and I we went up and stuck up on him. And as soon as I started flying, I went I got two shots off, and that's I was talking to you. My brother, reminiscing about this, said, yeah, if you said, your whope shoulder hurts so much, you may may go pick up all the dead birds. But we sat there, started the fire, stripped and dressed out the birds, and all the roasted them just to be able to have food.

That continued on. When I was eleven, we ran out of the food and I saw this flock of blackbirds crows, and so I took the twelve gate shotgun and my brother and I we went up and stuck up on him. And as soon as I started flying, I went I got two shots off, and that's I was talking to you. My brother, reminiscing about this, said, yeah, if you said, your whope shoulder hurts so much, you may may go pick up all the dead birds. But we sat there, started the fire, stripped and dressed out the birds, and all the roasted them just to be able to have food.

He escaped home by enrolling in the Army, went to college, then graduate school, then to Alabama and taught sociology at Auburn University. One time he caught a huge cheating ring going on with teachers in this department and football players, and blew the whistle. Made the New York Times in one of the most football crazed states in the country. He went, after football.

He escaped home by enrolling in the Army, went to college, then graduate school, then to Alabama and taught sociology at Auburn University. One time he caught a huge cheating ring going on with teachers in this department and football players, and blew the whistle. Made the New York Times in one of the most football crazed states in the country. He went, after football.

Today's the twenty eighth day of my eighty first year. So I'm on the old side. And six months after I retired, I had an encephalitis infection to the brain. And I survived that when I was sixty six, which is quite rare. But when I came to from it in the hospital, I had company, but I couldn't think of I couldn't take the words to say what I wanted to say.

Today's the twenty eighth day of my eighty first year. So I'm on the old side. And six months after I retired, I had an encephalitis infection to the brain. And I survived that when I was sixty six, which is quite rare. But when I came to from it in the hospital, I had company, but I couldn't think of I couldn't take the words to say what I wanted to say.

He forced himself to go through the alphabet A to Z, counting all the words he knew that began with each letter. He came up with one hundred and ninety six.

He forced himself to go through the alphabet A to Z, counting all the words he knew that began with each letter. He came up with one hundred and ninety six.

My first conclusion was that I was essentially brain dead. I might as well put myself down. Then after I thought of it, I thought, well, the way I measured it meant that I'm not completely brain dead. So I just decided to gets the suicide.

My first conclusion was that I was essentially brain dead. I might as well put myself down. Then after I thought of it, I thought, well, the way I measured it meant that I'm not completely brain dead. So I just decided to gets the suicide.

Slowly he recovered built himself back up. He was working on a new paper when we spoke, an analysis of health insurance status and mortality rates. By the way, you will hear all kinds of strange noises in the background as you listen to Gundlock talking.

Slowly he recovered built himself back up. He was working on a new paper when we spoke, an analysis of health insurance status and mortality rates. By the way, you will hear all kinds of strange noises in the background as you listen to Gundlock talking.

Let me go turn that thing off. Okay, my wife always leaves it unbalanced and it makes it a lot of noise. And if I'm going off on tangents that you're not interested in, but.

Let me go turn that thing off. Okay, my wife always leaves it unbalanced and it makes it a lot of noise. And if I'm going off on tangents that you're not interested in, but.

What actually.

What actually.

Some of what you're talking about now feeds into what I want to speak to. So sure, why don't we start with the stuff that was interested me the most, which was I read that damned on a rival paper and I just thought it was fascinating and I wanted to kind of talk to you a little bit about that, and that'd be a good place to start.

Some of what you're talking about now feeds into what I want to speak to. So sure, why don't we start with the stuff that was interested me the most, which was I read that damned on a rival paper and I just thought it was fascinating and I wanted to kind of talk to you a little bit about that, and that'd be a good place to start.

Okay.

Okay.

We talked a little about the paper, and then James Gunlock went off on what seemed like one of his tangents, although as I found out, it wasn't really a tangent at all. It was about the time back in the early nineteen nineties when he got a call from his brother his brother's daughter had run away.

We talked a little about the paper, and then James Gunlock went off on what seemed like one of his tangents, although as I found out, it wasn't really a tangent at all. It was about the time back in the early nineteen nineties when he got a call from his brother his brother's daughter had run away.

The police called him and ask him why he hadn't canceled the missing child. He said, well, she's not back home, and they said, Welching's never missed school. She worked out a system by where she was just staying with friends overnight in sequence and just avoiding going home by living out in the world and still going to school.

The police called him and ask him why he hadn't canceled the missing child. He said, well, she's not back home, and they said, Welching's never missed school. She worked out a system by where she was just staying with friends overnight in sequence and just avoiding going home by living out in the world and still going to school.

Gun Luck took his niece in. She was about fourteen, so is his daughter. Now he had two teenagers under his roof.

Gun Luck took his niece in. She was about fourteen, so is his daughter. Now he had two teenagers under his roof.

She eventually decided that we were such good parents that she found a couple of street boys had been thrown out of their own homes, and we ended up taking them in.

She eventually decided that we were such good parents that she found a couple of street boys had been thrown out of their own homes, and we ended up taking them in.

They were living in Montgomery then, and parts of the city were full of gangs, the bloods, the grips, the disciples. Word got out that the Gunlux house was a place of refuge.

They were living in Montgomery then, and parts of the city were full of gangs, the bloods, the grips, the disciples. Word got out that the Gunlux house was a place of refuge.

One time, we had this big lizard, and the lizard got out, so I was going around looking for it, and I looked under the bed and there was this boy. And I looked at him and he said, I guess you want to know why I'm here. And he was just kind of a temporary close eye street kid. He was sort of staying in our house to be out off the street and stuff without having contact with adults in the house.

One time, we had this big lizard, and the lizard got out, so I was going around looking for it, and I looked under the bed and there was this boy. And I looked at him and he said, I guess you want to know why I'm here. And he was just kind of a temporary close eye street kid. He was sort of staying in our house to be out off the street and stuff without having contact with adults in the house.

I sat in a small chair next to gunlux desk as he talked about the kids he took in, boys and gangs, boys living off the street, who stole car radios to stay alive and drank cheap liquor to stay warm at night. What is it about you do you think that led you to take in so many of these kids.

I sat in a small chair next to gunlux desk as he talked about the kids he took in, boys and gangs, boys living off the street, who stole car radios to stay alive and drank cheap liquor to stay warm at night. What is it about you do you think that led you to take in so many of these kids.

Well, I think it was ruined in the time that our parents left us alone on the farm. That I can really relate to kids not having parental support and subsistence support and other kinds of things.

Well, I think it was ruined in the time that our parents left us alone on the farm. That I can really relate to kids not having parental support and subsistence support and other kinds of things.

One of the kids they took in came from a little town called Valley in the northern part of the state, an old textile town. He was seventeen. He was involved in one of Montgomery's many gangs, but he was looking for a way out. His name was Brandon Young. How long did Brandon live with you?

One of the kids they took in came from a little town called Valley in the northern part of the state, an old textile town. He was seventeen. He was involved in one of Montgomery's many gangs, but he was looking for a way out. His name was Brandon Young. How long did Brandon live with you?

Probably only about six months.

Probably only about six months.

Yeah, but you got to know him, well, oh yeah, at first he was very you know, reserved and suspicious and other things.

Yeah, but you got to know him, well, oh yeah, at first he was very you know, reserved and suspicious and other things.

But you know, as we got to know him and stuff opened up and we talked about time she.

But you know, as we got to know him and stuff opened up and we talked about time she.

And then James Gunlock started talking again about the paper he wrote with Penealty Hanky damned upon arrival. The number of homicides in any community is a combination of two completely unrelated variables. The number of people victimized by acts of violence minus how good a job the medical system does at saving the lives of those victims. And a lot of times, what a murder rate really tells you is how good you're doctors are, and not how safe your streets are. This is the idea we explored in the previous episode. But there's a twist on that observation, a really important twist which the people who treat gunshots for a living have known about for a long time. So I'm assuming over the course of your career you have treated innumerable gunshot wounds.

And then James Gunlock started talking again about the paper he wrote with Penealty Hanky damned upon arrival. The number of homicides in any community is a combination of two completely unrelated variables. The number of people victimized by acts of violence minus how good a job the medical system does at saving the lives of those victims. And a lot of times, what a murder rate really tells you is how good you're doctors are, and not how safe your streets are. This is the idea we explored in the previous episode. But there's a twist on that observation, a really important twist which the people who treat gunshots for a living have known about for a long time. So I'm assuming over the course of your career you have treated innumerable gunshot wounds.

Unfortunately true.

Unfortunately true.

This is doctor Babach Serrani. He's a trauma surgeon at George Washington University Hospital in Washington, d C. If you get seriously injured by a bullet, you get taken to a trauma center, more specifically a Level one trauma center, which is a self contained, twenty four hour facility equipped with everything necessary to treat traumatic injury, general surgeons, orthopedic surgeons, neurosurgeons, plastic surgeons, and the caesiologists, er docs, radiologists, nurses with the right qualifications on and on. Trauma centers cost hundreds of millions of dollars to build and operate. They're relatively rare. DC has thirteen hospitals, but only four level ones. One of those is at George Washington. Serrani is the chief trauma sursion there. Do you know how many, roughly.

This is doctor Babach Serrani. He's a trauma surgeon at George Washington University Hospital in Washington, d C. If you get seriously injured by a bullet, you get taken to a trauma center, more specifically a Level one trauma center, which is a self contained, twenty four hour facility equipped with everything necessary to treat traumatic injury, general surgeons, orthopedic surgeons, neurosurgeons, plastic surgeons, and the caesiologists, er docs, radiologists, nurses with the right qualifications on and on. Trauma centers cost hundreds of millions of dollars to build and operate. They're relatively rare. DC has thirteen hospitals, but only four level ones. One of those is at George Washington. Serrani is the chief trauma sursion there. Do you know how many, roughly.

Speaking, Oh, my goodness, I would think probably by now the number of gunshrare victims I've seen personally. I've been in practice since two thousand and five, I would venture miss Bladwell five hundred plus.

Speaking, Oh, my goodness, I would think probably by now the number of gunshrare victims I've seen personally. I've been in practice since two thousand and five, I would venture miss Bladwell five hundred plus.

Wow.

Wow.

Yeah, And you weren't even there during DC's darkest years.

Yeah, And you weren't even there during DC's darkest years.

Correct, yeah, correct.

Correct, yeah, correct.

I wanted to talk to Serrani about time because trauma sursions are obsessed with time. There's a phrase common in their world, the golden hour. If you get shot, they really want to have you on the operating table as soon as possible. That's why we pull over for ambulances. Talk a little to me about time. You said, tends to get there within ten minutes, and you tend to get to the trauma center between twenty and forty five. What's the difference between twenty and forty five. What happens in that extra period of time that would diminish someone's chances of survival?

I wanted to talk to Serrani about time because trauma sursions are obsessed with time. There's a phrase common in their world, the golden hour. If you get shot, they really want to have you on the operating table as soon as possible. That's why we pull over for ambulances. Talk a little to me about time. You said, tends to get there within ten minutes, and you tend to get to the trauma center between twenty and forty five. What's the difference between twenty and forty five. What happens in that extra period of time that would diminish someone's chances of survival?

Yeah, I think it depends on where the injury is. You know, if you've been injured in the abdomen and it hits your intestine, honestly, nothing will happen between twenty and forty five minutes. That's plenty of time. But if you're bleeding, specifically speaking, if you're bleeding, then every minute that goes by is you know, the value of that is plutonium.

Yeah, I think it depends on where the injury is. You know, if you've been injured in the abdomen and it hits your intestine, honestly, nothing will happen between twenty and forty five minutes. That's plenty of time. But if you're bleeding, specifically speaking, if you're bleeding, then every minute that goes by is you know, the value of that is plutonium.

Like, for example, if you take a bullet to your liver, the liver is a maze of blood vessels.

Like, for example, if you take a bullet to your liver, the liver is a maze of blood vessels.

Making the liver, of all things, stop bleeding is exceedingly difficult. You know, kidney, I can take it out, you have two kidneys, spleen, I can take it out. You don't need a spleen. I cannot take out your liver that you need a liver to live, and so I'm obligated to try to repair it while it just continues to bleed.

Making the liver, of all things, stop bleeding is exceedingly difficult. You know, kidney, I can take it out, you have two kidneys, spleen, I can take it out. You don't need a spleen. I cannot take out your liver that you need a liver to live, and so I'm obligated to try to repair it while it just continues to bleed.

When we spoke, Surrouni had just treated someone who had taken a rifle shot to the liver.

When we spoke, Surrouni had just treated someone who had taken a rifle shot to the liver.

The reason he's alive, and I will take some credit at George Washington, but honestly, one of the bigger reasons he's alive is the paramedics. They completely scooped and ran with this guy. I think their entire scene time was like ten or twelve minutes, and they just high tailed it to the trauma center. When he showed up on our doorstep. You figure by now it's been twenty twenty five minutes of the most from the moment of wounding to arrival to the trauma center. He was probably five to ten minutes away from dying. He was the extreme end stages of.

The reason he's alive, and I will take some credit at George Washington, but honestly, one of the bigger reasons he's alive is the paramedics. They completely scooped and ran with this guy. I think their entire scene time was like ten or twelve minutes, and they just high tailed it to the trauma center. When he showed up on our doorstep. You figure by now it's been twenty twenty five minutes of the most from the moment of wounding to arrival to the trauma center. He was probably five to ten minutes away from dying. He was the extreme end stages of.

Shock or what about a bullet to the lungs?

Shock or what about a bullet to the lungs?

A paramedic can actually treat a gunshot win to the lung. They can temporize that person very nicely.

A paramedic can actually treat a gunshot win to the lung. They can temporize that person very nicely.

So do that.

So do that.

How do you temporize someone who's had a gunshot win to the lung?

How do you temporize someone who's had a gunshot win to the lung?

So, when you have a gunshot to the lung, assuming it has not hit a blood vessel, assuming you're not bleeding, all you have is a gunshot to the lung, which is I believe or not really really common. The problem is you have air leaking from your lung and that air is accumul inside the chest. As that air collects more and more inside the chest because it's leaking out of lung, it'll create a lot of pressure in the chest and it'll cause it'll alter the blood flow to your body. So the paramedic can simply put a needle inside your chest, believe it or not, just like literally in sort of needle through your skin into your chest and it's like popping a balloon. It'll allow that air that's accumulating to decompress and that's all you have to do. That will buy the person then tens of minutes if not more, to get to the trauma center to allow us to then fix the issue at hand. But that's a paramedic.

So, when you have a gunshot to the lung, assuming it has not hit a blood vessel, assuming you're not bleeding, all you have is a gunshot to the lung, which is I believe or not really really common. The problem is you have air leaking from your lung and that air is accumul inside the chest. As that air collects more and more inside the chest because it's leaking out of lung, it'll create a lot of pressure in the chest and it'll cause it'll alter the blood flow to your body. So the paramedic can simply put a needle inside your chest, believe it or not, just like literally in sort of needle through your skin into your chest and it's like popping a balloon. It'll allow that air that's accumulating to decompress and that's all you have to do. That will buy the person then tens of minutes if not more, to get to the trauma center to allow us to then fix the issue at hand. But that's a paramedic.

Skill absince that intervention that would be a fatal event. Correct, Just to deling on this time question for a moment. So if I have a gunshot wound to the chest and I have exactly happening to me what you just described, how much time do I have without an AMS's intervention? Half an hour?

Skill absince that intervention that would be a fatal event. Correct, Just to deling on this time question for a moment. So if I have a gunshot wound to the chest and I have exactly happening to me what you just described, how much time do I have without an AMS's intervention? Half an hour?

Yeah, probably about half an hour or so, I mean plus minus, But yes, I would think.

Yeah, probably about half an hour or so, I mean plus minus, But yes, I would think.

So, So let's think through the logic of this, a city or country's homicide rate is heavily dependent on how good its medical system is at treating gunshot ones. And what determines how good a medical system is a treating gunshot ones, at least in part, it's how quickly a gunshot victim can get to a Level one trauma center. Okay, second question, and in this case let's use Chicago as our example, classic big American city. Chicago absolutely confirms the theory that proximity to a trauma center matters. According to a big study done a couple years ago by the epidemiologist Marie Crandall, if you live more than five miles from a Level one trauma center in Chicago, you had a thirty five percent higher chance of dying from your wounds than if you were shot less than five miles from a level one. So here's the second question. What determines how quickly you get too trauma center in Chicago? Is it a random fact like whether there's an ambulance nearby when you get shot, or how bad the traffic is that day on the way to the hospital, or is there a pattern to who lives within five miles of a level one, and who doesn't. A physician at the University of Chicago named Elizabeth Tongue set out to answer that question a few years ago, what do you find in Chicago?

So, So let's think through the logic of this, a city or country's homicide rate is heavily dependent on how good its medical system is at treating gunshot ones. And what determines how good a medical system is a treating gunshot ones, at least in part, it's how quickly a gunshot victim can get to a Level one trauma center. Okay, second question, and in this case let's use Chicago as our example, classic big American city. Chicago absolutely confirms the theory that proximity to a trauma center matters. According to a big study done a couple years ago by the epidemiologist Marie Crandall, if you live more than five miles from a Level one trauma center in Chicago, you had a thirty five percent higher chance of dying from your wounds than if you were shot less than five miles from a level one. So here's the second question. What determines how quickly you get too trauma center in Chicago? Is it a random fact like whether there's an ambulance nearby when you get shot, or how bad the traffic is that day on the way to the hospital, or is there a pattern to who lives within five miles of a level one, and who doesn't. A physician at the University of Chicago named Elizabeth Tongue set out to answer that question a few years ago, what do you find in Chicago?

And so we found that black majority census tracks were disproportionately in these trauma deserts.

And so we found that black majority census tracks were disproportionately in these trauma deserts.

A trauma desert, by the way, is what er docs call places that are a long way from a level one.

A trauma desert, by the way, is what er docs call places that are a long way from a level one.

That racial disparity was essentially very large, approximately a sevenfold increase on the South Side in black communities.

That racial disparity was essentially very large, approximately a sevenfold increase on the South Side in black communities.

Wait to explain the sevenfold the racial disparity between what and what is sevenfold higher.

Wait to explain the sevenfold the racial disparity between what and what is sevenfold higher.

The racial disparity between black majority census tracks and white majority census tracks is an x sevenfold sevenfold wow.

The racial disparity between black majority census tracks and white majority census tracks is an x sevenfold sevenfold wow.

For a period of thirty years between nineteen ninety one and twenty eighteen, the south side of Chicago didn't even have a Level one trauma center. So if you got shot on the south Side, and by the way, the south Side is the area of Chicago where you're most likely to get shot, the ambulance had to take you all the way across the city uptown to Northwestern or Cook County or west to advocate Christ Medical Center miles away. Now, why did the South Side go so long without a trauma center because it makes no sense for any hospital to open one on the south Side. Treating gunshot wounds serious ones is incredibly expensive, and the typical gunshot victim in Chicago is a young black man from a poor neighborhood, and young black men living in poor neighborhoods in Chicago typically don't have health insurance or they're on Medicaid, which reimburses at a fraction of what private insurance does. The euphemism used in the healthcare world is payer mix, which refers to how many of your patients come to you blessed with private coverage. Opening a trauma center in a bad neighborhood messes with your payer mix deeply, which is a paradox. Right. The point of a trauma center is to be closest to the places where people are getting shot. But if you put your trauma center close to the places where people get shot, your payer mix will go to hell in a handbasket and you won't be able to afford to run your trauma center. So you put your trauma center as far away as possible from the people who most need your trauma center. As I said, at the very beginning of this series, the way America deals with gun violence is bonkers. We have a misaligned healthcare system. Yeah, what's the simplest way to realign it.

For a period of thirty years between nineteen ninety one and twenty eighteen, the south side of Chicago didn't even have a Level one trauma center. So if you got shot on the south Side, and by the way, the south Side is the area of Chicago where you're most likely to get shot, the ambulance had to take you all the way across the city uptown to Northwestern or Cook County or west to advocate Christ Medical Center miles away. Now, why did the South Side go so long without a trauma center because it makes no sense for any hospital to open one on the south Side. Treating gunshot wounds serious ones is incredibly expensive, and the typical gunshot victim in Chicago is a young black man from a poor neighborhood, and young black men living in poor neighborhoods in Chicago typically don't have health insurance or they're on Medicaid, which reimburses at a fraction of what private insurance does. The euphemism used in the healthcare world is payer mix, which refers to how many of your patients come to you blessed with private coverage. Opening a trauma center in a bad neighborhood messes with your payer mix deeply, which is a paradox. Right. The point of a trauma center is to be closest to the places where people are getting shot. But if you put your trauma center close to the places where people get shot, your payer mix will go to hell in a handbasket and you won't be able to afford to run your trauma center. So you put your trauma center as far away as possible from the people who most need your trauma center. As I said, at the very beginning of this series, the way America deals with gun violence is bonkers. We have a misaligned healthcare system. Yeah, what's the simplest way to realign it.

I mean, I think the simplest way to realign it is nationalized healthcare.

I mean, I think the simplest way to realign it is nationalized healthcare.

What she's saying is that if everyone has the same insurance like they do in Canada or Europe, then hospitals don't have to worry about payamics. You can put your trauma center where your trauma center makes the most sense and not worry about how much your patients will pay you. It's funny you say this. So I'm not someone in the medical world. Yeah, but I'm certainly sort of familiar with arguments around national health care. It had never occurred to me until just now listening to you that if one of the consequences of national health insurance is that hospitals would look different, would do different things, and would be in different places.

What she's saying is that if everyone has the same insurance like they do in Canada or Europe, then hospitals don't have to worry about payamics. You can put your trauma center where your trauma center makes the most sense and not worry about how much your patients will pay you. It's funny you say this. So I'm not someone in the medical world. Yeah, but I'm certainly sort of familiar with arguments around national health care. It had never occurred to me until just now listening to you that if one of the consequences of national health insurance is that hospitals would look different, would do different things, and would be in different places.

Yeah, I mean, the idea would be that under a nationalized healthcare system, we could be a little bit more thought out in the planning of health care. We're essentially taking the market forces out of that and we're saying, let's plan this that it should be planned, and let's incentivate. Let's incentivize hospitals appropriately to essentially be able to care for their patients at the level of care they need to be cared.

Yeah, I mean, the idea would be that under a nationalized healthcare system, we could be a little bit more thought out in the planning of health care. We're essentially taking the market forces out of that and we're saying, let's plan this that it should be planned, and let's incentivate. Let's incentivize hospitals appropriately to essentially be able to care for their patients at the level of care they need to be cared.

Yeah, or let's not penalize people who want to serve the sickest population exactly, which is what we're talking about.

Yeah, or let's not penalize people who want to serve the sickest population exactly, which is what we're talking about.

Yeah, exactly. Hospitals aren't even just not getting incentivized, they're actually getting penalized. And so that's the problem in terms of our healthcare financing system.

Yeah, exactly. Hospitals aren't even just not getting incentivized, they're actually getting penalized. And so that's the problem in terms of our healthcare financing system.

Yeah, yeah, it is. Yeah, such a kind of like, it's so weird that you would penalize somebody for essentially for doing the job in the best way.

Yeah, yeah, it is. Yeah, such a kind of like, it's so weird that you would penalize somebody for essentially for doing the job in the best way.

Right.

Right.

The whole reason people go into medicine is to help the sickest people. Absolutely, but the system is set up such that if doctors do what they went into medicine to do, the institutions they work for are penalized.

The whole reason people go into medicine is to help the sickest people. Absolutely, but the system is set up such that if doctors do what they went into medicine to do, the institutions they work for are penalized.

Yeah, yeah, absolutely, and so they're actually has been a lot written recently about the moral injury of our healthcare financing system and how it really does make a lot of healthcare workers feel incredibly demoralized at the end of the day. And you know, I mean, that's just that's not good for anyone.

Yeah, yeah, absolutely, and so they're actually has been a lot written recently about the moral injury of our healthcare financing system and how it really does make a lot of healthcare workers feel incredibly demoralized at the end of the day. And you know, I mean, that's just that's not good for anyone.

Final question, and here we come to the twist that the people who treat gunshot wounds think about all the time. Ay, it really matters how close you are to a trauma center. B In a place like Chicago, black people for years were really, really far from a trauma center. See. So, how much of the reason that black people have such a high homicide rate is just a function of the fact that we're not doing a terribly good job of saving the lives of black people after they've been shot. It's an uncomfortable question, and one of the very first scholars to venture down this path were Penelope Hanky and James Gundlock in the Journal of Criminal Justice, Volume twenty three, number four, nineteen ninety five, Damned upon arrival. The idea behind the paper was ingenious. A sociologist at Auburn named Alan Shields had assembled a database of homicide offenders from Tutwiler Prison, the all women's prison just north of Montgomery. Not an especially nice place. Tutwiler's primary distinction was that it was once named to the ten Worst Prisons in America list. So Gundlock and Hankey looked at all the murderers in Tutwiler and divided them by race. First, the white murders. There were forty seven people victimized by white women who died instantly no amount of medical attention would have saved them head shots, bulled to the heart, and a roughly equal number who were dead on arrival those who could at least theoretically have lived if they had gotten medical attention sooner. The ratio of killed instantly to dead on arrival was essentially one to one. Then Gundluck and Hankey looked at the victims of black murderers. What was their ratio? It wasn't one to one. It was way out of whack. There were many, many more victims who died on the way to the hospital, and also a far higher percentage who died at some point after being admitted. What the studies suggested was that a big chunk of the difference in homicide rates between blacks and whites in Alabama had to do with the quality of healthcare given to their victims, not the violent tendencies of the people who attacked them. Here's the key conclusion. Although this is by no means a definitive study of the issue, the strength of the findings is striking. The Tutwiler prison data suggested that almost one fourth of the African American female killer might not have been in prison for the killing had their victims received the same transportation and medical care as their Caucasian counterparts. The study covered four hundred and sixty eight African American murderers at Tutwiler, So that's one hundred and thirteen people who wouldn't have been convicted for homicide if their victims had received the same medical attention as white people. They had been convicted on lesser charges like aggravated assault, they wouldn't be murderers. And at the very end of the paper, Gunblock and Hankey give us a little hint of what they think was going on in Alabama. One anecdote related by a female inmate at Tutwiller Prison is particularly revealing. I'm reading from the final paragraph of the study. Having seriously wounded a male in an argument, she drove him to the doctor's house. At that time, she was advised by the maid that the doctor was having dinner and could not be disturbed. The man died. The assailant and victim were African American, the doctor was Caucasian. Hanke and Gunluck presented an early version of their paper at the American Society of Criminology meeting in Phoenix in the summer of nineteen ninety three, and while Gunluck was putting the finishing touches on the paper, Brandon Young moved into his house in Montgomery.

Final question, and here we come to the twist that the people who treat gunshot wounds think about all the time. Ay, it really matters how close you are to a trauma center. B In a place like Chicago, black people for years were really, really far from a trauma center. See. So, how much of the reason that black people have such a high homicide rate is just a function of the fact that we're not doing a terribly good job of saving the lives of black people after they've been shot. It's an uncomfortable question, and one of the very first scholars to venture down this path were Penelope Hanky and James Gundlock in the Journal of Criminal Justice, Volume twenty three, number four, nineteen ninety five, Damned upon arrival. The idea behind the paper was ingenious. A sociologist at Auburn named Alan Shields had assembled a database of homicide offenders from Tutwiler Prison, the all women's prison just north of Montgomery. Not an especially nice place. Tutwiler's primary distinction was that it was once named to the ten Worst Prisons in America list. So Gundlock and Hankey looked at all the murderers in Tutwiler and divided them by race. First, the white murders. There were forty seven people victimized by white women who died instantly no amount of medical attention would have saved them head shots, bulled to the heart, and a roughly equal number who were dead on arrival those who could at least theoretically have lived if they had gotten medical attention sooner. The ratio of killed instantly to dead on arrival was essentially one to one. Then Gundluck and Hankey looked at the victims of black murderers. What was their ratio? It wasn't one to one. It was way out of whack. There were many, many more victims who died on the way to the hospital, and also a far higher percentage who died at some point after being admitted. What the studies suggested was that a big chunk of the difference in homicide rates between blacks and whites in Alabama had to do with the quality of healthcare given to their victims, not the violent tendencies of the people who attacked them. Here's the key conclusion. Although this is by no means a definitive study of the issue, the strength of the findings is striking. The Tutwiler prison data suggested that almost one fourth of the African American female killer might not have been in prison for the killing had their victims received the same transportation and medical care as their Caucasian counterparts. The study covered four hundred and sixty eight African American murderers at Tutwiler, So that's one hundred and thirteen people who wouldn't have been convicted for homicide if their victims had received the same medical attention as white people. They had been convicted on lesser charges like aggravated assault, they wouldn't be murderers. And at the very end of the paper, Gunblock and Hankey give us a little hint of what they think was going on in Alabama. One anecdote related by a female inmate at Tutwiller Prison is particularly revealing. I'm reading from the final paragraph of the study. Having seriously wounded a male in an argument, she drove him to the doctor's house. At that time, she was advised by the maid that the doctor was having dinner and could not be disturbed. The man died. The assailant and victim were African American, the doctor was Caucasian. Hanke and Gunluck presented an early version of their paper at the American Society of Criminology meeting in Phoenix in the summer of nineteen ninety three, and while Gunluck was putting the finishing touches on the paper, Brandon Young moved into his house in Montgomery.

He was really a good guy. He was really smart, barely educated. Used a lot of words a bit wrong definition wise, because he had he was sort of working, I'm building his own vocabulary and that kind of stuff without the direction of teachers and such. He was very likable. He was very much for defending the down and out and that kind of kind of thing. He was. He was a very likable and even from an adults perspective, respectable person, even though he was a street gangster.

He was really a good guy. He was really smart, barely educated. Used a lot of words a bit wrong definition wise, because he had he was sort of working, I'm building his own vocabulary and that kind of stuff without the direction of teachers and such. He was very likable. He was very much for defending the down and out and that kind of kind of thing. He was. He was a very likable and even from an adults perspective, respectable person, even though he was a street gangster.

How did Brandon me before he before he moved in with you? How did he survive on the streets?

How did Brandon me before he before he moved in with you? How did he survive on the streets?

Never really told us. I don't know whether he was involved with selling drugs or not. If he was doing that, he wouldn't have told me. But he he never asked for money. He seemed he seemed to kind of know when we were kind of working toward pushing him to go ahead and work toward be where we could get him lined up where he could go to college and stuff before he was killed. But obviously that ended that he passed a ged uh that's the high school diploma equital time, so you know, and he actually did absolutely no studying for it or any of that other kind of stuff, and he just went in and took it and he plashed it with fine colors. You know. He was smart. He knew stuff, and I'm not sure how he picked up some of it stuff, but he would regularly read books. And if we could have gotten me on a route going through college and stuff, he would have turned into a very solid person. I'm I'm very sure he he had a strong streak aning of caring for people. Noah, I thought about him a lot back then, but I haven't lately, said.

Never really told us. I don't know whether he was involved with selling drugs or not. If he was doing that, he wouldn't have told me. But he he never asked for money. He seemed he seemed to kind of know when we were kind of working toward pushing him to go ahead and work toward be where we could get him lined up where he could go to college and stuff before he was killed. But obviously that ended that he passed a ged uh that's the high school diploma equital time, so you know, and he actually did absolutely no studying for it or any of that other kind of stuff, and he just went in and took it and he plashed it with fine colors. You know. He was smart. He knew stuff, and I'm not sure how he picked up some of it stuff, but he would regularly read books. And if we could have gotten me on a route going through college and stuff, he would have turned into a very solid person. I'm I'm very sure he he had a strong streak aning of caring for people. Noah, I thought about him a lot back then, but I haven't lately, said.

Brendan wanted out of the gang world, so he went to stay at a log cabin the Gunlocks owned forty five minutes or so north of Montgomery in the town of Nota Saga in Macon County. They thought he'd be safe there, and that's where he was with three of the other teenagers the gun Lucks had taken in on the night of August twenty third, nineteen ninety four. It was a few hours after midnight. Brendan heard a noise outside. He went to check.

Brendan wanted out of the gang world, so he went to stay at a log cabin the Gunlocks owned forty five minutes or so north of Montgomery in the town of Nota Saga in Macon County. They thought he'd be safe there, and that's where he was with three of the other teenagers the gun Lucks had taken in on the night of August twenty third, nineteen ninety four. It was a few hours after midnight. Brendan heard a noise outside. He went to check.

He put the other kids in a place that thing would be safe. There's a log house that has a suck up floor, which was the bedroom, and he had them, and the bedroom area essentially has no windows or other such things because the roof of the house is a ceiling in the bedroom area. And he got them upstairs and told them to get under the bed. When he first found out what was going on, and he stayed downstairs to try to figure out what he could do and that kind of stuff.

He put the other kids in a place that thing would be safe. There's a log house that has a suck up floor, which was the bedroom, and he had them, and the bedroom area essentially has no windows or other such things because the roof of the house is a ceiling in the bedroom area. And he got them upstairs and told them to get under the bed. When he first found out what was going on, and he stayed downstairs to try to figure out what he could do and that kind of stuff.

There were four people waiting outside. They had a shotgun. They saw Brandon through the window an open fire. I'm reading now from the account of the crime a few days later in the Montgomery Advertiser. Neither Brandon's friends nor the adults who cared for him can give a specific reason for his slaying. They say that some of the suspects used to be his friends, even fellow gang members. Maybe they were angree He was trying to free himself from them, to make a better life for himself. His friends looked up to him. We used to say that he was Peter Pan and they were the lost Boys, said his fifteen year old girlfriend, who asked not to be named for her own safety. Brandon was everybody's hero. He was my hero. Brandon was in love with the words respect and honor. He didn't do dry bys because he said, if you want to fight, fight like a man. In an interview this week before Thursday's arrest, the fifteen year old girlfriend was guarded when she talked about the Knight. Brandon died fraile and blue eyed. Her bright red nail polished chipped. She wore a gold chain with a heart shaped locket and a boy's ring. While everyone else had lunch, she sipped a coke and smoked cigarettes. We were going to go to Auburn, she said. We were going to get married. So Gunlock goes back and adds a paragraph to their article. Not a changed the main body of the text, because Brandon Young wasn't a female inmate at Tutwater Prison. So it was a footnote, because a footnote is where you put things that don't quite fit but are still important to the story. Wait, so take me back to that night, so you're it's it's in the wee hours of the morning. You're in Montgomery and you get a phone call. Yeah, it was one of the kids in the house, and so you jumped in your car, jumped in the car, broke the space limit.

There were four people waiting outside. They had a shotgun. They saw Brandon through the window an open fire. I'm reading now from the account of the crime a few days later in the Montgomery Advertiser. Neither Brandon's friends nor the adults who cared for him can give a specific reason for his slaying. They say that some of the suspects used to be his friends, even fellow gang members. Maybe they were angree He was trying to free himself from them, to make a better life for himself. His friends looked up to him. We used to say that he was Peter Pan and they were the lost Boys, said his fifteen year old girlfriend, who asked not to be named for her own safety. Brandon was everybody's hero. He was my hero. Brandon was in love with the words respect and honor. He didn't do dry bys because he said, if you want to fight, fight like a man. In an interview this week before Thursday's arrest, the fifteen year old girlfriend was guarded when she talked about the Knight. Brandon died fraile and blue eyed. Her bright red nail polished chipped. She wore a gold chain with a heart shaped locket and a boy's ring. While everyone else had lunch, she sipped a coke and smoked cigarettes. We were going to go to Auburn, she said. We were going to get married. So Gunlock goes back and adds a paragraph to their article. Not a changed the main body of the text, because Brandon Young wasn't a female inmate at Tutwater Prison. So it was a footnote, because a footnote is where you put things that don't quite fit but are still important to the story. Wait, so take me back to that night, so you're it's it's in the wee hours of the morning. You're in Montgomery and you get a phone call. Yeah, it was one of the kids in the house, and so you jumped in your car, jumped in the car, broke the space limit.

Got there. I usually break the space limit, but it broke it more when I was going there, and I got there before the ambulance did.

Got there. I usually break the space limit, but it broke it more when I was going there, and I got there before the ambulance did.

He was coming from Montgomery over forty miles away. The ambulance was coming from Tuskegee six miles away. He got there before the ambulance. The ambulance guy shows up, and did you confront him about why it took so long?

He was coming from Montgomery over forty miles away. The ambulance was coming from Tuskegee six miles away. He got there before the ambulance. The ambulance guy shows up, and did you confront him about why it took so long?

I wasn't in any mood for confronting or other such things.

I wasn't in any mood for confronting or other such things.

He just asked the ambulance driver simply, where have you been? And the ambulance driver said, most of the calls out here are for blacks. We didn't know Brandon was white.

He just asked the ambulance driver simply, where have you been? And the ambulance driver said, most of the calls out here are for blacks. We didn't know Brandon was white.

What he was trying to do when he was telling me about this was trying to tell me how to behave as a white guy in Alabama. You let him know when you're asking for services, if you're.

What he was trying to do when he was telling me about this was trying to tell me how to behave as a white guy in Alabama. You let him know when you're asking for services, if you're.

Quiet, it's.

Quiet, it's.

It's just, you know, the racism is so deep and pervasive that there's all kinds of subtle not really you know, taught the kids, but not really talk about kinds of things. And since I didn't grow up in Alabama, I didn't have that training.

It's just, you know, the racism is so deep and pervasive that there's all kinds of subtle not really you know, taught the kids, but not really talk about kinds of things. And since I didn't grow up in Alabama, I didn't have that training.

Yeah.

Yeah.

Yeah, did you when he said that, do you remember how you reacted?

Yeah, did you when he said that, do you remember how you reacted?

I don't remember. I was just I was just kind of astonished and down at h and you know, they were still in the process of taking the body it way, so it wasn't It wasn't kind of thing where there was a lot of time to do things and think about it. But he was just trying to pass on to me the kind of information I should have to survive as a white guy at the benefit of racism in Alabama.

I don't remember. I was just I was just kind of astonished and down at h and you know, they were still in the process of taking the body it way, so it wasn't It wasn't kind of thing where there was a lot of time to do things and think about it. But he was just trying to pass on to me the kind of information I should have to survive as a white guy at the benefit of racism in Alabama.

Yeah, so he was.

Yeah, so he was.

He was.

He was.

He wasn't apologetic or indignity was He was just kind.

He wasn't apologetic or indignity was He was just kind.

Of trying to be helpful, trying to be help trying to teach me what I should have known.

Of trying to be helpful, trying to be help trying to teach me what I should have known.

Yeah. Gunduck called his footnote a dedication to Brendan Young. I wanted to hear him read it.

Yeah. Gunduck called his footnote a dedication to Brendan Young. I wanted to hear him read it.

At three or two am on September the twenty third, nineteen ninety four, a little over a month after doctor HANKI and I submitted this article to the Journal of Criminal Justice. A death following the pattern described in this article. Little Stuckholm Jay Brandon, young age seventeen, was shot in the back with a twelve gay shotgun and killed in my house in a predominantly black part of Rulemaking County, Alabama. He bled to death while the ambuletce took over one hour to make the sixth trip from their station to our house. I want to recognize Brandon's good works. Brandon lived on the street for several years, and society did not approve of much of what he did to survive. Despite the street life, Brandon had the strength and the resolve to protect and care for other abused children he met on the streets. This good work has not been recognized. Also, in the early hours of September twenty three, nineteen ninety four, three killers attempted to kill everyone in our house. As they attacked, Brandon put his life on the line. He was murdered, but his actions saved three other young lives. I missed Brandon, and I know that he would have made many lives better if he had lived.

At three or two am on September the twenty third, nineteen ninety four, a little over a month after doctor HANKI and I submitted this article to the Journal of Criminal Justice. A death following the pattern described in this article. Little Stuckholm Jay Brandon, young age seventeen, was shot in the back with a twelve gay shotgun and killed in my house in a predominantly black part of Rulemaking County, Alabama. He bled to death while the ambuletce took over one hour to make the sixth trip from their station to our house. I want to recognize Brandon's good works. Brandon lived on the street for several years, and society did not approve of much of what he did to survive. Despite the street life, Brandon had the strength and the resolve to protect and care for other abused children he met on the streets. This good work has not been recognized. Also, in the early hours of September twenty three, nineteen ninety four, three killers attempted to kill everyone in our house. As they attacked, Brandon put his life on the line. He was murdered, but his actions saved three other young lives. I missed Brandon, and I know that he would have made many lives better if he had lived.

Our revisionist history Gun series was produced by Jacob Smith, Bend, daph Haffrey, Kiara Powell, Tally Emlin, and Leemn gistoo. We were edited by Peter Clowney and Julia Barton. Fact checking by Arthur Gomberts and Kashelle Williams, original scoring by Luisquira, mastering by FLONN Williams, Engineering by Nina Lawrence. I'm Malcolm Glapwell. You may have noticed there are two different dates given for Brandon Young's death. August twenty third, nineteen ninety four is the correct date. There was an error in Gundlock's original paper.

Our revisionist history Gun series was produced by Jacob Smith, Bend, daph Haffrey, Kiara Powell, Tally Emlin, and Leemn gistoo. We were edited by Peter Clowney and Julia Barton. Fact checking by Arthur Gomberts and Kashelle Williams, original scoring by Luisquira, mastering by FLONN Williams, Engineering by Nina Lawrence. I'm Malcolm Glapwell. You may have noticed there are two different dates given for Brandon Young's death. August twenty third, nineteen ninety four is the correct date. There was an error in Gundlock's original paper.