For Gunshot Survivors, Wounds That Don't Heal

RWJF scholar examines how victims’ lives are disfigured, physically and ‘existentially,’ by the lingering effects of gunshot injuries.

    • July 25, 2012

For his doctoral dissertation, Jooyoung Lee spent five years studying the lives of young black men in Los Angeles who hoped to find fame—or in their vernacular, to "blow up"—as rappers in the music industry. As Lee followed them, he was struck by “all the different ways that these young men were exposed to violence in their everyday lives, especially gun violence.”

Halfway through Lee’s research, his primary study subject, a rapper who goes by the name Flawliss, was shot and gravely injured. That inspired Lee, PhD, to seek a Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program grant with which to document how gunshot victims’ lives are forever changed by their injuries.

While much previous research has focused on gun homicides, only about one in five one-time gunshot victims die, says Lee: “Most live to see another day but are riddled with injuries that transform their lives in both practical and existential ways.” As an RWJF Health & Society Scholar (2009-2011) at the University of Pennsylvania, Lee drew on his Los Angeles experience to design a research study of gunshot victims in Philadelphia.

Lee’s report on that study, “Wounded: Life after the Shooting,” was published in the July 2012 edition of Annals of the American Academy of Political and Social Science. Lee is now an assistant professor of sociology at the University of Toronto.

In Los Angeles, Lee had seen how Flawliss’ life was changed from the moment two members of a Mexican street gang shot him in the back as part of an initiation rite. Before the shooting, the mid-20s rapper was preoccupied with honing his musical style and making connections in the music industry. After the shooting, Flawliss’ life revolved around medical visits, pain management, and learning to live with a colostomy bag that he found both burdensome and shameful.

In Philadelphia doing research under his RWJF Health & Society Scholars grant, Lee found the landscape of violence was somewhat different: “In Los Angeles, gangs control pretty big turfs, where in Philadelphia, there are more small, street groups that go block to block.” But in both cities, he found the medical, psychological and practical issues for gunshot victims were much the same.

Working with the outpatient trauma clinic of the Hospital of the University of Pennsylvania, Lee interviewed 40 gunshot victims, and then followed 10 of them more intensively over two years. The victims’ ages ranged from 18 to the early 60s, with an average age in the mid-20s. All but two of the victims were male, and all but one were blacks of various backgrounds: African, African-American or Dominican. The overwhelming majority lived in high-poverty, high-crime areas and did not have private health insurance.

In his study report, Lee changed victims’ names but used their real-life experiences to illustrate the concerns common to survivors, such as disfigurement, retained bullets, and the mixture of shame and fame they felt in their communities. He especially focused on three study subjects he called Winston, Kevin and David.

  • Shot in the abdomen by a would-be robber, Winston had to have parts of his intestines, kidney and pancreas removed, in operations that left him with an abdominal hernia and wearing a colostomy bag to manage bowel functions. After three months in the hospital, Winston came home to a big family celebration, Lee reported: “Midway through dinner, however, Winston received an abrupt reminder that he was not the same person he was before getting shot,” when his hernia began to make noise and bulge out from under his shirt. At that moment, Winston told Lee, “People lost their appetite. I felt bad, like I was a freak. I wish I would have just died that night.” Winston also told Lee of the shame and revulsion he felt when his colostomy bag came open a subway train, or when he was with his girlfriend. Though Winston needed the device to survive, wearing it “transform(ed) sexual advances made by his girlfriend into subjective reminders of his disfigured body,” the study says.
  • More than half the victims in Lee’s study lived with retained bullets, which can cause swelling and pain but which physicians often don’t remove if that would pose more risk than leaving the bullet where it is. One such victim was Kevin, who caught a stray bullet in his right leg as a bystander to a 2007 drive-by shooting. Four years later, Kevin told Lee he still endured chronic pain and was worried about losing his job because he was slower on his 10-hour housekeeping shifts than co-workers. “Although Kevin wanted to explain why he was having trouble keeping up, he worried that telling his boss about his gunshot injury would worsen his standing with her,” the study says. “Gunshot victims find themselves stuck between a rock and a hard place: They feel trapped between being labeled ‘lazy’ or unaccountable at work and being publicly identified as a gunshot victim who must have been doing something illegal to get shot.”
  • Victims often struggle to square the pain, shame and disability from their injuries with “the hero’s welcome” they receive from neighbors for surviving a shooting, Lee writes. David, who played football in college and on the practice squad of a professional team, was observing a street fight when two bullets entered his back and his right leg. When David talked to Lee about the “lightning-quick agility” he once had on the field, then showed him a stunted foot and leg that no longer bears his weight, David wept. “It’s like dragging a dead person around with you!” he complained—and yet, David said, others insisted the shooting made him “cool” or “hard.” The study notes how difficult it is for such victims to manage “the tensions between privately experienced and publicly perceived meanings of gunshot injuries.”

In the discussions Lee had with survivors about their injuries, “what really stood out to me was the shame,” he says. “In gangster rap music, violence is glorified, and there’s a romanticized image of someone like the rapper 50 Cent who came from the streets, who had been a drug dealer and had been shot, and then ‘blew up’ to be a star. But when I talked to these victims, they were just overwhelmed by the fact that they were able-bodied one day and the next day they were transformed into this disfigured version of themselves. And it was a very traumatic and shameful experience—it wasn’t this thing that was ‘so cool.’”

In his study’s conclusion, Lee contends that “Currently, social scientific research is overly committed to studying gun homicide. While these data add to our knowledge of crime and can be useful for policy-makers, studies that identify background risk factors for homicide overlook the lives of victims who live to see another day. It is important to conduct research on gun violence that begins with the victims’ perspective,” he says, so as to better understand “the messy and unpredictable lives of victims after the shooting.”

Lee currently is writing two books, one on the careers of aspiring rappers from Los Angeles and the second on the individual and community health effects of gunshot victimization in Philadelphia. His study report, “Wounded: Life after the Shooting,” was published in the July 2012 edition of Annals of the American Academy of Political and Social Science.