Warning: this story contains graphic images
John Doe’s torso was a nest of bullets, over a dozen lead pellets shot from two feet away. The moment Doe got off the ambulance, Joseph Sakran rushed him to the operating room and slashed through his abdomen. Doe’s innards were obliterated, covered by a mixture of stool and blood.
Sakran collected himself; he just had to control the contamination and stop the bleeding.
But then Doe’s heart stopped. Sakran pulled out of his abdomen and shucked Doe’s chest open like a clamshell. Without a word, he stuck his hand inside and began wringing the flagging muscle, trying to coax it back to life.
***
In 1951, the French practitioner René Leriche wrote: “Every surgeon carries within himself a small cemetery, where from time to time he goes to pray – a place of bitterness and regret, where he must look for an explanation for his failures.”
As a trauma surgeon at Johns Hopkins Medicine, Sakran knows that better than most. He works in Baltimore, which has the highest violent crime rate of any major city in the United States, staffing one of the nation’s busiest Level 1 trauma centers.
He’s also a victim of gun violence himself, having been shot in the throat at age 17.
While more than a hundred thousand people are shot every year in the US, Sakran is the rare case of a man who survived and made it his life’s work to save others.
“I’ve operated on thousands of patients over the years,” says Dipankar Mukherjee, Sakran’s vascular surgeon – the one who saved his life. “I haven’t met anybody like Joseph, who’s been able to take this experience and then turn it on its head.”
But in some ways, Sakran has always been fighting a losing battle. Over his career, he might save thousands of lives, but his scalpel will do nothing to excise gun violence or the revolving door of patients into his operating room. “It doesn’t matter how good I think I am, or how good our trauma center is,” Sakran says. “The best medical treatment for that kid was to prevent him from ever being shot in the first place.”
Reasonable as that may sound, implicit in it is a radical expansion of the social role of medicine. Historically one of the most conservative professions, medicine has long prided itself on being dispassionate, evidence-based and unmoored by external factors. In the name of professionalism, doctors are taught to keep their heads down, leave their political beliefs at the door and focus single-mindedly on what they’ve trained to do: patient care.
But Sakran represents an emerging model: a physician whose scope of practice swells beyond the hospital walls. He spent a year crafting health policy in the Senate, founded the coalitions Doctors for Biden and Doctors for Hillary, and has become one of the leading gun reform activists in the country, organizing tens of thousands of healthcare workers.
By advocating for gun violence prevention, Sakran recognizes that he’s inevitably courting controversy. But he also knows that, by the time his patients get to the hospital, it’s already too late. Treating the individual patient is not enough; medicine, Sakran believes, should treat populations.
His work comes at a time when the boundaries around medicine are being renegotiated. The Covid-19 pandemic elevated the social profile of physicians and offered them a platform to preach to the masses. But it also saw medical truths eroded by the politics of opposition, with Republicans twice as likely as Democrats to think scientists have agendas beyond the facts.
In this radically polarized country, should doctors ever be political?
***
Sakran looks like a linebacker turned art critic, his block-shaped, bespectacled face bearing a scruffy beard. Sakran was born in 1977, in Falls Church, Virginia, the son of Lebanese and Palestinian immigrants. His dad had moved the family a few years prior, leaving a high-paying engineering job in Wichita, Kansas, to work at the US patent office. It was less glamorous, sure, but also a safe government position with good benefits and a pension. “My dad’s not a risk taker,” Sakran says, “especially when he’s thinking of his family.”
Sakran is the oldest of three siblings, each two years apart, but his family was always one of strays. Over the holidays, school friends would leave their homes and spend dinnertime with the Sakrans, calling his parents “Mom” and “Dad”.
The Sakrans’ kids weren’t allowed to go to sleepovers, but anybody could spend the night at their place. “My parents valued the importance of an open home to include our friends – so that we stay close with them,” his sister Jenny says. “For my parents, their kids were all they had.”
Being immigrants with “no idea how to navigate the system”, Sakran says, his parents were singularly focused on education. For his 17th birthday, they gifted him SAT prep classes. Sakran remembers rushing out of the first session, more preoccupied with the night’s football game than the intricacies of algebra.
After homecoming, Sakran was hanging out with some friends when a fight broke out at a nearby park. There was a flash in the corner of his eye and a cacophony of screams, but Sakran didn’t hear the gunshot. He didn’t feel pain or the impact either, just a dizzy, tingling numbness. Something was clearly wrong – everyone had run away – but his mind hadn’t caught up.
Sakran staggered to the curb and sat down, finally seeing his white clothes spattered red. With every breath, bright arterial blood spurted out of his throat and pooled on the roadside. Someone must have called 911 because an ambulance arrived, but Sakran couldn’t lie down because he’d start choking on his blood.
“I was watching them ask me questions,” Sakran says. “It was almost like an out-of-body experience.”
His spirit suspended, Sakran could see the slumped figure, the frantic paramedics and his lips moving in response. He was there – but not.
The emergency medicine doctor and trauma resident were already waiting for Sakran as he was wheeled into Inova Fairfax hospital, completely alert. He only remembers flashes after that. The physicians arguing with each other, one saying: “I’m not going to be sued if we fucking lose him.” The trauma surgeon, Robert Ahmed, walking in and yelling: “What in the fuck are you all doing?” Ahmed unlocking the gurney, rushing him to the operating room and saying: “Joe, I have to do this to save your life.” Then darkness.
A .38 caliber bullet had ripped through Sakran’s trachea and severed his carotid artery, a high-speed throughway to the brain. It had smashed through his larynx, or voice box, and took out his phrenic nerve. The vascular surgeon took a vein from Sakran’s leg to replace the torn vessel in his neck, and Ahmed, on his second year out of training, tried to piece together the fractured bits of Sakran’s voice box. “Did I do what I was supposed to do?” Ahmed asks. “I didn’t know. I was basing a lot of this on on knowledge that I had gained from the literature, not from 10 other patients that I had treated because I had not had 10 other patients that I had treated like this.”
Sakran spent over a month in the hospital recovering. “It’s the first time I ever saw my dad cry,” Jenny, his sister, recounts. Their parents would put on brave faces in public but then break down when they thought they were alone. Sakran’s father eventually came back home to take care of his two siblings, “but my mom never came home,” Jenny says. She spent every night at the hospital, lying down on a bench near her son’s room, refusing to leave “until Joey was discharged”.
The detectives suspected the shootout was related to MS-13, perhaps an initiation gone wrong, gang members shooting into the crowd. According to Sakran, they eventually arrested a 16-year-old kid for the shooting – an undocumented immigrant from El Salvador – who was convicted, incarcerated for the maximum time and ultimately deported.
His parents pulled themselves together for their son, but they never really recovered. Costa Soteropoulos, Sakran’s best friend and a fellow surgeon, says he’s never had a candid conversation with Sakran’s parents about the night he was shot. “I think they went through so much trauma,” Soteropoulos says, “their minds had to bury it and move on. Anytime it’s rehashed, I see the despair in their eyes.” (I asked Sakran to connect me with his mom and dad; he put me in touch with his siblings instead.)
Sakran spent six months recuperating at home with a tracheostomy tube down his throat, his parents homeschooling him so that he could graduate on time. He only applied to one college, George Mason University, because it was 15 minutes from his house and he would still be able to live with his family. He got in but also kept returning to Inova Fairfax hospital, signing up to volunteer in the emergency department. Ahmed remembers attending to a patient when he saw Sakran: “And I’m like, ‘Joe, what the hell are you doing here?’” Most trauma survivors stay well away.
“One day, I hope to prove to him that what he did, what his team did, was not a waste,” Sakran says. “I may not look as good as you with my scars. But you know, I got the second chance.”
***
Johns Hopkins hospital is an eyesore, a chaotic motley of dull brick and psychedelic glass that cost $1.1bn. Influenced by Claude Monet’s lily pond series, a window palette of 26 shades – blues, greens, yellows, purples and grays – juts out the building.
It’s a stunning display of opulence in one of the most impoverished, violent parts of the city. “It’s just a bad, bad neighborhood,” says trauma surgeon Crisanto Torres about East Baltimore. Some patients get shot just outside the hospital and collapse on to the floor of the emergency department. Others get dropped outside before crawling their way in. “It’s weird, because they know exactly where to go,” Torres adds. “They come in walking and talking and saying, ‘Doctor, help me.’ And then three minutes later, they’re dead.” About 80% of Hopkins’ trauma patients come from within a five-mile radius.
Last year, I visited Johns Hopkins hospital to spend 24 hours on the trauma service, 7am to 7am. Sakran greeted me while lugging four bags of doughnuts and coffee for the previous night’s on-call team. A quiet hoarseness broke in and out of Sakran’s normal timbre as we chatted, a permanent reminder of his paralyzed vocal cord.
Two years ago, Sakran’s friend, a fellow trauma surgeon at Hopkins, was on his way to work when he was shot several times in a carjacking. The ambulance rushed him three miles to the hospital, and Sakran ran down to meet them at the trauma bay, making sure the residents stayed in the conference room. They didn’t need to see this.
After the operation, Sakran called his parents. He didn’t want them finding out on the news that a Hopkins surgeon had been shot. “They know that their oldest son, a trauma victim and survivor, is working in the most crime-ridden city in our country,” says Soteropoulos. “I think they’re traumatized every day.”
On the day I visited Sakran and his team, the shift began with morning rounds, everyone sitting around a conference room and talking through case files. There was the patient who fell down a flight of stairs and was in a coma, another who was driving 60mph and crashed into an eighteen-wheeler and one with a self-inflicted stab wound to the neck.
And then there was a woman in her 30s who had been shot in the abdomen. The human body can carry five liters of blood; she had lost seven, sustained by a steady flow of transfusions, her life still teetering on the edge.
Sakran knew the case well. As soon as he had gotten home the night before, he had been called back in to help. “No one sees it worse than Joe does,” says Soteropoulos. “He’s seeing the worst of the worst in our country pretty much every day.”
Rounds are a bloodbath of acronyms, a secret language of exclusively three-letter phrases – MVC (motor vehicle collision), TBI (traumatic brain injury), GSW (gunshot wound), the list goes on. Beyond the jargon, half the patients on the list don’t even have names: they’re Ninetyfour Doe or Golf Doe or Thirtyseven Doe or Watch Doe. Some of these anonyms are for unidentified individuals; others protect patients from someone trying to finish the job, so to say.
I watched Sakran visit a teenage girl in the ICU who’d been shot in the neck, her wound covered by a thick cervical collar, a tracheostomy tube prodding out, her mom sleeping by her side. “There are certain triggers,” admits Sakran when I ask him if he’s retraumatized by his work. He gets nervous when people sit behind him. He startles easily with loud noises. His trauma-molded neurons occasionally strip away and replay bursts of the past. “I was lucky enough not to be paralyzed,” he says. Sakran asked the girl if she could wiggle her toes; she couldn’t.
Usually, Sakran is the one to tell families in the waiting room that their loved one didn’t make it. Some become frantic with grief; others refuse to believe him. Sakran tells me this is the worst part of his job. “A part of me dies every time,” he says. “Sometimes you hear the screams long after you’ve walked out of the room.”
However, inside the operating room, Sakran is stone-faced and assertive. I watched him operate again on the woman who’d been shot in the abdomen, the place where her uterus and ovaries would be left hauntingly empty. “When I’m doing my job, I bottle up the emotions,” he says. “You have to be able to make one methodical decision after the other.” Once Sakran finished this round of damage control, he didn’t even close the woman’s incision. He just covered her abdomen with plastic wrap, tape and glue since they had to come back tomorrow to keep operating.
Although he trained at Hopkins for three years, Torres has never seen Sakran cry; however, he has seen him get frustrated after losing a patient. “He’ll throw something down, stomp his feet,” Torres tells me. And then Sakran retreats to his office and shuts the door. “He grieves there,” Torres says, “and I can see the watery eyes after.” Undoubtedly, Sakran is surrounded by friends and family who want to help him, but “it’s very ironic saying that because it’s always Joe who provides the comfort, the support to others.”
We left the hospital at 9am the next day; a car crash had come in right before shift change, the patient’s legs fractured in three places, liver lacerated, skull almost certainly cracked.
After 26 hours on call, I went back to my hotel room to get some sleep; Sakran was making the 90-minute drive down to Fairfax for his five-year-old niece’s dance recital.
***
As trauma surgeons know well, it’s not the bullet that kills you, but the path the bullet takes. Of course, there’s the melted, shredded flesh along the trajectory. But bullets also blast tissues apart at their seams, the initial cavitation pulsating outward. “If you think about a boat traveling on a lake, the faster the boat goes, the larger the wake behind the boat,” Sakran says. “It’s the same thing with a bullet.”
In 1993, the University of Pennsylvania professor William Schwab gave a keynote address at the Eastern Association for the Surgery of Trauma, discussing the bullet as pathogen. His predecessors had talked about dispelling fatalism or some other exalting fluff, but Schwab called on the attendees to “return home and organize your hospital, your outreach program, your colleagues, the police department”.
The opportunity, he emphasized, was serving “the true purpose of medicine – to use our skills for all the sick and with all our might better man’s time on this Earth”.
It was a revolutionary speech, one of the first examples of a physician publicly and unapologetically calling for gun control. “And it was completely falling on deaf ears at the American College of Surgeons and many places,” says Mike Rotondo, a trauma surgeon and the CEO of the University of Rochester Medical Faculty Group. After all, a surgeon’s job was to shut up and operate, not demand firearm legislation. If you really wanted to do advocacy, do something that mattered, like extracting more money from Medicare.
Historically, doctors have gotten away with being relatively apolitical because, with the public mostly on the same page about gun laws, it was easy not to care. As gun violence and school shootings continued to rise, surgeons began increasingly discussing the issue, but many, it turned out, still wanted nothing to do with it. “In 2014, when we came out with a statement on gun violence, there was a significant faction within the American College of Surgeons who were adamantly opposed to our position,” Rotondo says.
Resistance to change is often internal, but “the forces of change are always external”, he continues. And in this case, change came from the most unexpected source of them all: the National Rifle Association.
In November 2018, the NRA fired off a tweet warning “self-important anti-gun doctors to stay in their lane”. The message went viral, fueling more than 21,000 responses and the ire of doctors across the US. The forensic pathologist Judy Melinek shot back: “Do you have any idea how many bullets I pull out of corpses weekly? This isn’t just my lane. It’s my fucking highway.”
When Sakran saw the NRA’s message, he felt a wave of disbelief – and then just rage. “As a Trauma Surgeon and survivor of #GunViolence I cannot believe the audacity of the @NRA,” Sakran punched out on his phone. “Where are you when I’m having to tell all those families their loved one has died?”
Sakran channeled his anger into creating an online community called This Is Our Lane, and thousands of doctors began sharing their stories and pictures: of bloody scrubs soaked to the skin at 2am, of holding together a patient’s skull so that their family could say goodbye, of a pregnant woman who survived only because her fetus stopped the bullet.
“We sanitize these shootings too much for the American people,” Sakran says. Who understands the scope of devastation? “It’s the frontline workers and the healthcare professionals. It’s the children that are lucky enough to survive. It’s the parents that have to identify their children,” he says bitterly. “But the rest of the American people? They’re sitting in their homes; they got their loved ones around them. Everything is wonderful, not even for a minute thinking that this could be their kid, their community.”
In some ways, the NRA couldn’t have made a bigger mistake than telling doctors to stay in their lane, according to the president of the Brady Campaign, Kris Brown, because it pushed Sakran over the edge and helped unite the medical profession at large. “I’ll never forget this: the day the NRA pushed back on him is the day he called me, and I could hear it in his voice,” says Soteropoulos. “He was going to go to war.”
***
Sakran says he wouldn’t call it a war, though: “It’s a fight to prevent people from being killed.” Under the breathless gaze of the public and medical community, Sakran has to walk a fine line, infusing professionalism into his activism. He reminds me several times that he has no problem with responsible gun owners. He calls for “gun violence prevention”, never “gun control”. And despite congressional gridlock and dysfunction, Sakran says he’s still an unflinching believer in bipartisanship.
For Sakran, public health should be about policy, not politics. He’s testified on gun violence multiple times in front of Congress and was invited to the State of the Union address by the House gun violence prevention taskforce. He serves as chair of the board of the Brady Campaign – and as the first chief medical officer of any gun violence organization – organizing tens of thousands of physicians against gun violence, and he’s wrangled together nearly 50 medical organizations to identify consensus-based strategies and pool advocacy resources accordingly. (“Physicians are some of the worst people to have to organize – very stubborn, pigheaded,” says Soteropoulos. “He’s been able to overcome it.”)
One of Sakran’s most recent victories was getting the White House to establish the first White House Office of Gun Violence Prevention, in September 2023. The government has long de-prioritized this work, so at first, the Biden administration tried to placate advocates by housing gun violence prevention in the domestic policy council.
Sakran “continued to push and say, ‘Well, we certainly appreciate that, but it needs to have its own office,’” Brown says, so that the administration could coordinate gun policy issues across the federal government, from the Department of Commerce to the Centers for Disease Control and Prevention. He rallied a coalition of gun violence groups together behind the effort and, after three years pushing the administration, got the victory last fall.
“The fact that this happened, that Joe made this such a huge priority and that he never gave up, is emblematic of how Joe approaches everything – that’s just who he is,” Brown continues.
And none of this is to mention the various op-eds, regular TV appearances from Fox to MSNBC, and Sakran’s work organizing an advisory Hollywood Committee on Guns – to show safe storage practices in movies.
While there are models for physician-advocates across history, from Dr John Snow for clean water to Dr William Haddon for automobile airbags, these are the exceptions, not the rule. Ultimately, our prototype for a doctor is not that of an activist but someone you go to when you’re ill, someone who takes away your suffering. Society certainly needs people to advocate for the old, sick and helpless, but are doctors really the best people to do it?
On one hand, their expertise is undeniable. “Physicians have every element of health of our patients from quite literally the cradle to the grave,” says Patricia Turner, CEO of the American College of Surgeons. “We are the ones who are operating on the patients; we are the ones who are saving their lives.” Who better to advocate for patients than those on the frontlines?
But doctors are overextended as it is. From nurses to administrators to social workers, the healthcare system is teeming with support staff because physicians, with their unique expertise, should focus on treating patients. For most doctors, it’s less about advocacy being out of their lane than it is spending the limited time they have on what they know best. “You might not want a part-time surgeon,” Johns Hopkins’ chief of surgery, Andrew Cameron, puts it curtly.
The other part of the challenge is the doctor’s mantra of professionalism. “Your job as a doctor is to leave your own opinions at home,” Cameron continues, “to take care of all people, all types of people, even as we find ourselves in an incredibly polarized population.” From driving medical distrust to keeping people from seeking care, there’s a real danger to doctors being seen as partisan actors.
In the uncharted waters of a physician-activist, Sakran is swimming against these currents. He’s seen by his critics as a partisan hack not only because he advocates for gun violence prevention but also because he’s rallied healthcare professionals around Hillary Clinton’s and Joe Biden’s campaigns and worked as a health policy fellow for Senator Maggie Hassan. “He’s had death threats; he’s had to deal with the FBI,” says Brown, referring to Sakran’s activism. “This is really hard work, and it doesn’t get easier.”
However, I got the distinct impression that Sakran is not an activist because of some hidden political ambition; whatever he does is for his patients. He tells me the story of a Republican gun owner from Arkansas who made the trip to Hopkins so that Sakran would do his complex hernia repair. This patient told Sakran that, while he didn’t agree with his advocacy, they shared the same end goal: nobody wants to see children being killed.
As Cameron puts it, Sakran sees this bigger picture: only 10% to 20% of the variation in patient outcomes are determined by medical care, or inside the confines of the hospital. It’s a relatively surprising statistic until you consider the socioeconomic, behavioral and environmental factors driving death and disease, from poverty to smoking to homelessness. You can’t control your diabetes if you can’t buy insulin; you can’t live to 70 if you get shot in the head as a teenager.
As Sakran describes it, his work is not about mindlessly expanding the boundaries around healthcare; it is about re-situating medicine at the center of society. As partisan actors transform health issues into political flashpoints, there’s almost a professional responsibility for doctors to get out of the hospital and protect their patients from these emerging threats.
Something will have to give. For Sakran, it’s long been his personal life. Until last year, he lived alone in Baltimore, no kids, unmarried, barely seeing the inside of his home – at 46 years old.
While Sakran got engaged in April, it’s not clear how much will change, if only because Sakran has long deferred his own happiness for the sake of his patients – and his country. “As one of his best friends, that pains me so much,” says Brown. “With Joe, my take on it is, it will never be enough because people are still dying.”
***
When Doe’s ambulance arrived at the hospital, Sakran was in his car, having just finished a 24-hour shift and about to leave for a rare family vacation. But now he was standing over Doe’s lifeless body, his torso open, heart quiet, almost every organ battered with holes.
Sakran transfused over a hundred liters of blood into Doe: as much as he was putting in was spurting right out. “I remember talking to his son and his wife that night,” Sakran says, “and I told them he has a 99% chance of dying.”
John Doe, whose real name is Brandon Fisher, underwent 23 surgeries and spent six months in the hospital, including two in the ICU. He had to learn how to walk again, how to eat, how to bend down. But at least he survived. “My heart stopped for nine minutes,” Fisher tells me, but Sakran pulled him back. “I call him Mr Miracle Hands.”
Last June, Fisher returned to Hopkins for Gun Violence Awareness Day, and in front of a packed auditorium of a couple hundred people, Fisher shared his story. He grew up in East Baltimore, thrown in the streets at a young age when his parents broke up. He had his own son at 17 years old and was quickly forced to learn how to raise a kid in the projects. Fisher understands gun violence because he’s lived it his whole life, and like Sakran, he wants to use his story to make the country safer. “I think that’s my calling,” Fisher says.
Sakran tells me it’s a miracle that Fisher is even alive right now; not everyone gets this happy ending. “If we’re lucky, you’re going to save nine out of ten,” says Cameron. “And the one you can’t save – it’s of no solace or help to the patient’s family, or to you, that the other nine did well.” Cameron continues, exasperated: “We will never fix this problem with better surgery.”
When Sakran looks to the 2024 election, the stakes couldn’t be higher. “As healthcare professionals, we have to be part of the type of change that we want to see,” he says.
“How do we combat all the different things we are facing, whether it’s gun violence, or racism, or immigration, or reproductive rights – it’s so critical. And these are all on the ballot.”
