Paul was a line cook at a sports bar when his roommate and landlord, Cordell, shot him.
Paul had been bad at managing his money, and tensions between the two reached a boiling point when he fell behind on four months of rent.
One morning, Cordell stormed into their shared apartment with what Paul thought was a BB gun. Cordell fired, and the first bullet nicked Paul’s scalp and ricocheted off his index finger. A second round entered and exited the side of Paul’s chest. The third round ripped through his shoulder and came out of his armpit. Paul collapsed.
Paul “played dead” for the next half hour, silently watching Cordell clean up the crime scene. He watched Cordell crawl around on hands and knees collecting bullet casings; and in the most chilling moment, Paul remembers Cordell staring into his eyes and kicking his feet to check if he was still alive.
At one point, Paul tried to escape, screaming for help out of a rear door that led into an alleyway. Cordell intercepted him and dragged him back into the kitchen. He then placed the muzzle of his gun against Paul’s face and fired a fourth round. This bullet shattered Paul’s jaw and ripped through his neck and chest, lodging in a band of muscle just beneath his collarbone.
Cordell then left Paul alone. Paul was slipping in and out of consciousness. To stay alert, he focused on the sound of water running through old pipes in the ceiling. With a sudden surge of adrenalin, he made a clumsy sprint to the front door. Cordell heard him and came running down the stairs with his gun drawn. Paul closed his eyes, expecting to get shot again. But, the gun jammed and Paul managed to escape. Minutes later, a passerby discovered him lying at the side of the road in a pool of his own blood.
Paul’s story haunted me. The details of Cordell’s execution-style shooting were much different than the accounts I got from other gunshot victims in the outpatient trauma clinic at the University of Pennsylvania. Most of the victims I met had been shot during stickups, drive-by shootings and other street altercations. Paul’s shooting was different. It was cold and calculated and occurred in his home – a place where he was supposed to be safe. This was horrible for Paul, who suffered from terrifying flashbacks.
I met Paul two weeks after he’d been shot. I’d walked into a hospital room, where he was slumped over an exam table. He motioned for me to check out his hand. His pinky and ring fingers were coiled, like an eagle’s claw. “Does it hurt?” I asked. Paul’s eyes widened, “Does it hurt?! Every morning I wake up, this shit hurts!”
Later that day, Paul asked his doctor for a refill of Percocet. Paul’s doctor listened to his story, but denied the request, saying, “Percocet is not a long-term pain option. You can try taking Motrin or Extra Strength Tylenol. They should help you.” Paul protested, but to no avail. We sat in silence after his doctor left. Paul let out a deep sigh, “Motrin?! Percs barely do the trick!”
Paul would have liked physical rehabilitation, but he did not have health insurance and could not pay for it out of pocket. In the meantime, Percocet helped him regain some semblance of his former life. Without it, pain invaded his body and disrupted his sleep. As we left the clinic, I asked Paul what he was planning to do. He shrugged, “I know some people who got Percs. You can get everything on the street.”
With Percocet to ease his pain, Paul was initially able to keep his job as a line cook. He managed with the help of other kitchen staff for a week, but became a liability during busy nights. With his permanently clenched left hand, he could still hold the fryer, but he couldn’t do basic things like open jars or lift boxes. His friends on staff picked up the slack for as long as they could, but once service started slowing down considerably, Paul was let go.
Paul was one of nine gunshot victims in Philadelphia I interacted with weekly for almost two years beginning in January 2010 as part of an ethnographic study I was conducting. I use the term “victim” throughout because this is how participants referred to themselves. Thirty-eight of the 40 participants identified as black or African-American. One identified as white and one as Latin American. Their ages ranged from 18 to 60; the median age was 24. All but three of the participants were men.
I spent time with Paul at homeless shelters; I attended his meetings with social workers; I also spent time with him in his old neighbourhood, which was located next to one of Philadelphia’s largest and most racially segregated housing projects. By the time he reached adulthood, Paul had witnessed the shooting murders of 11 close friends, family members and acquaintances. Although he had grown up immersed in street culture, Paul was not dealing drugs when he got shot. He had left this life behind and often remarked that he did not miss the stress and anxiety that came with drug dealing.
After the shooting, Paul spent most of his days trying to control the sharp and throbbing pains in his body. This is a dilemma faced by thousands of gunshot victims who are wounded each year in the U.S. Most of these victims do not have health insurance or are under-insured when they get shot. Indeed, while fatal shootings dominate news coverage, most people do not die from shootings. According to the U.S. Centers for Disease Control and Prevention, approximately one in five shootings are fatal.
Under American law, all gunshot victims are entitled to emergency and followup care when they arrive wounded in hospitals. But once they are deemed healed by physicians, they return to their home communities, where victims such as Paul continue to struggle with injuries, chronic pain and health problems that diminish their quality of life. Getting shot is often the beginning of a downward spiral in a person’s health. Sudden and unanticipated disability can jolt them out of the labour market – sometimes indefinitely. A serious injury presents particular problems for working poor victims such as Paul who depend on an able body for their livelihood.
Social scientists often use a term called “structural violence” to explain why young black men such as Paul are the most at-risk group for fatal gun violence in the United States. Between 2000 and 2015, overall rates of gun homicide have decreased in the U.S. But gun homicide rates per 100,000 people are still more than eight times higher for African Americans than for whites. And while improved surgical techniques and other advances in trauma care have helped reduce gunshot mortality rates, surviving victims face a lifetime of pain and disability. Even their interactions with health-care providers can be problematic. Physicians and nurses often develop a skeptical disposition toward gunshot victims because they believe that victims must have been doing something illicit or risky to get shot.
The structural violence perspective helps us appreciate larger racial-ethnic and class disparities in exposure to gun violence, but it also raises additional questions about how people collectively respond to adverse life events. How do gunshot victims make sense of and try to manage their injuries? What survival strategies do they employ? And how do these strategies affect their road to recovery?
I noticed one day that Paul was clutching a black rosary dangling around his neck. He kissed it and peered up at the sky and said, “I always got this with me now.” He explained that an elderly woman at his church had given it to him. It became something like a talisman; Paul felt it would keep him safe from future harm. “God got my back,” he said. The elders in the church had also organized a clothing drive for him when he came out of the hospital. “They knew I was homeless and didn’t have nothing, so they took donations.”
Paul told me that he had grown up going to church, but stopped after his mom passed away. Getting shot and coming close to death had inspired him to go back.
Paul started visiting a local Baptist church two weeks after getting out of the hospital and immediately bonded with one of the senior pastors. The pair met every couple of weeks for private prayers and Bible study. At first, the pastor had sometimes prayed with Paul after the sermon. Then, Paul started visiting with the pastor during the week. “Sometimes I just go in and we shoot the shit, just like we doing now,” he said. Other times, they would sit quietly and pray together. “What do you talk about?” I asked. Paul shrugged, “Pretty much everything. I like Pastor Mike because he told me that this ain’t the end. I survived! He tells me that God has a plan. This is just the beginning.”
All of this confirmed Paul’s wishes to get baptized. “At the end of the day, I wanna be straight with my creator,” he said. “Do you think about those things more now?” I asked. Paul laughed, “Yeah, most definitely. I realize I might be going back to that bright light and I wanna be straight. I don’t want nothing to keep me from heaven.”
Many social and behavioural scientists are skeptical of religious institutions and take an agnostic view of spiritual matters and the afterlife. But, as Paul’s story shows, there are other ways that we might think about religious institutions, particularly in the lives of people who survive traumatic violence. On the one hand, religious institutions are important centres of community life. They provide much more than just moral and spiritual guidance. They are hubs that connect people – powerful institutional buffers against social isolation. These are especially important functions in communities that have been transformed by poverty and violence.
Religious institutions play a special role in the lives of gunshot victims, whose injuries and lingering mental health issues disrupt their social and working lives. Near-death experiences can cut people off from the outside world. It can make them retreat into the confines of their home or rob them of the very relationships that help them cope with trauma. Religious institutions provide people with a safe space to connect with other worshippers who openly empathize and pray for them. This is a powerful source of social and emotional support.
Religious institutions also help victims rebuild their lives. Members of his congregation came to Paul’s aid when he needed clothing, a place to stay and a ride to and from appointments. These are some of the less visible ways that religious institutions support victims such as Paul, who don’t have family to help them.
Paul’s story also shows that spirituality isn’t just a cognitive salve that helps a person grapple with the prospect of their own mortality. It is a broader orientation to crisis management and it helps a person cope with the unpredictability of traumatic injury. Time and again, researchers have shown that strong spiritual beliefs help inspire hope and lead people to feel a greater sense of control of their lives. Spirituality has also been shown to help people make meaning out of their suffering. A person who believes that adversity is natural feels less daunted by the tasks that lie ahead of them in rebuilding their lives.
Paul leaned on the support of people such as the church elders and Pastor Mike. They helped him see the shooting as an important – even integral – part of a divine plan for his spiritual growth and salvation. These interactions changed Paul’s view of his near-death experience. What felt overwhelming and crushing in some moments would become more manageable and part of his traumatic rebirth. In fact, he would talk about getting shot and almost dying in thankful terms, saying that this experience would ultimately save his life.
Of course, people say this when they’re trying to maintain a positive and upbeat attitude about a dreadful scenario. But positive thinking is, in its own way, a source of resiliency. It helps shield victims from depression and crippling thoughts, and it inspires them to go out and seek more help.
In the summer of 2011, Paul testified against Cordell in his criminal case. Paul’s testimony helped the prosecution convict Cordell on attempted murder and gun charges. Cordell was sentenced to 14 years in a state prison. I was surprised to find Paul in a sombre mood after the hearing. I naively thought he would feel a sense of closure. “So do you feel like you can move on?” I asked. Paul shook his head. “No. I mean, look at my hand. This shit is never gonna be right.” I tried to console Paul, but didn’t know how to cheer him up. His hand looked worse than the first day we’d met, more than a year earlier. Many of his fingers were coiled up and swollen. He complained about throbbing pains in his hands and said that many of his fingers were going completely numb.
Later that summer, Paul got baptized. We met up at his cousin’s house. “What do you think?” he asked, as he answered the front door. Paul was wearing his best dress shirt. It still had the ironed creases in it from the dry cleaners. “I can’t wait to see Pastor Mike. It’s been too long,” he said, putting on the jacket to his two-piece suit. I sat down on a couch and watched Paul get ready for his big day. He was excited and nervous, but seemed hopeful about what the future might bring.
This article is adapted from Ricochet, a forthcoming book by U of T sociology professor Jooyoung Lee.