Revisionist History - Guns Part 5: The Footnote

Episode Date: September 28, 2023

At the end of a forgotten study of convicted murderers, the author left a devastating footnote.  We travel to an old plantation house outside Montgomery Alabama to hear his story — and what it tells us about American gun violence.See omnystudio.com/listener for privacy information.

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 23, Number 4, Pages 313 to 323, 1995. Lead author, Penelope J. Hanke. Second author, James H. Gundlach. It made me go all the way to a little town in Alabama to have the man who wrote the footnote explain to me, 30 years

later, just what it meant. Can you do me a favor? Can you read that, read the footnote for me? Small print. At 3.02 a.m. on September 23, 1994, a little over a month after Dr. Hankey and I submitted this article to the Journal of Criminal Justice,

a death following the pattern described in this article literally stuck home. J. Brandon Young III, age 17, was shot in the back with a 12-gauge shotgun and killed in my house in a predominantly black part of Rural 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 Gundlach lives in Shorter, Alabama, a little town just south of Tuskegee, along I-85. 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 18 counties that make up the Black Belt of Alabama,

where the cotton plantations were in the days before the Civil War. Gundlach lives with his wife in an 1840s plantation house, a doctor's 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 pad around, presenting their giant heads for attention. The house looks untouched from the 19th century. There's an abandoned truck in the backyard. I grew up tough. I was a World War II 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 bridge, taking my mother with him, and be gone for days. Gundlach is tall, stooped, wisps of white hair. He moves and talks slowly. That continued on when I was 11. We ran out of food, and I saw this big flock

of blackbirds, crows. And so I took the 12-gauge shotgun and my brother and I, we went up and snuck up on them and as soon as they started flying I went and I got two shots off. And as I was talking to my brother reminiscing about this, he said, yeah, and you said your whole shoulder hurt so much you made me go pick up all the dead birds. But we sat there started the fire, stripped and dressed out the birds and on a stick 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 his 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 28th day of my 81st year, so I'm on the old side. And six months after I retired, I had an encephalitis infection of the brain. And I survived it when I was 66 from it in the hospital, I had company, but I couldn't think of 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 196. My first conclusion was that I was essentially brain dead. I may 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 against 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 Gundlach talking. Let me go turn that thing off. Okay. My wife always leaves it unbalanced, and it makes an awful lot of noise. And if I'm going off on tangents,

if you're not interested, you know. Well, why don't actually, some of what you're talking about now feeds into what I want to speak to. Sure. So why don't we start with the stuff that was interesting to me the most,

which was, I read that Damned on Arrival paper. Mm-hmm. And I just, I thought it was absolutely fascinating. And I wanted to kind of talk to you a little bit about that, and that would be a good place to start. Okay. We talked a little about the paper, and then James Gundlach 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 1990s when he got a call from his brother. His brother's daughter had run away. The police called him and asked him why he hadn't canceled the missing child. He said, well, she's not back home. They said, well, she's never missed school.

She worked out a system by which 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. Gundluck took his niece in. She was about 14. So was 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 that 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 Crips, the Disciples. Word got out that the Gundlach's house was a place of refuge. One time, we had this big lizard, the disciples. Word got out that the Gundlach's 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 quasi street kid. He was sort of staying in our house to be out off the street and stuff without having contact with the adults in the house. I sat in a small chair next to Gundlach's desk as he talked about the kids he took in. Boys in 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 really in the time that our parents left us alone on the farm that I can really relate to kids not having parental support and sufficient 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 17. 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. Yeah. But you got to know him well. Oh, yeah. At first, he was very, you know, reserved and suspicious and other such things. But,

you know, as he got to know me and stuff, he opened up and would talk about things. And then James Gundlick started talking again about the paper he wrote with Penelope Hankey, 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 your 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. This is Dr. Babak Sarani. 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 24-hour facility equipped with everything necessary to treat traumatic injury. General surgeons, orthopedic surgeons, neurosurgeons, plastic surgeons, anesthesiologists, ER docs, radiologists, nurses with the right qualifications, on and on. Level 1 trauma centers cost hundreds of millions of dollars to build and operate.

They're relatively rare. D.C. has 13 hospitals, but only four level ones. One of those is at George Washington. Sarani is the chief trauma surgeon there. Do you know how many, roughly speaking? Oh my goodness. I would think probably by now, the number of gunshot victims I've seen personally, I've been in practice since 2005. I would venture Mr. Gladwell 500 plus. Wow. Yeah. And you weren't even there during DC's darkest years.

Correct. Correct. I wanted to talk to Sarani about time because trauma surgeons 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 bit to me about time. You said EMS tends to get there within 10 minutes and you tend to get to the trauma center between 20 and 45. What's the difference between 20 and 45? 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 20 and 45 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. 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. 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, Sirani had just treated someone who had taken a rifle shot to the liver. The reason he's alive, and we'll take some credit at George Washington, but honestly,

one of the big reasons he's alive is the paramedics. They completely scooped and ran with this guy. I think their entire scene time was like 10 or 12 minutes, and they of wounding to arrival to the trauma center, he was probably five to 10 minutes away from dying. He was at the extreme end stages of shock. Or what about a bullet to the lungs? A paramedic can actually treat a gunshot wound to the lung. They can temporize that person very nicely. So do that. How do you temporize someone who's had a gunshot wound to the lung? So when you have a gunshot to 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, believe it or not, really, really common.

The problem is you have air leaking from your lung and that air is accumulating inside the chest. As that air collects more and more inside the chest, because it's leaking out of the 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, literally insert a 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. Absent that intervention, that would be a fatal event.

Correct. Just to linger on this time question for a moment. So if I have a gunshot wound to the chest and I have exactly what happened to me, what you just described, how much time do I have without an EMS's intervention? Half an hour? 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 wounds. And what determines how good a medical system is at treating gunshot wounds? 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 35% 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 to a 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 Tong set out to answer that question a few years ago. What do you find in Chicago? And so we found that Black majority census tracts 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. That racial disparity was essentially very large, approximately a seven-fold increase on the South Side in Black

communities. Wait, so explain the sevenfold. The racial disparity between what and what is sevenfold higher? The racial disparity between Black-majority census tracts and white-majority census tracts. Is 7x? Sevenfold. Sevenfold. Wow. For a period of 30 years, between 1991 and 2018, the South Side of Chicago didn't even have a Level 1 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 pay-your-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 health care. 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 payer mix. 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 healthcare. We're essentially taking the market forces out of that. And we're saying, let's plan this the way that it should be planned. And let's incentivize hospitals appropriately to essentially be able to care for their patients at the level of care they need to be cared for. 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, 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? 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 there actually has been a lot written recently about the moral injury of our healthcare financing system and how it really does make a lot written recently about the moral injury of our health care financing system, and how it really does make a lot of health care 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. A. 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. C. 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 Hankey and James Gundlach in the Journal of Criminal Justice, Volume 23, Number 4, 1995. 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 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 10 worst prisons in America list. So Gundlach and Hankey looked at all the murderers in Tutwiler and divided them by race. First, the white murders. There were 47 people victimized by white women who died instantly.

No amount of medical attention would have saved them. Headshots, bullet to the heart. And a roughly equal number who were dead on arrival. Those who could, at least theoretically, have lived if they'd gotten medical attention sooner. The ratio of killed instantly to dead on arrival was essentially one-to-one. Then Gundlach and Henke 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 study 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 health care 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 killers 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 468 African-American murderers at Tutwiler. So that's 113 people who wouldn't have been convicted for homicide if their victims had received the same medical attention as white people. They'd have been convicted on lesser charges, like aggravated assault.

They wouldn't be murderers. And at the very end of the paper, Gundlach and Hankey give us a little hint of what they think was going on in Alabama. One anecdote related by a female inmate at Tutwala 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.

Hankey and Gundlach presented an early version of their paper at the American Society of Criminology meeting in Phoenix in the summer of 1993. And while Gundlach 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 was sort of working on 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 um that kind of kind of thing he was uh he was a very likable and uh even from an adult's perspective, respectable person, even though he was a street gangster. How did Brandon make, 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 never asked for money. He seemed to kind of know, and we were kind of working toward pushing him to go ahead and work toward where we could get him lined up to where he could go to college and stuff before he was killed. Obviously that ended that. He passed the GED. That's the high school diploma equivalent thing. So, you know, and

he 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 not sure how he picked up some of the stuff, but he would regularly read books and if we could you know have gotten him on a route going through college and stuff he would have turned into a very solid person I'm very sure he he had a strong streak in him of caring for people. And... I don't know.

I thought about him a lot back then, but I haven't lately. Yeah. Brandon wanted out of the gang world, so he went to stay at a log cabin the Gundlucks owned 45 minutes or so north of Montgomery.

In the town of Notosulga in Macon County. They thought he'd be safe there. And that's where he was with three of the other teenagers the Gundlucks had taken in on the night of

August 23rd, 1994. It was a few hours after midnight. Brandon heard a noise outside. He went to check. He put the other kids in a place that they would be safe. This old house, it has a second floor area, 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 the 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 and opened 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 angry 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 15-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 drive-bys because he said, if you want to fight, fight like a man. In an interview this week before Thursday's arrest, the 15-year-old girlfriend was guarded when she talked about the night Brandon died. Frail and blue-eyed, her bright red nail polish 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 Gundlach goes back and adds a paragraph to their article not a change to the main body of the text because Brandon Young wasn't a female inmate at Tutwala 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 so take me back to that night so you're 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 speed limit, got there. I usually break the speed limit, but I broke it more when I was going there. And I got there before the ambulance did. He was coming from Montgomery, over 40 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. 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 them know when you're asking for services that you're white. Mm-hmm. It's just, the racism is so deep and pervasive

that there's all kinds of subtle, not really, taught the kids, but not really talked about kinds of things. And since I didn't grow up in Alabama I didn't have that training yeah yeah did you um 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 and they were still in the process of taking the body away. So it wasn't the 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 to benefit racism in Alabama. Yeah. So he was... He wasn't apologetic or indignant. He was just kind of... Trying to be helpful. Trying to be helpful. Trying to be helpful.

Trying to teach me what I should have known. Yeah. Gundlach called his footnote a dedication to Brandon Young. I wanted to hear him read it. At 3.02 a.m. on September the 23rd, 1994, a little over a month after Dr. Hanke and I submitted this article to the Journal of Criminal Justice, a death following the pattern described in this article literally stuck home. J. Brandon Young III, age 17, was shot in the back with a 12-gauge shotgun and killed in my house in a predominantly black part of Ruhlmacon County, Alabama. He bled to death while the ambulance took over one hour to make the six-mile 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 23, 1994, 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 miss Brandon and I know that he would have made many lives better if he had lived. To be continued... We were edited by Peter Clowney and Julia Barton. Fact-checking by Arthur Gompertz and Cashel Williams.

Original scoring by Luis Guerra. Mastering by Flan Williams. Engineering by Nina Lawrence. I'm Malcolm Gladwell. You may have noticed there are two different dates given for Brandon Young's death. August 23, 1994 is the correct date. There was an error in Gundlach's original paper.