Joseph Sakran remembers the day in 1994 when an errant bullet changed the trajectory of his life.
Then a senior at Lake Braddock Secondary School in Burke, Va., he remembers the flash from the gun fired during a fight after a football game, people dispersing and blood gushing over his clothes. He had been shot in the throat.
Over the next six months, Sakran had a tracheostomy and underwent multiple surgeries to help him breathe and speak. The 17-year-old also resolved to become a physician. He believed his destiny was "to give others that second chance I've been given."
Now 39 and a trauma surgeon at Johns Hopkins Hospital, Sakran is on the forefront of a movement among medical professionals growing more vocal about a surge in gun violence in Baltimore, a city where more than 240 people have been shot to death this year, and across the country. His medical advocacy group is joining forces with another physicians organization, and he hopes to launch more in-depth research into shootings and victim outcomes.
Sakran says he is motivated by his experience as a survivor and his experience performing emergency surgeries on gunshot victims. He said he recalls the looks on his parents' faces two decades ago when talking to the parents of shooting victims he is trying to save.
"Their faces are chiseled in my mind," he said. "I imagine what they had been going through — and not always does someone survive."
In Baltimore, one out of three people shot last year died, making the city one of the most lethal of America's largest cities, according to a yearlong Baltimore Sun investigation. The odds for gunshot victims worsened last year in at least 10 of those cities, including Baltimore, Chicago and Milwaukee, The Sun found.
While medical advances and practices have dramatically improved the survival rate of most trauma patients, studies by hospitals including Johns Hopkins have shown the chances of survival for gunshot victims have decreased. At the same time, a number of deadly trends have taken root, such as criminals using higher-caliber guns with large-capacity magazines, leaving multiple-gunshot victims to bleed out more quickly.
Political impasses over universal background checks for gun purchasers and increasing federal funding for gun violence research was among the reasons Sakran started the group Doctors for Hillary two years ago. The group supported Democratic presidential nominee Hillary Clinton, who made gun control a central tenet of her campaign. Sakran said his group includes a few hundred core members and 65,000 followers on Facebook.
In the wake of Donald Trump's win over Clinton, Sakran plans to merge his group with Doctors for America, a political advocacy group of health professionals that pushed for health care reform and has made increased federal funding for gun violence research a top goal.
Sakran hopes to continue pushing for universal background checks, closing loopholes that allow customers at gun shows to bypass background checks, preventing "straw" purchasers from legally buying guns for people with criminal records, and greater restrictions on "military-style weapons."
"More than ever it's going to be important for us to really take a concerted effort to say that this is not a Democratic issue, not a Republican issue. This is an American issue," he said.
Trump has opposed limits on gun ownership, and any gun-control measure is likely to meet stiff resistance in a Republican-controlled Congress. Trump, a Republican, has said he would appoint Supreme Court justices who uphold the constitutional right to bear arms and that he would seek to expand mental health treatment programs in the wake of mass shootings by mentally ill people in recent years.
Doctors for America Executive Director Alice Chen, an internal medicine physician and assistant professor at George Washington University and the David Geffen School of Medicine at UCLA, said common ground can be found on issues such as preventing suicides and child injuries by firearms.
"All of us have a responsibility to be more civically engaged," Chen said. "Certainly we have to think about what are the likeliest things that we can get passed in the new political environment. … But the urgency to do something does not change."
Sakran said seeking reforms on a state-by-state basis may be another route for doctors to pursue.
While Maryland already has some of the strictest gun laws in the nation, Baltimore Police Commissioner Kevin Davis plans to step up efforts to lobby lawmakers in the General Assembly session that begins in January for mandatory prison time for people arrested with illegal handguns and high-capacity gun magazines. Other proposals legislators plan to push include bills to ban guns from college campuses and prevent people on federal terrorist watch lists from buying them.
S. Rob Todd, chief of general surgery at Ben Taub Hospital in Houston and a member of Sakran's group, said surgeons need to continue to make the public and politicians aware of the worsening conditions in which many gunshot victims arrive at hospitals. Todd, also a professor at the Baylor College of Medicine, said the percentage of gunshot victims dying in the emergency room has increased significantly since 2000.
"At some point, we have to stop being quiet and we have to start speaking up," he said. "We can talk about the gravity of the situation. We can talk about what we see."
Sakran said he also wants to study the degree to which gun violence has become more intense nationally using data from medical examiners' records and the National Trauma Data Bank, which gathers statistics from hospitals.
He also wants to study Johns Hopkins patients who have been shot on more than one occasion to determine factors that put people at a greater risk of being victimized.
Sakran has vivid memories of his own shooting. He remembers turning his head toward two people who were arguing when someone fired a .38-caliber gun into the crowd of high-schoolers, striking him and another student, who also survived. He remembers choking on his blood as paramedics tried to place him flat in a medevac, and a trauma surgeon taking charge amid chaos, wheeling him into an operating room.
Sakran's trachea was ruptured and his left carotid artery, which provides blood flow to his brain, was severed. One of his vocal cords was paralyzed, as was a phrenic nerve, which helps with speaking and breathing.
Sakran underwent multiple operations at Inova Fairfax Hospital, where he was born and, years later, where he would do his residency.
In a permanent, slightly hoarse tone with a volume about half of what it should be, Sakran speaks admiringly about the trauma surgeon and vascular surgeon who saved his life and taught him as a young resident.
"I was really inspired to give others the opportunity I had been given," he said.
The bullet that struck Sakran was surgically removed weeks later. He keeps it in a container on his dresser, and takes it out to examine every once in a while as a reminder of his near-fatal shooting and his mission to save others.