On Friday afternoon, Dr. Judy Palfrey was doing her rounds at Children's Hospital, above Longwood Avenue. Two miles away, on the other side of town, her husband, Sean, like her a pediatrician, was doing the same at Boston Medical Center.
The news about what had happened 150 miles away in Connecticut seeped out slowly along the corridors where sick children are cared for. The adults — the nurses, the parents, doctors like the Palfreys — gradually realized the extent of the horror in Newtown but did their best not to betray that knowledge to the kids.
Silence was imperative as the Palfreys finished their rounds. But when they got home to Cambridge, and compared their days, they knew that away from their patients, it was time to be anything but silent.
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It may be that the violent deaths of 20 innocent children will finally force this country to have an extended, rational debate about limiting the access to high-powered weapons and ammunition. Judy Palfrey was ready for that debate 21 years ago after the death of just one.
His name was Charles Copney, he was 11 years old, and when he was killed in 1991, caught in the crossfire of rival gangs, he was the youngest child in Boston to die of a gunshot. In those intervening years, the dubious title of being the youngest victim kept dropping and now a jury in Boston is deliberating the fate of a man charged with shooting a 2-year-old boy to death in a drug rip in Mattapan.
"Charles Copney was my patient since he was 2 years old," Judy Palfrey was saying. "We were able to treat his asthma. We were able to treat a cancer, a tumor that required the amputation of his toe. And then he goes out for a bottle of milk and is dead."
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His death changed the way Judy Palfrey looked at her responsibility as a physician, as a pediatrician. Guns were killing children as surely as any malignant tumor, as any virulent virus. She felt as ethically and medically obligated to remove guns from the lives of her patients as she was to remove Charles Copney's toe.
The organization of which she later served as president, the American Academy of Pediatrics, issued guidelines requiring pediatricians to ask children's parents or caregivers whether there were guns in their house.
A reasonable requirement, aimed at reducing the number of accidental discharges that kill and injure children. Except that in Florida, legislators passed a law in response to those guidelines that exposed doctors who had the temerity to ask such a question to sanctions by the state board of medicine.
"It was ludicrous," Judy Palfrey said.
The pediatrician's group went to court and, last year, prevailed, but the fact that safeguarding children could somehow be construed as overzealous, intrusive meddling into the lives of gun owners underscores the difficulty of injecting common sense into the debate on how to lower the incidence of gun violence.
"People have got to overcome the fear of discussing this rationally," Sean Palfrey said. "There has to be a graded response. But you've got to start somewhere and you've got to start now."
Start, for example, with reinstituting the assault rifle ban that was allowed to expire in 2004, a decade after it was introduced. Start, for example, with limiting access to large-capacity magazines that, among other things, make it easier to kill a lot of people in a short period of time. Start, for example, with requiring background checks of buyers at gun shows and private sales.
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Like so many school shooters before him, Adam Lanza, the 20-year-old who shot and killed 20 children and six teachers and staff at Sandy Hook Elementary School after, police believe, killing his mother, appeared to have had serious mental health issues. And the reality is that it is easier for people like Adam Lanza to access legally purchased guns, from a gun shop or, in his case, his mother's house, than quality mental health care. More evidence that, as Judy Palfrey has long argued, approaching gun policy as public health policy will save lives.
An outright ban on guns is as unrealistic as the lack of any limits on sales of weapons is unthinkable. It won't happen. But as Judy Palfrey concluded 21 years ago, as she stared at the lifeless body of a little boy she had saved from everything but bullets, the carnage can be reduced, the number of children and adults killed and wounded by guns in America can be lowered.
"But it can't be if we don't talk about it," Judy Palfrey said. "What are we afraid of?"
The killing of six people, including a young girl, and the wounding of a congresswoman in Arizona wasn't enough. The killing of 12 people in a movie theater in Colorado wasn't enough. Maybe the killing of 20 children in a school in Connecticut will force a serious conversation.
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Earlier this week, before Newtown lost its children and its innocence, a young resident physician Judy Palfrey didn't know knocked on the door of her office and handed her a note. It was from Pat Copney, Charles Copney's mother, saying she hadn't heard from her in a while. She just wanted to talk.
Kevin Cullen is a Globe columnist. He can be reached at cullen@globe.com. Follow him on Twitter @GlobeCullen.