Firearm-related ED visits by insurance status
On a day this spring, Hall mills around the public hospital’s trauma unit. It was unusually quiet, but Hall’s tiny frame radiates excitement. “There’s my baby!” Hall shouts. “All pretty in pink.” She approaches Givens, a tall, slender woman who strolls into the trauma unit wearing bright pink workout clothes and pink Nike shoes. Hall engulfs Givens in a hug. Givens, 34, gets out her smartphone and shows everyone photos of her recent wedding in Las Vegas. It feels like a family reunion.
Hall is often the one who performs critical care and then listens to the patients who are concerned about retaliation. Hall also plays the prodding motherly role, for example, when she forced Givens to get out of bed and into rehab.
When the outcomes aren’t as good, family members and friends of gunshot victims are left to grapple with the lingering aftereffects. Hall knows. She sees it daily at the safety net hospital and also has been through it. She lost her son to random gun violence years ago.
“The devastation in your heart,” Hall says, and then pauses. “I think I identify with a lot of these families because I’ve been there.”
Twenty-one years ago, Chicago police officers arrived at Hall’s home in Dolton, a village on Chicago’s southern border. Someone had attempted to carjack her 23-year-old son, Jerry, at a gas station and shot him in the head.
Jerry borrowed Hall’s car that day. She surmises her wellbehaved son didn’t want to give up his mother’s red Audi. But the car wasn’t important to her at all. Jerry was her firstborn, a child conceived through rape at a young age.
“Bad things happen to good people, I guess,” she says with a shrug, adding that she loved him with “everything in my soul.”
Hall’s grief ran so deep that she became suicidal for about three years. She knows the details surrounding Jerry’s death, but she’s buried them deep within her. Hall never sought professional help even though counselors and other resources were not far away.
Jerry’s younger sister, Nicole; Hall’s grandson, Jaciar; and her husband, Brian, kept her going. Hall managed to make her way into work every day. Physicians and other co-workers helped her cope. Some days, she still had to go off into a utility closet to cry.
Hall, who has worked in Stroger’s trauma unit for 36 years, tries not to think about what happened to Jerry when she cares for gunshot victims. Many emergency physicians and nurses aren’t so lucky and sometimes encounter “vicarious traumatization,” a term that describes when workers absorb a patient’s traumatic event into their own lives. Some surveys of healthcare workers show treating gun violence patients leaves unforgettable impressions.
Hall and the Stroger trauma staff pour their energy into providing the physical and emotional support gunshot victims need. Givens is living proof of their efforts. They also want to tackle the socio-economic and cultural factors that play into Chicago’s raging gun violence. But that’s much easier said than done.
Stroger Hospital’s trauma center encompasses 15 beds, as well as an intensive-care unit and an observation unit. The center is packed in the spring and summer, when people are enjoying the warmer weather. Victims of car crashes, burns, assaults and shootings fill the resuscitation bays. On the busiest days, stretchers are parked in a line, waiting for the next vacant bed.
“We live in a city where nearly 3,000 people got shot last year, which is something that is just mind-boggling,” says Andy Wheeler, a patient and family support coordinator at Stroger who helps victims get back on their feet. Last year, Stroger staff treated 900 of those gunshot victims alone. Nearly 1,800 people in Chicago took a bullet in the first six unseasonably warm months of 2016. Many were steered to Stroger.
During the three-day Memorial Day weekend, 69 people were shot in Chicago; six of them died.
“It’s just an escalation of craziness, and there’s no control,” Hall says.
The financial toll of these types of gun cases weighs heavily on the healthcare system. Just the hospital costs of
firearm assault injuries totaled $630 million in 2010, the Urban Institute estimates. Gun-related deaths and injuries cost $52 billion in 2013 when factoring in lifetime medical and work-loss costs, according to the Centers for Disease Control and Prevention.
Those who make it out alive may need to receive nutrition through an IV for a year or more. Others need follow-up operations or are prescribed pain medication for the rest of their lives. And those are just the costly physical problems.
What about people who can’t easily return to the hospital for their follow-up visits? What about their jobs and income? What happens to them psychologically when they go back into the neighborhood that incubated the problem?
“There’s so much beyond the physical and medical aspects of what happens to someone when they are shot,” says trauma surgeon Dr. Kimberly Joseph, a 23-year veteran of the safety net system. She’s also the division chair for critical care and prevention in Stroger Hospital’s trauma department. “Just working out the logistics of your life— that by itself can be a huge obstacle that comes out of this gunshot wound.”
Mental health issues may pose an even bigger barrier to recovery, with many survivors suffering from post-traumatic stress disorder or other conditions. Hall has seen this firsthand with Givens, who still experiences bouts of PTSD. Soon after Givens was discharged from Stroger, on the Fourth of July 2011, thunderous rounds of fireworks petrified her, reminding her of the ear-splitting shots that were fired just feet from her body. She’s also called Hall and taken naps at the hospital when she heard gunfire in her neighborhood.
It’s gotten better. But the mental trauma may never go away.
“I think about it every day … every day,” Givens says. “I’m still trying to get over this.”
Joseph remembers when public health officials were willing to investigate the root causes of gun violence. Political beliefs have shifted, and America’s firearms fetish has intensified. That leaves Stroger and other safety net hospitals to conduct a lot of social work and violence analysis on their own. And that requires Stroger’s trauma staff—a devoted group that has little turnover—to understand the people who are affected.
Most of Stroger Hospital’s gunshot patients are black and male, and many live in Chicago’s poor, segregated neighborhoods on the West and South sides. Some are innocent bystanders, but many others are intended targets of an interpersonal dispute. Gang-related activity factors into some of the shootings, but certainly not all. Most victims are either uninsured or on Medicaid.
Trauma nurse Kathy Buday, one of Hall’s colleagues, used to see a lot of 24- and 25-year-olds when she started at the hospital 12 years ago. Now, a lot of teenagers are entering the trauma unit with bullet wounds. That’s when Hall’s maternal instincts kick in.
“I can really calm them down. I think as a black woman they see me (as) more of a mother figure,” Hall says. She always preaches the importance of staying in school. Hugs are a common prescription.
The physical wreckage is getting a lot worse, though. It’s common for patients to have massive bullet wounds from AK-47s, AR-15s and other semi-automatic weapons. The powerful firearms completely blow off limbs. Some victims leave as paraplegics or quadriplegics.
“Before, the bullets would just bounce all around
them. It could cut them up. But with a lot of work and diligence, the patients seemed to make it out of there,” Hall says. “Now, you can get one huge bullet that really rips a person up so severely that you can’t repair it.”
And yet others, even if they’re saved once, may be carted through the hospital’s doors again.
“I do not look at our patients through rose-colored glasses,” Joseph says. “Some of our patients, no matter what you try to do to help them, they have decided on a course, and you can only do so much. But it’s hard to make the argument that somebody who is 15 years old has chosen the path that they are on.”
Joseph argues solving the problem is no different than when the federal government reduced the mortality of car crashes decades ago. Seat belts, speed limits, the phase-out of hood ornaments and the campaign to shame drunk driving contributed to that cause.
Stroger’s clinicians and social workers use the hospital-based violence intervention model Healing Hurt People and partner with not-for-profit groups like Cure Violence and Project BrotherHood to give gunshot victims a safe haven and prevent any retal-
iatory gang violence. They also promote basic health screenings to minority communities that desperately need more primary care. Hall isn’t directly involved with those groups but lends a hand if they ever need help.
In the years since Jerry’s death, Hall has taken a critical view of guns. But she hasn’t given up on humanity, though few could blame her if she did. People just need the right opportunities and resources, she says. Hall often exchanges phone numbers with gun victims, as she did with Givens, or their family members. She understands the pain that will crop up in the days, months and years ahead. In some ways, it helps heal both the victim and Hall.
“I may have lost my son 20 years ago, but there may be so many others you’ve gained,” Hall says. Yet the loss of Jerry, she says, is “something that you never get over, something that hurts continuously.”
A month before Jerry was murdered, Hall began thinking about making plans to move her family to a quieter
suburb after sensing the village of Dolton was getting more violent. She liked an area in southwest suburban Matteson that was close to a park and a library, and it’s where she and her huband, a paramedic, plan to retire.
They like to go there to walk in the nearby forest preserves, away from the city. They both say it’s serene, and in a way, therapeutic. It helps them disconnect from the chaos of their shared work experience. For now they live in a quiet neighborhood in far southwest Chicago called Beverly.
Hall was supposed to retire this past December, but she couldn’t bring herself to leave.
“If I just stop doing everything, I have to find another focus in my life,” she says.
Next: The Doctor
Coming in the July 11 issue: Dr. George Garcia used to be an Army combat surgeon. Now he works in a Miami trauma center, where he says it’s “busier than Afghanistan.”