Treating Gun Violence with Medicine and Compassion

University of Chicago Medicine will begin providing trauma care in Spring 2018. It’s already laying the groundwork to address social factors behind the victims and perpetrators of violence.

Dr. Damon Arnold, a medical director for Blue Cross and Blue Shield Plans in Illinois, Montana, New Mexico, Oklahoma and Texas, is working with University of Chicago Medicine and community organizations on Chicago's South Side to address social factors driving gun violence. PHOTO CREDIT: BEN HERSHEY

When Dr. Damon Arnold was a resident physician at Chicago’s Cook County Hospital in the late 1980s, he treated a teenage boy who was brought to the emergency department with a gunshot wound. During the exam, the boy told Dr. Arnold he didn’t have to go to school, and then pulled out a wad of $100 bills he made on the street to show the doctor why.

Four weeks later, that same boy returned to the same emergency department, dead on arrival with gunshot wounds.

Memories of that boy and others like him – and the desire to make a difference for current and future generations – have fueled Arnold’s passion for public health throughout his long career in medicine. During his 26 years in the Army National Guard, he served as commander of the Joint Medical Command and State Surgeon General for 12 years, and he later served as director of the Illinois Department of Public Health.

He’s now part of an innovative program at University of Chicago Medicine to bring a broader approach to treating gun violence when the hospital’s new emergency department begins accepting trauma patients next spring. That opening will bring long-awaited urgent, high-level care to Chicago’s South Side, which is home to some of the city’s most impoverished and highest-crime neighborhoods. The area hasn’t had adult trauma care since a nearby hospital closed in 1991, forcing ambulances to transport critically injured patients miles away for treatment.

In anticipation of the new emergency department and trauma services, University of Chicago Medicine established a 20-member volunteer group called the Community Advisory Council.

The mission of the council is to serve as advisers to University of Chicago Medicine leadership on broader issues in the diverse communities around the hospital, including ways to address and prevent violence. Arnold, now a medical director for Blue Cross and Blue Shield Plans in Illinois, Montana, New Mexico, Oklahoma and Texas, will play a key role as chair of the council’s Trauma Care and Violence Prevention Workgroup.

It’s a more holistic approach to looking at the community.

A primary goal of Arnold’s committee is to identify ways the hospital can go beyond medical care to provide the needed social interventions for everyone involved in a shooting. For example, a social worker might connect a low-income family with resources for food or housing aid; someone experienced with gangs might help a young person figure out how to break free from gang affiliations; an unemployed parent could get help searching for a job and filling out applications. The key is intervening early with both the patient and the perpetrator, as well as their family and friends, to find out what is going on that eventually led to a shooting.

“This is an endeavor not just to provide trauma care services,” Arnold says. “It also addresses the needs of people who fall prey to gunshot wounds, the ones we define as victims, and the perpetrators who are actually firing the guns, who sometimes people say are victims themselves. It’s a more holistic approach to looking at the community and figuring out how we can prevent people from walking in this door. Ho­­­w can we stop this needless violence?”

The question of how to stop needless violence, particularly gun violence, has reverberated throughout Chicago as the city’s crime statistics climbed in recent years. As of October, there were more than 500 homicides with firearms and more than 3,000 shootings in Chicago in 2017. The pace is only slightly behind 2016, which was one of the most violent years in decades.

Roots of Violence

University of Chicago Medicine is a sprawling complex in the city’s safe, upper class Hyde Park neighborhood, but crime is much more prevalent just a few miles in almost any direction. While that proximity might be a concern for some people, it’s exactly the environment where David Crump wants to work.

Crump is University of Chicago Medicine’s first violence recovery program manager. He will be partnering with the Community Advisory Council as part of the hospital’s Urban Health Initiative, which oversees community health programs and services.

“We may have a very valuable resource for them, but even getting there can put their life at risk,” says David Crump, University of Chicago Medicine’s first violence recovery program manager. PHOTO CREDIT: UNIVERSITY OF CHICAGO MEDICINE

Before coming to University of Chicago in March, Crump spent 28 years working in youth advocacy and gang intervention in Boston, most recently as a violence recovery specialist at Brigham and Women’s Hospital. His roots in violence prevention go back to about age 17, when he formed an after-school hip hop club to help keep kids off the streets.

Treating the wound, he learned, is only a small part of treating the patient.

“We understand there are a lot of barriers to people getting connected to services,” Crump says. “We can’t just give the information to them and walk away. Most of our patients need extensive follow up. A lot of people are navigating a treacherous environment that’s unsafe. We may have a very valuable resource for them, but even getting there can put their life at risk.”

We want to totally wrap services around people.

A key part of his job is collaborating with community partners who already are doing violence prevention work, finding ways they can work together to strengthen what’s available. For example, getting someone the proper ID so he or she can get a job. Or providing support for community members who are continually responding to violence in their neighborhoods – the ones who must tell families a loved one has died or try to keep the crime scene calm so there is no retaliatory violence.

“We are helping to stabilize them psychologically and connecting them with the University of Chicago Medicine,” Crump says. “We want to totally wrap services around people. Say we have a 21-year-old gunshot victim come in. He might have one, two or three siblings still in school. We could help let the school know what happened, in case one of those siblings is acting out in class. Having that initial response could go a long way toward helping that family get services. The sooner you build a relationship with people and let them know you care, the easier it is to walk with them in their journey and help them deal with the stress.”

At the Helm

Crump came to Chicago at the request of Dr. Selwyn Rogers Jr., who was hired by University of Chicago Medicine as the founding director of its new trauma center. Rogers, who joined the health system at the start of the year, also was appointed executive vice president for community health and oversees the Urban Health Initiative.

Rogers had worked with Crump at Brigham and Women’s Hospital in Boston, where, Crump says, “Dr. Rogers sewed up their bodies and I sewed up their souls.”

Dr. Selwyn Rogers - University of Chicago Medicine

University of Chicago Medicine hired Dr. Selwyn Rogers to lead its new trauma program and its Urban Health Initiative. PHOTO CREDIT: UNIVERSITY OF CHICAGO MEDICINE

Throughout his career, Rogers has focused his clinical and research interests on the health care needs of underserved populations.

He believes that in order for Chicago – and all other areas touched by violence – to see a real difference, every human life must be treated as sacred, regardless of where the person is from, their income level or any other factors.

“We’ve got to get uncomfortable. Someone who lives on the Gold Coast should be as uncomfortable about the shooting of a child on the South Side as they would be about a shooting occurring in their neighborhood,” he says. “We’ve got a single firearm for every man, woman and child in this country. And what is the shelf life of guns? Decades. A gun stays in our society for 20 or 30 years.”

Like Arnold and Crump, Rogers has seen the effects of violence throughout his career. One story he carries with him is from his time as a young trauma surgeon in Boston, when he had to tell a mother that her 28-year-old son had died from his gunshot wounds. She didn’t cry or break down. Instead, she insisted that her granddaughter, the patient’s daughter, see her father for the first and last time because he’d been in prison for most of her life.

“Then I witnessed the most touching, brave thing I ever saw,” Rogers says. “The mom walked her granddaughter over, the daughter touched her dad’s hand, and it was very quiet. There was no crying. After it was all over, I said to the mother, ‘Help me understand the source of your strength.’ I thought she would say faith, but she looked at me and said ‘I had to do this with my other son two years ago.’ That’s why I do this work. If we don’t find a way to do this differently, there will be more mothers we have to do that for.”

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