We are multitasking, selfless healers with a duty to our community.
VIOLENCE
( continued from page 27) workers, but also desensitizes us to the plight of our patients.
Let’ s not forget the victims of domestic abuse, male or female. At UofL ED we( and the patients) are lucky to have Sexual Assault Forensic Examiner nurses who complete the comprehensive exam, and selflessly appear in court months later. Representatives from the Center for Women and Families travel all over the city to provide safe discharge of patients. And think of the victims of suicidal violence, so desperate to terminate their psychic pain that they would put a loaded gun to the mouth or chest. Can we even bring ourselves to picture that level of despair? Is it even healthy to try? We go through the motions,“ GSW to chest, self-inflicted, needs trauma admit, a sitter, psych consult.” On to the next patient( there are 10 waiting now). That transition back to a façade of normalcy is a skill that comes at a cost, detachment.
We break the bad news of a violent death to a family. They charge at us. That charge is one of retribution. They want someone to blame, someone to punish. We jump out of the way as they run out the door to go find the enemy. Can you imagine having an enemy that you want to kill? This isn’ t fighting over whose tree is dropping leaves in your yard. This is life or death. Nurses and doctors fear for their safety in these encounters; we have to protect ourselves. The family conference rooms at UofL are often overflowing with family members at the time of delivery of bad news of another death. When we stick to our rule of two family members per patient, we sacrifice a cozy atmosphere to provide safety to ER staff. Lockdown status, though unsightly for our image, exists to prevent further violence in the hospital.
The most crucial people in the ER to intervene with these patients are often the forgotten ones: a medical student, a psych rotator, a nurse in orientation, a tech who lost her brother to gang violence. Why is it almost never the physician who spends the extra minutes at the bedside? Who else can perform the high level, artful, emotionally intelligent intercession? How disingenuous of us to claim that we are too busy to counsel a patient who might have never even talked to a doctor in his / her adulthood, who might have a huge respect for doctors that saved their brother’ s, sister’ s or even their own life. We are squandering opportunities for meaningful, brief, but high-yield impact in these human beings. We pensively consider discharging the chest pain patient who has a < 1 percent chance of MI in 30 days, but promptly allow victims of violence to elope from the ER, naively assuming they will follow up in trauma clinic or with the community advocates. How many of these patients are able( or even try) to make follow-up appointments in the trauma clinic? They come back to the ER months later asking for the bullet
28 LOUISVILLE MEDICINE
( which has now migrated to the skin) to be removed.
We are multitasking, selfless healers with a duty to our community.
Let’ s step up to the challenge.
Others in this issue will provide the powerful narratives of programs like Pivot to Peace, Safe and Healthy Neighborhoods, and Community Health Worker KJ Fields( who has personally saved the lives of Louisville’ s youth). But as Dr. Mitchell pointed out in his talk, it is not enough to delegate these responsibilities to community organizations. Many of the doctors I surveyed related a perceived inability to“ make a difference” and“ break the cycle of violence.” But physicians should be leading these programs. Sure, we’ re fighting expansion of EMR responsibilities, decreasing reimbursement, time constraints, metrics, and, oh yeah, we have families as well. But, we juggled 10 or 20 patients alone on a call night when we had barely fully developed prefrontal cortices. We memorized all of the medications and allergies for every ICU patient. We retracted or cut suture at the end of a 24-hour call, awake only as a side effect of our empty stomachs. We are multitasking, selfless healers with a duty to our community. Let’ s step up to the challenge.
The Emergency Medicine department is now working with Dr. Keith Miller and the surgery service to integrate our efforts with the Mayor’ s office. Finally, physicians are becoming involved in these discussions. We must all participate in the“ Cure Violence” model to ensure safety to Louisvillians. The Trauma Gun Shot Registry will pull in data from LMPD, finally breaking down silos that have kept us isolated from each other. GLMS members can play a part in this as well, by supporting the program and sharing the publications that will result from the registry. The simple act of putting our essays together for this issue bridged a few communication gaps between the parties involved.
The family medicine intern who found the two gunshot victims is now in her second year of residency. She treats hypertension and diabetes, CHF and arthritis, remaining patient and nonjudgemental in the face of noncompliance and what on the surface may appear to be indifference. But her patients are all fighting battles of which she knows nothing, unless she asks. Start with one patient. Listen, understand, empathize, and care about this person who might come back in next time with a hole in his chest; or who might coldly deliver vengeance upon his childhood friend. Start with one patient. And then another.
Dr. Huecker is a practicing UofL Emergency Medicine Physician and Faculty Member.