Louisville Medicine Volume 66, Issue 3 | Page 29

VIOLENCE
START WITH One Patient
Martin Huecker, MD
Ferdinand Hodler, The Dying Valentine Godé-Darel, 1914
© Kunstmuseum Solothurn (Switzerland - Solothurn)
W
ith M.D. behind her name
for a couple of months, an
intern was walking into the
hospital before sunrise to
see her patients before
rounds. She saw a car parked at a meter with
a man inside, slumped down in the passenger
seat. She found a security guard and activated
a rapid response team. The team arrived and placed the patient, who
was bleeding from a gunshot wound (GSW), on a gurney bound
for the ER trauma room. A couple of hours later, the very same
intern was briskly walking back across the street to the outpatient
clinic to see her medically underserved patients. She noticed the
very same car and looked inside this time. In the back seat was a
second gentleman, lethargic, also bleeding. She opened the door
and shouted to arouse the man. Another response team met her
outside, whisking the patient to the ER.
This did not happen in LA County, Chicago, Miami or Baltimore;
it happened right outside UofL Hospital. Victims of gun violence
come by ambulance, helicopter, private vehicle, and sometimes walk
right in the front door. But no one likes to talk about it. Statistics on
gun violence do not make many appearances in medical literature.
Dr. Roger Mitchell, a forensic pathologist in Washington DC, gave a
powerful talk at the 2018 American Academy of Emergency Medi-
cine Scientific Assembly in San Diego. He implored physicians who
treat living trauma victims to speak up, and to actively research and
implement programs to intervene with these individuals to break
the cycle of violence. Dr. Mit chell points out how we euphemize
gunshot victims. We check out “a patient with penetrating trauma
to the chest,” or a gang banger who got struck with a baseball bat
that “suffered a blunt splenic injury.” These folks are beat up. They
are viciously attacked. They somehow survive and leave the hospital,
returning to the dangerous environment from which they came.
Most of us who work in the ER find it difficult to maintain com-
passion with every patient. Many of them even incite the violence
that ends their own lives or ability to walk unassisted. This creates
not only a judgmental attitude in physicians and other health care
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AUGUST 2018
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