Jen and I have met a number of people to photograph and interview for this website, and it has always been clear whom the story will focus on. Not so much this time.
Thomas M. Scalea, MD, is the physician-in-chief of the R. Adams Cowley Shock Trauma Center at the University of Maryland Medical Center in Baltimore. Prior to our sit-down, I imagined Dr. Scalea sharing stories about grueling days spent on the Trauma Resuscitation Unit (TRU), Shock Trauma’s version of an emergency room. I figured he would delve into the physical and emotional challenges of dedicating his life to the care of severely injured patients. Perhaps we would even get a peek at the TRU. Only one of these expectations came to fruition.
Dr. Scalea’s office is covered in an abundance of awards and photographs with dignitaries. This is to be expected of a man who heads the only freestanding trauma center in the nation. Sprinkled among these recognitions are notes and mementoes from people whose children have been saved. There are cards from his students, residents, nurses and aides thanking him for his guidance and support. Several of these snapshots capture Dr. Scalea at galas holding a glass of water, a signal he is eternally on call, toasting fellow partygoers with wine glasses.
Jen and I sit and down and begin our conversation much as we have all the others: “tell us about yourself and the impact guns have had upon you?” He tells us that interpersonal violence, most of it involving guns, is roughly 25 percent of the people he and his team treat. He says the number should be closer to ten or twelve percent and that his colleagues in New York City do not see these inflated numbers. In response to my questions about the grueling nature of treating a gunshot wound, he explains that, in many ways, it is often easier to treat a gunshot wound victim than a motorcycle accident victim “since you aren’t dealing with injuries from the top of the head to the bottom of the toe and there isn’t a question as to where the injury is.” My skills as an interviewer are clearly lacking.
Then I stumble upon the question that works: “How do you help your staff deal with the emotional impact of this work?” He raises his eyebrows and shakes a pointed finger my way. “There is nothing in our society that says you have to pick up a gun and shoot someone. Car accidents, even if you remove drunk driving from the equation… industrial accidents, even if you have all the safety precautions in the world…we’ll never be able to stop those. These, the gun shot injuries, they are completely unnecessary.” He pauses for a moment, “And, in my mind, potentially preventable.” Dr. Scalea’s staff is forced to confront an onslaught of injuries that would be unheard of in any other industrialized country.
The individuals treated at the TRU are generally diverse. All genders, races, ages, socioeconomic backgrounds are well represented on the floor. Car crashes don’t discriminate. Gun violence does. As Dr. Scalea notes, “The disease of penetrated injury, and around here that’s almost all gun violence, is a disease of young people. Around here it is almost all African American young men.” Young men like 15-year-old Nigel who came to the TRU with over 20 gun shot wounds. “He’s a perfectly sweet kid,” Dr. Scalea smiles while talking about his patient. Nigel was mute for three weeks, capable of speaking but refusing to engage with anyone. He would pretend he was asleep when caretakers entered room or would grunt one-word responses to questions. His refusal to participate in the decision-making process made it exceptionally difficult to provide medical care. According to the medical team, Nigel was suffering from acute PTSD.
What finally changed the course of Nigel’s care? Dr. Scalea grins, “The thing that finally got him animated was he got pissed off with me.” Dr. Scalea was going on vacation and told Nigel he’d be gone for a bit. “Where?”, Nigel demanded. “None of your goddamn business,” Dr. Scalea retorted. Nigel sat up, “I want to know where you are going!” Dr. Scalea told Nigel he was traveling to Australia. Nigel marveled, “Australia, all across the world? Will you bring me something?”He's saving men from gunfire only to lose them to untreated bed sores. Go #BehindtheStatistics w/ Dr. Scalea!Click To Tweet
Nigel is one of many young men whom Dr. Scalea saved from death’s eager grip. He and his staff are remarkably successful at preventing death. Ninety-six percent of the patients who enter TRU survive. Trauma medicine has advanced so significantly that individuals whom healthcare professionals once considered impossible to treat are now surviving at astonishing rates. As high as our country’s gun death rates are, our gun injury rates are much higher.
Surviving and living are two different things. Dr. Scalea asks us, “Do you remember Christopher Reeve?” We do. “Well, he did great things to educate the public on spinal cord injuries. But we can’t all be Superman.” Most of Dr. Scalea’s patients with gunshot wounds do not return to homes with in-house physical therapists, state-of-the-art wheelchairs, specialized workout equipment, and 24-hour care.
The men shot on the streets of Baltimore are increasingly more likely to survive the initial injury only to die a few years later from a subsequent soft tissue infection. Dr. Scalea and his colleagues are saving these men from deadly gunfire only to see them die from untreated bed sores.
I know a lot of mothers whose sons were treated at the TRU. Most of their children were part of the four percent who did not survive. Dr. Scalea spoke about the mothers when we met with him. “Delivering the worst possible news to the parents is the hardest thing I do.” The hardest thing he does. It isn’t the constant demand of being on call 24 hours a day. It isn’t the stress of attending to severely injured patients. It isn’t the juggling of managing his practice, academic and managerial responsibilities. No. The hardest thing Dr. Scalea does is tell parents that their child has died.
These parents, the women I know, love Dr. Scalea. When I mentioned to a group of them that I was going to see him, they all burst into a chorus of compliments.
“He’s so nice!”
“He spoke to me. To me! He didn’t send one of his little students over. He came to me.”
“He brought me candy.”
In a world where so many of us are privileged enough not to have to take the time to care, Dr. Scalea makes sure that his patients and their families know that he does.
Written by Liz Banach, Executive Director, Marylanders to Prevent Gun Violence