Mayhem in the halls of medicine


The epidemic of violent youth crime is having an impact on all institutions, not least the hospitals and health clinics that are on the front lines of urban violence. In recent weeks, health and medical personnel from around the region have begun to voice alarm.

Workers at emergency rooms, for example, have learned the clinical setting no longer automatically confers immunity from violence. Nurses in Washington, D.C., report cases of drive-by shooters who boldly stalk their victims through the hospital corridors to finish off the job if need be.

Meanwhile, workers at a sexually transmitted disease clinic in Baltimore now hesitate to press clients to submit to routine physical examinations; they have learned that patients' reluctance to disrobe may mean they are carrying weapons.

"If a 15-year-old kid comes in and refuses to take off his jacket in the examining room, I don't push it," one doctor said. "If he has a gun, there's no way you're going to try to reason with a kid like that."

Trauma physicians marvel at the number and severity of gunshot injuries they now encounter on a daily basis. It is not uncommon for patients to be brought in with multiple bullet wounds; nor are emergency room personnel surprised to find any number of gunshot wounds that have already healed on the bodies of victims who arrive at the hospital fresh from the latest shooting. Ambulance and trauma crews have learned the quickest way to sort things out may simply be to ask: "Where are you bleeding now?"

The ubiquity and sheer frequency of violence also have meant that trauma surgeons, who once rarely had time to get to know the people they saved, increasingly are seeing "repeaters" -- people who say, "Give me Dr. Jones. I had him last time I was shot."

One doctor found himself speechless when a young gunshot victim informed him that he already knew the physician by reputation, since the previous week the doctor had treated his brother for a bullet wound and a month earlier had treated the boy's mother when she collapsed at work.

The profusion of easily available handguns is fueling this crisis. Medical personnel are exposed to many of the same workplace dangers that afflict police officers on the beat and schoolteachers in the classroom. It underlines the debilitating impact that the relentless climb in firearms-related violence is having on another essential community institution.

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