Impact of violence may be most profound on young


When 10-year-old Tauris Johnson arrived at Johns Hopkins Children's Center at 5:52 on the afternoon of Nov. 4, it was obvious to the medical staff that he had virtually no chance of survival.

The youth -- who took a bullet to his head as he played football outside his East Baltimore home, the innocent victim of a drive-by shoot-out between rival drug dealers -- had no reflexes or eye motion; a CAT scan confirmed the enormity of the damage to his brain.

"There was massive damage inside his brain. We just wanted to keep him going until we could talk to his family," said Patricia A. Papa, a nurse who is the trauma coordinator at the Children's Center.

At 8:25 p.m. -- 2 1/2 hours after he was admitted -- Tauris Johnson died in the hospital's Pediatric Intensive Care Unit.

The Johnson youth's death is part of an epidemic of violence among urban youth.

Through the first 10 months of 1993, 31 children 18 and under were homicide victims -- slightly more than 10 percent of the 295 murders recorded at that time, according to figures compiled by the city's Police Department.

Consider minors, those 21 and under, and the figures jumped to 63, or 21 percent of the total.

Since October, in addition to young Tauris, six other youths under 21 have been killed in Baltimore. Among them: 13-year-old Lawrence Miller, who was shot once in the chest Nov. 22 in a spray of bullets fired into an East Baltimore apartment.

The Miller youth, also rushed to Hopkins Children's Center, had the blood vessels between his heart and right lung virtually destroyed, emptying his heart of blood.

He was pronounced dead a scant 23 minutes after arriving.

Among the grim litany of the city's murders, none seem more tragic and senseless than those of children.

Tauris Johnson's death, in particular, helped inspire last month's anti-drug Going Out of Business Day and a City Council bill calling for an expanded nighttime curfew to try to keep kids out of harm's way.

And, outside of the victim's immediate families, few take their deaths harder than those who work to save them.

"The pediatric trauma staff has not gotten used to it. It always hurts," says Ms. Papa.

So far this year, Hopkins Children's Center's pediatric trauma unit has treated 31 children for gunshot injuries -- compared to just 19 last year and 13 in 1991.

There has been only one month this year -- May -- in which a child was not admitted with a gunshot injury.

Perhaps remarkably, so far this year, the Johnson and Miller youths are the only gunshot victims treated at Hopkins to have died.

"We don't rest on that fact," says David G. Nichols, director of the Hopkins Children's Center Pediatric Intensive Care Unit. "There are things you can do and things you can't do. The best therapy for this is prevention."

Dr. Nichols is one of several doctors at the Children's Center who are outspoken on the issue of gun violence and the need for stiffer gun control laws.

"These injuries are preventable," he declares. "There is no child who should be critically ill because of a gunshot wound."

Youthful gunshot victims, he adds, are "something peculiar to the United States, except in places where wars are going on."

Medically, child gunshot victims are more difficult to treat than adult victims.

"Children are smaller and have a small blood volume. The loss of a pint of blood can leave an adult light-headed, but can be life-threatening to a child."

And though the public focus is often on homicide, Dr. Nichols points out that nonlethal gunshot wounds also take a steep financial and emotional toll.

Last month, a national survey of children's hospitals found that it cost an average of $14,000 to treat each child struck by gunfire -- excluding doctors' bills and any rehabilitation costs.

Dr. Nichols says spinal cord injuries are especially hard on families as well as victims, changing young lives forever and forcing entire households to be reorganized.

Any gunshot wound can affect parents as well as children.

"The parents are filled with anguish, grief, fury and guilt. They feel a sense of failure that they were unable to protect their child," he says.

Dr. Nichols takes some heart in recent congressional interest in limiting children's exposure to violence on television and in video games -- violence which he says helps create "a fantasy idea of what life and death and guns mean."

"There's a limit to what physicians can do. This is something everyone has to view as their problem," he says.

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