Baltimore's street violence creates an epidemic of spinal cord injuries

Luther Bridges had it made. Just out of prison, where he had served time for stealing, he was earning $1,000 a week delivering heroin to an East Baltimore stash house. Bridges, nicknamed "Buddy Ice," had stylish clothes and pretty women. The work couldn't have been easier.

Then, in an alley where addicts were lined up 20 deep, Bridges got into a fight with a customer who pushed to the front. The man fired first. Bridges crumpled to the ground and watched a streetlight fade.


"I wake up in the hospital, and everyone's crying - my mother, stepfather, friends," he said. "They're all crying tears. I'm crying too, but I don't know why. Then, I realize I can't move my legs."

Bridges, 27, is one of hundreds of victims in an epidemic of spinal cord injuries that has made the sight of young men in wheelchairs a familiar part of the Baltimore landscape.


You see them rolling with traffic, sitting on corners, waiting for buses - even dragging their chairs up and down rowhouse steps.

Though there are plenty of innocent victims, increasing numbers who suffer paralyzing wounds were shot in drug deals gone bad.

Police routinely spot young men in wheelchairs who, until recently, were buying or selling drugs on healthy legs. Some don't let their injuries stop them, dealing drugs from their chairs.

Doctors say they've treated paraplegics who've returned to the streets and come back as quadriplegics.

Few, it seems, enter the trade without knowing that, someday, they might spend the rest of their lives paralyzed.

"The way I see it," said Bridges, "no one sells drugs without knowing you can get locked up, stuck up or shot. Anything can happen."

Nationally, gunfire accounts for about a quarter of the 10,000 paralyzing injuries that occur each year. About 60 percent result from car crashes or falls.

But Baltimore is one of nine drug-infested cities where gun violence is the leading cause of spinal cord injury, according to the National Spinal Cord Injury Association in Silver Spring.


"If you were to look around the streets of Baltimore around the turn of the last century and saw a young man in a wheelchair, you'd say it was probably tuberculosis or polio," said Dr. Edward Cornwell, chief of adult trauma at Johns Hopkins Hospital. "In mid-century, you'd say it was wartime.

"Now, it's interpersonal violence on the streets. If you saw a kid in a wheelchair now and asked him to lift his shirt, you'd see the scar."

Youth and poverty are common denominators among those paralyzed by bullets. Researchers who have studied the demographics of gun violence say the victims are typically 15 to 19 years old, African-American or Hispanic, poorly educated and uninsured.

As a consequence, the cost to taxpayers is huge.

With Medicaid paying most of the bill, a person who is paralyzed from the waist down accumulates almost $200,000 in medical expenses the first year and $20,000 every year after that, according to the Spinal Cord Information Network, a national clearinghouse in Alabama.

At that rate, Buddy has accumulated more than $300,000 in medical bills, all borne by taxpayers.


Higher cost of quadriplegia

For a person paralyzed from the neck down, the costs are far greater: $340,000 to $530,000 in the first year, $39,000 to $95,000 every succeeding year. For quadriplegics on breathing machines, the cost is higher.

Through fortitude or luck, some who suffer spinal injuries have learned to live independently and hold down jobs. But others will always need help doing such simple things as dressing or bathing.

The sudden loss of independence can take an emotional toll: Depression and substance abuse run higher among the paralyzed.

Most victims lose control of their bladder and bowels and must schedule their lives around catheter changes and other procedures, or risk fatal complications.

Patients who don't remember to shift positions every half-hour or so are subject to pressure sores that can grow as large as footballs and reach to the bone.


Such infections have sent Bridges to a succession of hospitals and nursing homes. Last month, he spent four days in the hospital after a fever that stemmed from a long-festering ulcer on his leg.

The sore might have been there for weeks - but his paralyzed legs and feet are incapable of producing the warning signals of pain.

Bridges, who is 5 feet tall and has a delicate, willowy frame, was 21 and living with his mother in East Baltimore when he was shot.

When he left prison, he worked briefly at a car wash but ditched the job when some prison buddies made him a "lieutenant" in their drug ring.

In the morning, he dropped bags of heroin at a "stash house" where the dealers were supplied. At night, he retrieved what was left.

One night in 1993, on his way to close up shop, Bridges veered through an alley near the corner of Ashland and Port streets in East Baltimore. He found trouble.


Addicts who had peacefully lined up to get their fix were yelling at a man who had breached etiquette and jumped to the front.

"I'm a fair-minded person, and I called to my man, 'You move to the back of the line, and I'll make sure you get served.' He puts a finger in my face, pushes my head, and we start fighting," said Bridges.

Bridges beat the man with a stick, then ran into the stash house to get a gun. When he emerged, the man fired five times before Bridges could get off a shot. One of the bullets pierced his spine.

After a month at Maryland Shock Trauma Center and two months at a rehabilitation hospital, he returned to his mother's house near Johns Hopkins Hospital to face life in a wheelchair.

He hated it. He hated himself.

"I became a nuisance to my parents, even to my friends," he said. "Every five seconds I was asking for something. I was like a little baby. 'Mom, I can't reach my shoes. Mom, they're too tight.'"


Once he started venturing outside, he rolled to the drug markets where he had made his money. Hoping to ease his depression, he started injecting.

"I was using moderately before I got shot," he said. "Afterwards, it got terrible. I was panhandling, stealing, doing anything I could. I was killing myself. I didn't want to live."

His attitude changed when he looked in the mirror and saw his ghastly image.

"I looked like a monster," he said, pushing back his cheeks to show how emaciated he'd become. "My friends would see me, and their expression was pure embarrassment. I said to myself, 'This isn't me.'"

Four months ago, Bridges enrolled in a methadone clinic at Maryland General Hospital and a self-help program that he calls his "spirituality group." He says he has never felt better.

Every day, after wheeling to his methadone appointment, Bridges rolls to Lexington Market, where he watches the parade of people and enjoys the world's best lima bean soup.


Then, he retreats to the solitude of his one-bedroom apartment nearby, where he enjoys public radio and C-SPAN.

Occasionally, he leafs through a psychology text that a therapist gave him and dreams of getting a degree so he can help people.

His apartment, though sparsely furnished, is decorated with slogans and symbols of his recovery. A brass plaque says "Don't Quit" in large letters above a motivational poem. His front door bears a sign, "A Winner Makes Commitments. A Loser Makes Promises."

Sometimes in his travels, he sees sad reminders of a past that remains perilously close.

"I ran into a buddy. When I last saw him, he was in a wheelchair getting high. Now, he was still out there using. I told him how to get help. I gave him my counselor's name and number. That's all I can do. I can't drag him by the shoulders."

Bridges says he used to know shooting victims who sold drugs from their chairs. They hid bags in the metal tubing, assuming - sometimes wrongly - that police would never find it there.


Some were more obvious, such as the paraplegic who was recently arrested in East Baltimore after police found him sitting on 35 vials of crack cocaine.

Though most shooting victims do not resort to crime, the lure is strong for some who cannot imagine any other path.

"I had that 'I don't care' attitude," said Howard Megginson, 37, a paraplegic who served time in prison after police raided his apartment and found bags of heroin.

Two years earlier, he was paralyzed by a man who shot him once in the side. Megginson said the shooting wasn't drug-related, but he started dealing after falling into a depression over his injury.

"I just got fed up," he said.

At the Roxbury Correctional Institution in Hagerstown, he was among a group of paralyzed inmates who sued the state for equal access to facilities and jobs. The state settled the case without admitting fault but did make improvements at the prison.


To police who patrol the open-air markets, the scars of drug-related violence are everywhere.

Recently, in the neighborhood where Bridges was shot, Patrolman John "Curly" Carroll stopped his car every block or so and asked young men clustered on stoops whether they had ever been shot. Few said they had, but most acknowledged they had at least been "shot at."

"How many times are you going to have to get shot before you leave the streets?" Carroll yelled to a teen-ager who, months before, was sprayed with bullets while he lay sleeping on a couch.

The boy, who had sold drugs for his assailant, simply shrugged.

"Show us your scars," Carroll said.

Lifting one pant leg, then the other, and then his shirt, the boy displayed six darkened scars about the size of dimes.


"It's an unbelievable waste of talent," Carroll said later. "I think about it all the time - most will end up in jail or shot. The street is going to get them one way or another. "

When a bullet strikes, it rarely travels in a straight, predictable path. If it slams into bone, for instance, it not only throws off dangerous shards but starts tumbling end over end - cutting a wider swath than before.

Damage is not limited to the tissue it hits.

"It also has a blast effect - a zone of injury that ripples through tissue like a car sucking wind," said Dr. Carnell Cooper, a surgeon at Shock Trauma.

A bullet's devastation

The zone can be millimeters or inches wide, depending on the size of the bullet, how fast it is traveling and whether it is tumbling or traveling straight. The bullet's heat accounts for some of the spillover.


Any tissue is vulnerable, but the spinal cord is particularly unforgiving. A bundle of nerves that carries signals from the brain to the limbs, the cord can be permanently damaged if it is severed or bruised.

"It's like hitting your finger with a hammer. It swells over time," Cooper said. "With all that swelling or bleeding, nerve cells die."

Cooper said he is shocked by the large number of spinal cord patients who were shot, beaten or stabbed previously. A quarter of all assault victims treated at Shock Trauma are repeat victims, he said.

In most cases, they were hurt in the course of dealing or buying drugs - or simply keeping dangerous company.

"We had a person who came back recently with a gunshot to the head who had a scar on his belly from a previous injury," Cooper said. "We also had a person who was a paraplegic from a previous gunshot injury and was shot again. This time, he came back with multiple injuries to the chest and died."

A paraplegic treated at Kernan Hospital, a rehabilitation center in Northwest Baltimore that gets the largest number of spinal cord patients in the state, returned with a bullet in his neck. Now, he is a quadriplegic.


"Half of our gunshot victims have been shot at least once before," said Karen Seeley, a physical therapist there.

The problem has become so pervasive that patients entering the spinal cord unit sometimes see friends and adversaries who were also shot. Recently, the staff had to make sure that a paraplegic on the unit didn't see the hospital's newest arrival - the man who shot him. The shooter, it turns out, had been hit later by someone else.

As hard as paralysis is to accept, many victims are eerily familiar with the condition.

"I have patients who come in and already know what brand of wheelchair they want because their cousin has it," said Seeley.

Hospitals are not required to report each spinal cord injury they treat, so it is difficult to gauge how large the problem is. But there are indicators.

Dr. Stephen Wegener, a psychologist who counsels spinal cord patients at Good Samaritan Hospital, estimates that 210 people across the state are paralyzed each year by traumatic injuries.


About a quarter of them were shooting victims, he says. But some experts, including the Spinal Cord Injury Association, say the percentage is much higher in Baltimore, where people drive less and are exposed more to violence.

To meet some patients is to marvel at a human's capacity for survival.

One night in 1996, Donald Kosh was shot six times - in the head, hand, neck, arm, stomach and chest - by a man who asked his help in finding a marijuana dealer. En route, the man shot and robbed Kosh and left him for dead.

"Every shot that hit me is lifting me and turning me around," said Kosh, 25, who lives in a third-story apartment near the Shot Tower. "I've got holes everywhere."

One of the bullets hit his spinal cord, paralyzing him from the waist down. Another ripped apart his throat, leaving him with a thick, ropy scar that stretches from ear to ear. For a year, he couldn't speak.

Surgeons who reconstructed his throat inserted a plastic plate, which pings when Kosh knocks it with his fist.


Kosh says he started dealing cocaine and heroin when he was 15. He was twice convicted and has done jail time.

"But when I was shot, I caught myself," he said.

Signs of recovery

Recently, he started to regain some of the feeling in his legs and can shuffle short distances with a metal walker.

Now, he is studying to become a Jehovah's Witness and watches his four children while his wife works at a shopping center. Someday, he says, he would like go back to school and become a coroner.

"My main goal is to serve Jehovah and make sure my kids don't fall in my path," he said. "I'll get jobs here and there. Nothing too good. I've already messed up my life."


Loyde Elliott doesn't expect much from life.

Paralyzed from the neck down, he has lived at the Deaton Specialty Hospital and Home just below the Inner Harbor since he was shot 13 years ago. It is doubtful he will ever leave.

He spends his days lying in bed or draped over a wheelchair. He passes the time watching rented videotapes, and gets help copying them for a personal collection he's building.

"I lived to be 35 and loved it," said Elliott, who is 48. "If I had to do it again, I would do everything but I wouldn't mess with drugs."

He is an intelligent man who graduated from high school and studied business administration at a community college.

Before he was injured, he worked as a plumber, helping to lay pipes for the National Aquarium and other projects during Baltimore's renaissance.


But he also developed a powerful drug habit. The night he was shot, he says, he was floating on a combination of methadone, heroin and cocaine. At a drug corner in East Baltimore, a man called his name and started shooting.

"I returned fire, then I just passed out. I don't remember anything else."

A bullet hit his spinal cord high on his neck - so high that signals no longer travel to his lungs, much less his arms or legs.

Nowadays, doctors sometimes call this injury "a Christopher Reeve" after the actor who was similarly incapacitated when he was thrown from a horse.

For Elliott, each breath comes by way of a plastic tube that's inserted into his windpipe below the Adam's apple. A machine pumps air through the tube with a monotonous, swooshing rhythm.

Occasionally, he gags from fluids that accumulate in his throat, and a nurse has to suction them.


Like Reeve, Elliott has learned to speak between heaves of the respirator. He talks with an exasperated urgency, as if he has to pack extra words in before the machine cuts in.

Unlike Reeve, Elliott lives a solitary existence. His friends and family stopped visiting long ago. Medicaid pays Deaton $262,000 a year to keep him alive. Elliott isn't sure he wants to be.

"From my neck up," he said, "I have feeling just like you do. From my neck up, my head feels just like yours does. Unless you go deeper."