Doing More Than Patching Holes | Jackson County Combat, MO

WARNING: Some readers might find the graphic details in this article, written by a trauma surgeon describing his experiences treating gunshot wound victims, disturbing.

Dr. Robert Winfield • University of Kansas Medical Center

THURSDAY, JANUARY 2, 2020

I remember the day that my perspective on gun violence changed forever.

I was the trauma surgeon on call at Barnes-Jewish Hospital in St. Louis. I was making my way through the labyrinthine hallway to the emergency department to see a patient who had been in a car crash, when I was stopped by a nurse who asked, “Dr. Winfield, did you take care of that kid who got shot in the butt yesterday?”

The case had taken place less than 24 hours prior, but was already among the more memorable of the surgeries I had performed in my life.

The patient was a teenager; one of a steady stream of young, primarily African-American, males I have cared for following gunshot wounds (GSW) in St. Louis and Kansas City. The trauma page had people laughing prior to his arrival, because all it said was “GSW to butt, ETA 5 minutes.” It didn’t take long for the laughter to subside once he arrived though, because he was visibly in shock from blood loss: pale, clammy, a dazed look on his face. My heart sank when we saw that the patient had indeed been shot in the left butt cheek, but the bullet had left his body through the right groin.

He hardly spoke, but asked weakly where his “mama” was, and the ambulance team relayed to us that she was a drug addict and thought that she was on her way. We started transfusing blood and had him in the operating room inside of 10 minutes, so that we could explore his abdomen and pelvis for injuries. When we sliced into his belly, we released torrential bleeding, making him profoundly unstable. I tried everything to stop the bleeding. I called for backup from another trauma surgeon as well as a vascular specialist. It was the vascular surgeon who finally said, “There’s nothing else that we can do”, and we declared a time of death.

The bullet had shredded bone, arteries and veins to an unsalvageable degree as it passed through the body.

Sobbing With Mom

At moments like that, I have to remind myself that although I failed, the patient would have certainly died without me and I gave him a chance—it was the bullet that ultimately killed him, not me. This is a reality of my job, and although it doesn’t always work (over the long term, I constantly question whether I did the right thing when an outcome is poor), it usually quiets my self-doubt enough over the short term to move on and help the next patient, which is what had to happen that day, since my relief didn’t arrive for another couple of hours.

Mentally, I had somewhat moved on by the next day, when the nurse stopped me. I told her, “Yeah, he died on the operating table. It was awful.” What was worse than awful was what she said next: “His mother is here.”

“Now?” I asked. “He died yesterday.”

“She doesn’t know,” the nurse replied. “Since you were involved in the case, can you talk to her?”

I was mortified. We had tried to contact Mom after the surgery, but weren’t able to reach her. A disconnected phone was the only number that we had. I remembered that the ambulance team mentioned that she was a drug addict. Perhaps she had forgotten or gotten distracted? I generally have a good sense about how I’m going to proceed with telling someone that their loved one is dead, but for, perhaps, the first time since I was a medical student, I had no idea how things were going to go.

Mom was seated in a dark, quiet room in the emergency department usually reserved for patients who had been discharged but who were waiting for a ride home. She was thin and dressed in old dirty clothing that smelled like cigarette smoke; her hair was messy, and although I guessed her to be younger than me, she appeared significantly older. I introduced myself and let her know that I was the trauma surgeon who had cared for her son the previous day, and that he had been shot.

In a distressed tone, she said, “I know. I tried to get on the ambulance with him, but they wouldn’t let me on. They wouldn’t even let me say goodbye.”

Although I had nothing to do with that part of the story, I was embarrassed, because I remembered him asking for his “mama” as he was laying in shock in the trauma bay, and because I was about to say: “I’m sorry. Unfortunately, the bullet caused injuries that we weren’t able to repair. We tried very hard, we had three surgeons working on him, but we weren’t able to save him.”

The sound that emerged from her mouth at that point was hoarse, started low, and built to a higher-pitched crescendo. As a word, it most seemed like a very long, drawn out, “No”, but it wasn’t a word so much as it was a pain leaving her body, and it was worse than anything my ears had ever heard. I remember that sound as though she were repeating it over and over again in my ear as I write this, and it brings tears to my eyes, just like it did then.

“I’m so sorry.” I sobbed repeatedly, as she wailed next to me. After a few moments of this, I left her in the company of the nurses, who were offering to help her find her son and make arrangements.

DEVASTATING DAMAGE — A bullet might be relatively tiny, but the damage it inflicts can be catastrophic, like the shattered femur (thigh bone) shown in the X-ray of a gunshot wound victim.

Not Losing Faith

Entering the room, I had accepted that gun violence was associated (although not exclusively) with race, poverty, drugs, and gang activity. My purpose in life was to give people second chances without judgement; my job was to patch the holes that guns had created and get them back out there, perhaps to a new and better tomorrow. A tomorrow in which poor decisions could be viewed within the context of the dangers they represented and could be overcome by a desire for change.

Exiting the room, the only thing that I cared about was that every victim of gun violence had a mother. At a glance, I knew nothing about the circumstances under which this teen sustained his injury. Drugs? Gangs? Bystander? I had never seen them together, but his last words were asking for his “mama” and the anguish she expressed when I told her of his death was like a bullet fired into my soul. It occurred to me that regardless of the circumstances, this mother loved her child every bit as much as my mother loves me or as much as I love my own children. Was she on drugs? Was he in a gang? I didn’t care. She loved him and was devastated by losing him. I never wanted another person to experience that.

Because of this, I opened my eyes more widely, and began to ask questions that went beyond what maneuver I should employ to repair a bullet hole to the aorta. Why was race associated with gun violence? What made a neighborhood a bad neighborhood in the first place? The answers to these questions require pages if not books to describe, but suffice it to say, solutions to gun violence require in part that we overcome our own history, tear down artificial boundaries and recognize that if problems are afflicting any member of the community, that we all suffer.

Since that day, I’ve cared for countless victims of gun violence. Some, you may have heard of, like the two Wyandotte County (Kansas) Sheriff’s Officers who were shot to death during a prison transfer. Most, though, are not headline worthy in the usual sense, and are relegated to perhaps a 15-second spot on the evening news. I’ve seen a pregnant woman from Lenexa who was holding her two-year old son while shot, with all three sustaining injuries. I’ve seen a house party full of teenagers shot up in KCK, leaving two dead and five wounded. I’ve seen a Kansas City man that had been shot in the head in front of his four-year old daughter on their front porch; I had to cry in a stairwell after I watched her hold his hand in our intensive care unit, not realizing that her father was brain dead.

Each of these cases has driven me to do more: to understand the risk factors better and consider new solutions; to speak to anyone, anywhere, at any time, who wants to talk about gun violence and its root causes; to take my fight outside of the hospital and into the streets where violence occurs. At times it seems insurmountable, and as we faced one of the busiest years for gun violence in Kansas City’s recent history in 2019, it could be easy to lose faith as 2020 begins. I don’t, though, because the sound of that mother’s voice won’t let me.

Project RISE
Keeping Surivors Alive!
A new COMBAT-funded program at Truman Medical Center is focused on treating all the wounds—seen and unseen—a gunshot can cause. Studies have tracked what becomes of gunshot wound (GSW) survivors long-term. They’ve discovered some alarming trends, including the high risks of survivors being shot again and eventually dying in another firearms-related incident. The TMC program, Project RISE, seeks to identify shooting victims with severe PTSD symptoms and provide early intervention. TMC doctors and nurses can start administering “psychological first aid” the moment a wounded patient has been physically stabilized.
» MORE

At a firearm symposium he organized at KU Medical Center last spring, Dr. Robert Winfield posed this question—Is firearm violence really a problem in Kansas City?—and then he showed the data that proved the answer was an definite "yes."

The words of the trauma surgeons who had treated countless gunshot wounds carried a lot of weight during the symposium about the epidemic of firearm violence across the nation and in our own community. But the one non-surgeon who spoke during the day-long event, author Kathy Shorr, really struck a chord when she said, “Our kids are worrying about being shot in their schools. How many are going to have PTSD? Our kids are thinking like kids in a war-torn nation."

» Surgeons Have Seen The Carnage Of Gun Violence Up Close—And It's Personal

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