Care in the cycle of gun violence

How can hospitals best care for victims of gun violence and help interrupt the cycle? A Medical Director of a Trauma Intervention Program in Philadelphia offers insight and advice.

By Dr. Erica Harris

Their faces are bright, splashed in color, glowing even. Some solemn faces look thoughtful and inviting. Some are surrounded by their children and families – love you can see. It’s their smiles, however, that captivate me the most as I walk through the hallway on my way to work in the emergency department. This walk is a ritual in solitude and metered breathing to center myself before what have become increasingly difficult shifts. But today, I slow down and finally stop to let myself feel what their faces are trying to tell me.

“Frankie and Marcus”
Portrait of Francisco Caraballo
by Karen Ruggles / Souls Shot Portrait Project

These portraits are part of the Souls Shot Portrait Project exhibition, each one representing a life lost to or altered by gun violence. Created by fine artists in collaboration with the families and friends of victims, the portraits  have been displayed in many public places throughout Pennsylvania and New Jersey. As a Level 1 trauma center in North Philadelphia, an impoverished section of a city with among the highest per capita murder rates in the country, Einstein Medical Center Philadelphia cares for hundreds of victims of gun violence each year. Hosting this portrait exhibition seemed not only natural, but imperative.

Looking at these beautiful souls and learning of their tragic deaths raises awareness of our gun violence epidemic in personal and meaningful ways. This is important for those who may not see gun violence regularly, those who may not be aware that it is the leading cause of death for young brown and Black men and boys, or who may not know that the frequency of shootings in neighborhoods increases directly with increasing poverty levels.

But I think of the patients and visitors who live and work around the hospital. They know these things already. They feel them. They are terrorized daily by the sound of gunfire erupting around them. They must make room to live around their fear of being shot while waiting for a bus, sending their children to school, sitting on their porch, or buying groceries. Many themselves have lost a loved one to gun violence. For these visitors, I hope the message they carry home is that we have not forgotten them, that their lives matter, and that they deserve space and visibility.

As I increasingly struggle with my work on the front line of a smoldering pandemic and the steady upward trend in gun violence in my city, the gifts these portraits give me is a perfectly quixotic hope.

It’s the smiles that get me: In these, I see life and not death.

I feel the energy and immeasurable value of these peoples’ lives and not the tragedy of their deaths.

I feel.


Laying the first brick

“Portrait of Tianna Nicole Valentine Eatman”
by Mary Begnardi / Souls Shot Portrait Project

There is a perhaps necessary emotional deadening that can happen when you are confronted so regularly with what seems subhuman, horrific, and hopeless. The easiest thing to do is compartmentalize, defer, or even neglect feeling altogether.

None of us set out to do this, of course. But to feel the pain of all of those around us, to even absorb their narrative, would be paralyzing. Instead, we learn to treat these (mostly young) bodies with skill.

With great intensity we offer them everything we’ve learned in our training and as much of ourselves as we can spare. Sometimes they do well enough to go home, forever altered but alive. Other times, we can only steel ourselves to their mother’s screams on hearing the bad news before we move on to the next patient.

As health practitioners, we are more than 3years deep into our unique witnessing of a global pandemic that has exposed and widened socioeconomic inequity, laying bare the cracks in our foundation that have allowed more of our patients to struggle against the things that promise to keep them unwell.

As healers, we see in these times of challenge immense opportunity to shape a healthier future for our patients and our communities. It can be daunting to look out upon the smoking horizon, our own backs tired and aching, and will an understanding of where to lay the first brick for the groundwork of a better tomorrow.


Interrupting the cycle of violence

“That Smile”
Portrait of James Walke III
by Ann Price Hartzell / Souls Shot Portrait Project

At my hospital, I am the Medical Director of the Trauma Intervention Program, a hospital-based violence intervention program that treats violence as a public health problem in need of evidence-based and trauma-informed solutions. The program works specifically with young victims of interpersonal violence ages 14 to 30 years old. We work to address the physical and mental health sequelae of trauma, intervening at the point of hospitalization to interrupt the cycle of violence.

Similar programs throughout the country have been shown to decrease re-injury and involvement with the criminal justice system. They are one tool in the fight against the trend of rising gun violence levels nationally.

Due to the funding struggles that many social service programs have faced, the program has not functioned at capacity for the past several years, despite a documented rise in all forms of injury caused by violence at our hospital, including gun violence. Meanwhile, the patients have grown increasingly younger and their care more complicated by devastating injuries from the powerful military-grade firearms that have found their way onto crowded city streets. Incidents of mass shooting events have become more regular (although still unlikely to make national news), and our staff have grown more weary as we shuffle patients around in our overflowing department to care for them.

For these high-risk patients, the prevailing paradigm of “treat and street” – treating physical wounds and then discharging – is grossly inadequate at best and dangerous at worst. Without specific guidance and intervention, these young patients face significant risk of both reinjury and death in the years following their initial injury.

The needs are enormous. How can a hospital help, when funding for such support is in often minimal to zero, and staffing is tight already?

Certainly, lifting the entire unfunded workload of the Trauma Intervention Program on my shoulders alone would have been unfeasible and inhumane. It has been tempting for me to throw in the towel. I understand acutely the frustration of so many of my colleagues who wish to impart meaningful social change through their practice and either meet seemingly insurmountable resistance, or do not even know where to begin.

What else can do we do? What are the options?


Together, a way forward

“Family of Hassan”
Portrait of Hassan Wood
by Warren Keyser

One critical solution that has kept essential services flowing to our most vulnerable patients has been the simple act of collaboration.

We looked beyond our hospital walls to the inspiring work that has been done by an array of community groups and violence-intervention programs at other institutions to find ways to continue to connect our patients with vital services in their recovery beyond the trauma bay.

Northwest Victims Services, a nonprofit organization that helps families after experiencing the trauma of violence, has kept their boots on the ground and their fingers on the pulse of the needs of the neighborhoods we serve. Their deep roots are invaluable in establishing trust with a traumatized population.

We have also linked with CureViolence, a nonprofit organization that focuses on community-level intervention to help detect and interrupt conflict, foster healthier behavior among high-risk individuals, and build healthy social norms. violence. They have helped us expand our impact onto the streets beyond the hospital while also better serving those inside.

As Einstein Medical Center Philadelphia’s Trauma Intervention Program is founded on the model of the hospital-based Healing Hurt People Program, we have also maintained a close connection to this program. We refer patients here for intensive trauma-informed treatment of the unfortunate but anticipated psychological impacts of violent injury.

Even as our funding begins to ramp up and we have hired staff for our Trauma Intervention Program, these precious relationships will remain integral to our hospital’s response to the growing threat of interpersonal violence. I found unexpected benefit in finding my fault lines and asking for help, in looking to the strengths of others and their history of established work in the community.

This continues to be the best advice I offer to those looking to help shape a brighter future within (and outside) the house of medicine: Your strength lies in your connections, not in what you can do alone.

Portrait of Josalissa Melendez
by Wendy Elliot-Vandivier

As a matter of not only practicality but of respect for what has come before you, do not reinvent the wheel. You may be surprised to discover the array of work that is already being done in your community, or in the partnerships you can build, however unconventional, to better serve your patients.

Every small step counts, and they add up quickly.

My walk through the halls of the Souls Shot exhibition has been a particular gift to me today. It is easy to become mired in the darkness of treating the worst things people do to one another, but the smiles shining from these portraits show me something else. Life. Hope. A reason to fight.

Dr. Erica Harris is an attending physician in the Department of Emergency Medicine at Einstein Healthcare Network-Jefferson Health in Philadelphia, Medical Director of Einstein’s Trauma Intervention Program, Associate Director of the Jefferson Center for Injury Research and Prevention, and a faculty member of the Einstein Center for Humanism. She is also a 2022-2023 Gold Humanism Scholar at the Harvard Macy Institute Program for Educators. Jefferson Health is a Hippocrates member of the Gold Partners Council.