A trauma surgeon speaks: ‘Bullets destroy not just what’s in its path but everything surrounding it’ – The Cincinnati Enquirer

This year in Hamilton County, 15 juveniles have been charged with murder, more than were charged in the last four years combined. Why the increase? 'Kids Who Kill,' The Enquirer's series on juvenile violence, continues with this conversation.

Dr. Victor Garcia is a pediatric surgeon and the founding director of trauma services at Cincinnati Childrens Hospital Medical Center.

Enquirer reporter Keith BieryGolick:Where do you want to begin?

Garcia: Things are really not going well as far as violence is concerned. If anything, it's actually worse. As the chief of police has said, he's never seen not only the degree of violence, but also the change in victims and perpetrators to juveniles.

But to me, that's not surprising.

Why not?

Because it's not the individuals, it's the neighborhood that they live in. That is absolutely clear. That's the science and much of what we do in public policy is not informed by science.

I was recruited here to build a trauma program. And the motivation for this is that injury is a leading cause of death for children. Injury, not cancer, not infectious diseases. It's actually injury. And actually, more children die as a result of injury than any single or combination of diseases. Most people don't know that.

Parents of a murdered child speak: 'It's 100% normal for teens to have guns' in some neighborhoods

In the military, I spent 20 years there, PTSD (post-traumatic stress disorder) was slow to be appreciated by the Department of Defense.

Especially when you were there, right?

Yeah, toughen up. Youre weak. But we now know that it is just as real a phenomenon and just as detrimental as getting shot itself, except that you end up with substance abuse and shooting somebody else, et cetera. You have then not post-traumatic stress in our inner-city neighborhoods, but you have persistent-traumatic stress.

There's data that shows, like for Avondale, or this study was done in Philadelphia Medical School. One out of three children know somebody who's been killed, has seen somebody killed or has heard gunshots growing up. And as young as one month of age, a child growing up in an Avondale neighborhood … their hippocampus is fundamentally altered.

And not in a good way.

What does that do to your brain?

What happens is it increases cortisol. It promotes this whole fight-flight thing so that there's increased adolescent express reactivity. So you're more likely to do things like that. It impairs the executive function.What does that mean? It's where you weigh right and wrong.

It's: Oh, no, let me hold off. Well, let me take a deep breath. That part of the brain that executive decision-making helps you to make the right decision.

What means most to you in your office?

(Dr. Garcia stands up and grabs what looks like a small pill bottle from his bookshelf.)

Do you know what that is?

It looks like a bullet.

Thats right.

Why do you have this?

It's a reminder of the purpose of this work. That's what I take care of. It's stupid, stupid deaths.

I live in the suburbs. I live in Newtown. Cul-de-sac. I'm the only Black person in that area. Kids are running and playing, and they're drawing, playing hopscotch and whatnot. And then when I go into Seven Hills Neighborhood House (a social services resource in Cincinnatis West End), I don't see that. It is not just degrees, but totally different environments where Black kids are living here.

Totally different worlds.

What is it about that bullet in particular?

It was a bullet that killed a Black girl who died in my hands, despite this being the best trauma program and me being the founder of it. And despite my skill as a surgeon, or the resources that we have here, when I went to tell that mother that her child didn't die in vain, I would not be content with at the end of my day saying, I did everything I could. Sorry.

Because I've been at this for a long time. And thats a vivid, constant reminder.

What do you remember about her death?

It's easier for me to remember because there's a particular protocol. When you have somebody that comes up with a gunshot wound to the chest, there are certain things that you have to do. You put a chest tube in. You make sure the child is intubated. Secure the airway. You put in IVs, depending on where the wound is.

It needs to be up here as opposed to down here, because if the aorta is disrupted, then you're just having blood going out through the hole. Then you check to see if the blood pressure comes up, right? And whether the heart rate, which is usually tachycardia, whether it goes down. If a child comes in, and there are no vital signs at all. No signs of life. We know that the likelihood of successfully resuscitating that patient is very low and you don't bother. You just do a couple of rounds of epinephrine, and then you say, OK, time of death.

But if they come up with signs of life, then you're going to do what's called a resuscitated thoracotomy right there in the emergency room. You can use what's called a lebsche knife. And then you find the bleeding and you put your finger in or put in a Foley catheter with a balloon so that you can stop the bleeding from coming out. The other thing that you do, initially, is you cross-clamp the aorta to try to sort of minimize the blood loss and make sure the blood is flowing up to the brain because you can actually save a child but if there's been no blood flow to the brain, then theyre brain dead.

So, there is blood everywhere. And there's a group of 12people that we have as part of our team. I can remember that because, unfortunately, we do that on a regular basis.

The most recent one was a 13-year-old in Evanston. One child is dead right there at the scene. And the other one came here. Same thing. Theres what's called the snuff box, right here. It's between the nipples. And if that's where your bullet goes, then the likelihood is you're going to have a wound to the heart. That child gets brought up to the operating room. We opened the chest, and it went through the lungs. It missed the heart by that much.(Dr. Garcia holds up his fingers, an inch or so apart from each other.)

We put chest tubes in initially. You can make a determination depending on what the color of the blood is whether it's bright red or dark as to what the likelihood is that you've got a major vessel versus just a lung.

What's the difference?

It's better if it's dark. Because if it's dark, then if you can expand a lung, most of the time the bleeding will stop. If it's bright red, then it's either going to be the intercostal arteries or it's going to be the heart.

So, we open the chest. And then it was clear that it was the lung and not the heart. We packed that off and then saw that there was a hole in the diaphragm and then we went ahead and decided to go ahead and open the belly to address that.

Fortunately, that child survived.

And when did that happen? You said that was the last one.

Well, that was the most recent one. It wont be the last one.

What does a bullet do to the body?

It depends on the count of the bullet and the speed those two things. And the weapons that we have now are very different than the weapons we had when I was growing up. The weapons that are available to these kids, you don't have to be a good aim. You don't have to be able to hit right in the heart or anything like that. The tissue damage is just extraordinary because of the tumbling and the speed. The cavitation that takes place once the bullet goes through it sort of destroys not just what is in its path, but everything surrounding it. It's pretty devastating.

What does it feel like to realize no matter how good of a surgeon you are, you cant save everybody?

I hate to say it. It's anger. Anger knowing that people are dying, literally and figuratively. And it doesn't have to be. I mean, it'd be one thing if you're born in my world, a child is born after eight months. And the child is born with some fatal condition. All we can do is comfort the parents and provide comfort and humane treatment for that child.

What angers me and frustrates me as a human being is that these are needless lives that are being lost. Needless because we, as a society, should be doing things differently. And it'd be one thing if you didn't know. So there's no excuse if you didn't know that smoking causes cancer, right? We didn't know for the longest period of time. We were truly blind. We were misled.

I wonder to what extent the gun industry knows what it's doing and promoting. The other day, I'm driving on Martin Luther King where it turns onto Burnet. And there was a point in time where there was a (billboard). It was advertising for Kentucky a gun store. But I found it interesting as I'm waiting at the stoplight because there's lots of traffic. I wonder, and I dont know for sure, whether they're promoting that particularly in the poor Black neighborhoods.

Is it difficult for children to learn in these environments?

When I really started this work early on, I went to the vice superintendent for security for the public school system. And when I met with him, I thought that the busing was why are kids busing? He said the reason for the bus, which is one of the highest budget items, is because it's not safe for the kids to walk to the school. I didn't know that.

What have you learned about people?

We had like 12young men here in my office. Fifteen (years old), 16, maybe a couple that are 20. Young Black boys. So, I asked them. I took a poll. I said, what are your goals in life?

Eight of the 12 said, I want to get out of the 'hood. The others said, I want to be a basketball player. And the other one said, I want to be a football player. But eight out of 12 said, "I want to get out." So, what does that tell me? What should it tell you?

They know what the likelihood is for them.They're either going to get imprisoned or they're going to get killed. Can you imagine? There are no children here. That's the reality in Avondale and the West End.

We used to have street workers and the guys in the street over to our house. All these Black guys pulling into Ivy Hills(laughs). These are guys who are in the life and guys halfway in the life. And so we would have, like, maybe 20 or 30 people.

These guys came in and it was sort of in the winter. So, they had their coats and they said, What do I do with my coat? I said just take it upstairs. And later the next day or ... maybe a week afterward, they said, You know, Doc. We've never been to a house like this.

Just a deprivation. When we allow them to go up the stairs without somebody checking on them, they said it meant the world that you trusted us.

What frustrates you the most?

I would put photographs of children who have been shot and injured in lectures. They're coming in, "talk about trauma," and then you get pictures of kids with bullet wounds and bellies that are openand they can't be closed because of all the damage that has been done.

There's a science behind that. Number one is compassion fatigue. We know that if you talk about 10,000 people dying of such and such, OK, that's terrible. But if you show a picture of somebody. You're going to donate money, not for the 10,000 people who are dying in Somalia, but they'll show you a picture of that one child.

So what I found myself frustrated about is when I talk to people and say, 'Look, we have 15 kids indicted for murder, or whatever the number is.' (The response is:) 'Oh, that's terrible.' And so the consequence of that is: 'Well, I'll just stay away from that area. We won't gothere.'But if you can make it personal, that actually touches not just the mind with the data, but then the emotion.

I'm pulling out all stops trying to get people to understand that, for example, the reason we have this phenomenon, as far as the violence is concerned, is not because there are bad people, but it's what the environment has done to them. Just like PTSD.

What's the reality of gun violence?

Its a form of genocide.

Is there a solution?

Let me make it personal. My wife, I was previously married, the mother of my children died of cancer.

At a young age, right?

Yeah. And we spared no expense, when I was living in Washington, D.C., to go to Stanford to give her the best treatment that was possible. Unfortunately, she still died. But there was some solace in that we spared no expense.

You did everything you could.

Yeah, but we are not doing everything we could here. If I look at this and see what we should be applying to this issue, which is even more complex and more challenging than lymphoma, then that keeps me up at night because children are dying every day. Literally and figuratively.(Long pause.)

Sorry. Sorry. I have these awards up on the wall. Its all bull----.

My frustration is: How do I get people to realize were not doing everything we could?

Kids Who Kill: More teens are facing murder charges. How it came to this

The above conversation has been edited for clarity. Enquirer reporter Keith BieryGolickrecorded and transcribed theinterviewbefore editing. In some cases, questions and answers have been shortened and moved to make the conversations easier to follow and to remove unnecessary asides and repetitions.

The rest is here:
A trauma surgeon speaks: 'Bullets destroy not just what's in its path but everything surrounding it' - The Cincinnati Enquirer