We are multitasking , selfless healers with a duty to our community .
VIOLENCE
( continued from page 27 ) workers , but also desensitizes us to the plight of our patients .
Let ’ s not forget the victims of domestic abuse , male or female . At UofL ED we ( and the patients ) are lucky to have Sexual Assault Forensic Examiner nurses who complete the comprehensive exam , and selflessly appear in court months later . Representatives from the Center for Women and Families travel all over the city to provide safe discharge of patients . And think of the victims of suicidal violence , so desperate to terminate their psychic pain that they would put a loaded gun to the mouth or chest . Can we even bring ourselves to picture that level of despair ? Is it even healthy to try ? We go through the motions , “ GSW to chest , self-inflicted , needs trauma admit , a sitter , psych consult .” On to the next patient ( there are 10 waiting now ). That transition back to a façade of normalcy is a skill that comes at a cost , detachment .
We break the bad news of a violent death to a family . They charge at us . That charge is one of retribution . They want someone to blame , someone to punish . We jump out of the way as they run out the door to go find the enemy . Can you imagine having an enemy that you want to kill ? This isn ’ t fighting over whose tree is dropping leaves in your yard . This is life or death . Nurses and doctors fear for their safety in these encounters ; we have to protect ourselves . The family conference rooms at UofL are often overflowing with family members at the time of delivery of bad news of another death . When we stick to our rule of two family members per patient , we sacrifice a cozy atmosphere to provide safety to ER staff . Lockdown status , though unsightly for our image , exists to prevent further violence in the hospital .
The most crucial people in the ER to intervene with these patients are often the forgotten ones : a medical student , a psych rotator , a nurse in orientation , a tech who lost her brother to gang violence . Why is it almost never the physician who spends the extra minutes at the bedside ? Who else can perform the high level , artful , emotionally intelligent intercession ? How disingenuous of us to claim that we are too busy to counsel a patient who might have never even talked to a doctor in his / her adulthood , who might have a huge respect for doctors that saved their brother ’ s , sister ’ s or even their own life . We are squandering opportunities for meaningful , brief , but high-yield impact in these human beings . We pensively consider discharging the chest pain patient who has a < 1 percent chance of MI in 30 days , but promptly allow victims of violence to elope from the ER , naively assuming they will follow up in trauma clinic or with the community advocates . How many of these patients are able ( or even try ) to make follow-up appointments in the trauma clinic ? They come back to the ER months later asking for the bullet
28 LOUISVILLE MEDICINE
( which has now migrated to the skin ) to be removed .
We are multitasking , selfless healers with a duty to our community .
Let ’ s step up to the challenge .
Others in this issue will provide the powerful narratives of programs like Pivot to Peace , Safe and Healthy Neighborhoods , and Community Health Worker KJ Fields ( who has personally saved the lives of Louisville ’ s youth ). But as Dr . Mitchell pointed out in his talk , it is not enough to delegate these responsibilities to community organizations . Many of the doctors I surveyed related a perceived inability to “ make a difference ” and “ break the cycle of violence .” But physicians should be leading these programs . Sure , we ’ re fighting expansion of EMR responsibilities , decreasing reimbursement , time constraints , metrics , and , oh yeah , we have families as well . But , we juggled 10 or 20 patients alone on a call night when we had barely fully developed prefrontal cortices . We memorized all of the medications and allergies for every ICU patient . We retracted or cut suture at the end of a 24-hour call , awake only as a side effect of our empty stomachs . We are multitasking , selfless healers with a duty to our community . Let ’ s step up to the challenge .
The Emergency Medicine department is now working with Dr . Keith Miller and the surgery service to integrate our efforts with the Mayor ’ s office . Finally , physicians are becoming involved in these discussions . We must all participate in the “ Cure Violence ” model to ensure safety to Louisvillians . The Trauma Gun Shot Registry will pull in data from LMPD , finally breaking down silos that have kept us isolated from each other . GLMS members can play a part in this as well , by supporting the program and sharing the publications that will result from the registry . The simple act of putting our essays together for this issue bridged a few communication gaps between the parties involved .
The family medicine intern who found the two gunshot victims is now in her second year of residency . She treats hypertension and diabetes , CHF and arthritis , remaining patient and nonjudgemental in the face of noncompliance and what on the surface may appear to be indifference . But her patients are all fighting battles of which she knows nothing , unless she asks . Start with one patient . Listen , understand , empathize , and care about this person who might come back in next time with a hole in his chest ; or who might coldly deliver vengeance upon his childhood friend . Start with one patient . And then another .
Dr . Huecker is a practicing UofL Emergency Medicine Physician and Faculty Member .