The Bullet and the Damage Done
On a recent Thursday afternoon at the hospital of the University of Pennsylvania, one of the busiest and best gunshot-wound hospitals in the country, the call came in about a “scoop and run.” That’s cop speak for a victim so full of holes that the officers on the scene don’t wait for an ambulance to respond. This’ victim, the dispatcher told Dr. Elliott Haut, a thirty-two-year-old surgeon on call, had been shot multiple times, including once in the face, in broad daylight inside a Jamaican restaurant about twenty-five blocks away.
That would be West Philadelphia, Haut knew, and he wasn’t surprised. Sometime around the late 1980s — when crack hit the city — that neighborhood of abandoned buildings and crumbling hope had become an urban battleground. Last year, 1,320 people were shot in Philadelphia, many in West Philly. In the last six months alone, Haut himself had treated about 100 of them.
A white police van driven by two young patrolmen squealed to a stop outside the HUP trauma bay minutes later. Facedown on the floor in the back of the van, in an already drying pool of blood, lay a muscular black man about six feet two inches tall. Paramedics slid the man onto a stretcher and hustled him inside, where Haut and a colleague, Dr. Ruby Skinner, set to work. Trauma patient No. 843, who carried no identification, had taken at least seven rounds, probably from a 9 mm handgun, including one that tore through the roof of his mouth, flipping the patient’s teeth upward grotesquely, like the wet mustache of a sea lion. That shot looked like it came from almost point-blank range.
On the streets of Philadelphia, as in most major American cities, the 9 mm semiautomatic remains the weapon of choice, having replaced bulky, inaccurate Saturday Night Specials about fifteen years ago. Shooters like the “9” because it is small and thin and holds more ammo than most revolvers — between seven and thirty-two cartridges — thus increasing the chances of hitting a target. From a trauma surgeon’s perspective, that means that people who get shot with a 9 mm tend to get hit, on average, with two bullets, increasing the likelihood of grievous injury.
“No pulse!” cried a nurse, feeling in the man’s groin area and around his neck, as another nurse cut his clothes from his body. A doctor struggled to insert an airway through the man’s bloody clump of lips and teeth. A CO2 sensor confirmed what the surgeons already knew: Trauma patient No. 843 was not breathing. Haut turned the man on his side; a crushed, blackened slug dropped onto the examining table.
Skinner ordered the insertion of intravenous lines to pump in drugs that might restart the heart. If the patient wasn’t revived within a couple of minutes, Skinner would decide whether or not to open the man’s chest and take his stopped heart into her surgical-gloved hands and massage it. A young hospital chaplain looked on apprehensively, clutching his Bible.
HUP was not always one of America’s top trauma centers. Until 1987, it was a second-rate inner-city hospital. That year, Dr. C. William Schwab, a professor of surgery at the hospital and head of its division of Traumatology and Surgical Critical Care, installed a helipad on the roof — so patients can be coptered in — and led a campaign to transform HUP into what is known as a Level One Trauma Center, meaning it has highly trained staff and state-of-the-art systems in place that enable it to offer care for critically ill patients twenty-four hours a day.
Bullets injure 100,000 people and kill 28,000 a year in the United States, second only to car crashes in terms of deaths related to injury. HUP averages one gunshot victim per day, more on hot summer weekends; fully fifty-one percent of the people who died in its trauma center in 2002 had been shot. Wounds inflicted by-high-powered rifles, which can fire bullets at more than 3,000 feet per second, are rare, although two young people rushed to the HUP trauma bay last year lost parts of their legs to slugs from an AK-47.
Contrary to what Hollywood teaches us, many gunshot injuries are not simple through-and-through holes that either kill the victim instantly or heal up after being cleaned and dressed. Bullets, depending on their trajectory, can inflict horrible wounds that damage vital organs and blood vessels and require radical, debilitating and expensive surgical procedures in order to prevent death. In many cases, life after being shot is never the same. “These events take place in less than a tenth of a second, followed by a lifetime of trying to get patched up and rehabilitated,” said Dr. Stephen Hargarten, a firearm-injury expert at the Medical College of Wisconsin, in Milwaukee. “And we’re all affected, either emotionally or in our pocketbook.”
Take the case of Stanley Ramsey, 19, shot one night in July 1999 outside a Southwest Philadelphia chicken restaurant, in an all too typical dispute over money and drugs. Within minutes, Ramsey lay unconscious in the HUP trauma bay, a bullet having severed his spine and spinal cord, while a team of five doctors and five support staff tended to his wounds. The surgeon in charge that night, Dr. Patrick Reilly, HUP’s trauma program director, figured Stanley Ramsey would not do well at all.
Ramsey lived, barely. He stayed in intensive care for six weeks and underwent four surgeries. And that, for Stanley Ramsey, now a quadriplegic, was only the beginning. During the two-year period following the shooting, Ramsey required a ventilator to breathe for him and, at various times, developed blood infections, contracted pneumonia, came down with a chronic hip ulcer and suffered uncontrollable muscle spasms. Speaking in a hoarse, barely audible stutter, he testified lying supine on a hospital gurney at the trial of his assailant.
Even today, after many months of dispiriting and exhausting rehab, Ramsey cannot even push a button; he pilots his motorized wheelchair by blowing into a straw. “Ramsey’s future is bleak,” Reilly said. “I don’t think his quality of life will ever improve.” Nonetheless, the total cost to date of Ramsey’s care and the police investigation of his case already exceeds $2 million, much of that covered by Pennsylvania taxpayers. Should he live another forty years, that $2 million figure will mushroom to $15 million. Add that to the costs incurred by others in Ramsey’s predicament: Every year, HUP treats about fifteen people who have been shot in the spine.
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