The worst week of my professional life occurred in October 2015 a few years after I had moved to Cleveland as an academic surgeon. I was in charge of caring for four children under the age of 10 who had been shot, and a new victim arrived in critical condition. The 6-month-old infant had caught a stray bullet waiting in the car as her mother was buying candles for her father’s birthday. I’ll never forget holding the girl’s heart in my hand after unsuccessfully trying to revive her and later being present when we shared the grim news with her family.
This began a journey for me at UH Rainbow Babies & Children’s Hospital to address the problem of violence from a new vantage. In Cleveland, our child gun violence rate during and since the pandemic has gone up more than 47%. More people between the age of 2 and 18 died from gun violence than from all the other causes of pediatric death put together in our city. And these numbers continue to escalate.
Our children and families not only suffer at the time of a violent injury but also face a greater risk of reinjury, mental health comorbidities, and chronic health conditions. When we looked at our own hospital experience, we found that patients who were victims of violence had a 30% reinjury rate.
What could we do to interrupt this deadly cycle? I desired to go deep and to understand the roots of violence. When I looked further into our hospital data, I discovered that 30% of victims would return with a major depressive condition or self-injury attempt. And broader data showed that victims of violence have a significantly higher number of adverse childhood experiences. On top of that, I already knew that Cleveland high school students had the highest child suicide rate in the country. This all helped me understand that violence had a tremendous effect on victims not only physically, but mentally and spiritually—it affected the whole person and was part of the cycle.
So, I wanted to move beyond the downstream efforts of simply treating victims and releasing them. As a child, I was fascinated by a Japanese art form called kintsugi. After a clay pot is inadvertently broken and is of minimal apparent value, an artisan can mend it together with gold epoxy. Then this broken but repaired vessel becomes more valuable than it was in its native state. To me, that applies to the human condition. Like kintsugi, I wanted to make patients stronger—in fact, “stronger in the broken places,” creating post-traumatic growth and new meaning for their lives.
That’s what our hospital-based violence intervention program—which is based on programs from Children’s Wisconsin and Children’s Hospital of Philadelphia—aims to do. Knowing that violence affects the whole person, we use a holistic, person-centered approach. We start by getting to know the patient better in their environment, meeting them in their homes within 48 hours of discharge. Then, working with community, civic and philanthropic partners, we help meet basic needs like food, clothing and housing security. We connect them to other services like mental health therapy, academic support, and vocational services. It is a one-year program, and our average participants retain for seven months. Only two of 56 patients have been retraumatized.
The final piece we want to create is a trauma-informed hospital environment, not only for patients but for care providers who, like me, experienced a moral injury caring for victims of violence. We want providers to understand they like our patients have trauma. We endeavor to create a healing environment for everyone.