Chicago has made national headlines for the more than 780 murders committed in the city last year, and more than 100 committed already in 2017. Amid this climate of bloodshed, most of it gang-related, the University of Chicago is now building the only adult Level I trauma center on the city’s South Side, where the vast majority of the killings occur. Selwyn Rogers Jr., M.D., a Harvard-trained surgeon and public health expert who is leading the effort, sat down with H&HN to discuss what interested him in trauma care and how clinicians can avoid burnout when treating victims of violence.
This is the first part of our interview with Rogers. You can find the second installment here, and be sure to check out both our March cover story on mass shootings, and the American Hospital Association’s resource page on violence.
Tell us about yourself and what interested you in a career in trauma care?
ROGERS: The challenge of being a person interested in learning as much as possible is that you can't specialize in everything. I gravitated to a career in trauma care because I like taking care of the whole person, and trauma is an equal opportunity disease. It affects young people, old people, black people, white people, rich people, poor people. In addition, you have to think about how an altered physiology like trauma affects people's lives. When I was in training In Boston, I became interested in things like gun violence and intentional trauma, and why gunshot wounds and stab wounds disproportionately affected people of color. That led me to realize that I had very little understanding of epidemiology or the study or the incidence of disease. When I took my first academic job, it convinced me to pursue a master’s in public health because I wanted to understand how the study of disease incidence could affect outcomes.
Then I became a trauma surgeon on the faculty of Vanderbilt University, where I earned that master's degree. It allowed me to see the broader context of how social determinants of health, like poverty, underemployment, unemployment, lack of insurance, race and ethnicity can have an impact on disease. [His career path led him back to Boston, then to Temple University in Philadelphia and the University of Texas Medical Branch at Galveston.] In Galvestonl, I was happy doing administrative work while still doing trauma call once or twice a month. But like many, I was sitting on the sidelines looking at what was happening in Chicago and in many other urban settings in America. But Chicago has become the poster child for intentional violence partly because of its size and the sheer numbers.
How do you keep from being overwhelmed in the face of such violence?
ROGERS: I’m a person of deep faith, but I have an incredible support structure. I have three kids ages 21, 18 and 14. I see that if not for circumstances that include engaged parents, social networks and folks who believe in and care for them, they could be kids caught up in violence on the South Side of Chicago. But they've been blessed with lots of opportunities. They also keep me grounded. That groundedness and that connection are part of my wellness. I also have a very committed fiancée who gets it. We talk multiple times during the day, morning and night, and we nurture each other. I also understand that if I can’t take care of myself, I can’t take care of others. That means a healthy dose of exercise, eating right, sleeping as best I can and trying to maintain a sense of humor. I say all the time that if you can’t have fun at work, where can you have fun? You spend so much time there, you may as well enjoy it. The context of getting joy out of your work is so vital. If it’s work, that’s painful. If it’s joy, if you have purpose and there’s meaning, that propels you forward even during stressful times.
Could you talk about the impact of such tragic cases as those of 11-year-old Takiya Holmes and 12-year-old Kanari Gentry-Bowers who were both gunned down in separate incidents in February? How does that affect not only the community, but also the hospital staff who are treating them?
ROGERS: Eleven and 12-year-olds should be in fifth and sixth grade. I ask myself: What about the class that those two young girls should have been in today and what are they studying? What’s the unseen impact on their classmates?
Kids should never experience trauma like this, right? What’s the effect on their peers as they move forward? Are they receptive to mental health services? How do they think about their place in the world? Where does their hope for a better day come from?
And how does violence affect the community? Does the community feel safe? Does it feel valued? Those are questions to which I have no answers. And I don't have a shared, lived experience, except in the context of being a trauma surgeon.
I view [my work] as a blessing every day because I get to enter people’s lives at their time of greatest need and try to help them during that part of their journey. Sometimes, it actually borders on miraculous. Sometimes, I receive greeting cards from people I haven’t thought about in a decade, but they thought about me and the impact that I had had on their lives. It’s moving and powerful.
The other impact, if you don’t maintain perspective, is burnout, and a de-identification of who the other [person] is — someone who has feelings. Every victim of violent trauma is a person who experienced pain and suffering. Even the perpetrator is a victim in the greater scheme of things. Yes, he or she actually committed a crime and needs to be punished for that crime, but when a 16-year-old pulls a gun in the midst of a conflict and kills another 16-year-old — as someone who believes in the goodness of humans — I ask myself how that 16-year-old got to that point? Where did we as a society fail?
How can hospitals support the nurses and physicians who are dealing with the psychological aftermath of these tragedies?
ROGERS: That's a great question and there's increasing recognition of burnout among nurses and physicians. This is a new area that people are just beginning to make sense of, or are at least better able to describe. Now that we can describe it, there is an incredible opportunity to treat it. There is, at times, a reluctance to accept that we as nurses, doctors, psychiatrists, clinicians and therapists are affected by these events.
I'll give you a nontrauma example that was profound at my last institution, the UT Medical Branch. To show gratitude to our staff, [leaders] serve a Christmas meal. I was partnered with one of the nurse administrators in obstetrics and she and I were serving dessert. A woman wearing a badge that identified her as a member of the environmental services staff, approaches and my partner Deb says, 'Oh my goodness, good to see you, Chris. How are you doing? How's your family?' It created a degree of familiarity, comfort and ease. After Chris left, I said to Deb, 'That’s so great that you know so much about her.' She said, 'Well, we weren't always good friends, but something happened and we bonded.' A woman in labor, who had received no prenatal care, showed up at the hospital. During the birthing process, the baby ripped the placenta and the woman started bleeding and died. Everyone did everything they could to save the woman's life.
Chris was the housekeeper who, after all of that, cleaned up the room. A couple of days later, she asked Deb what had happened to the woman. Because maternal deaths aren't very common, Deb had orchestrated a grieving process for the nursing team and the medical team. No one thought about the housekeeper. But she had cleaned that room all by herself. When Deb told Chris the woman had died, they cried together.
That's an example of something that we don't think about. Every one of these things affects us because we're all human, but we often don't acknowledge it. What I worry about is the effect, for example, on the 11- and 12-year-olds in those two Chicago girls’ classes? How are they developing and how are they thinking about the world? What's the impact of what we call toxic stress? We know that when our military veterans go off to war and deal with tragic events, some are resilient and bounce back as if nothing happened, even though they aren't able to talk about it. Others develop post-traumatic stress disorder with symptoms that need to be managed, ideally through a combination of psychological and psychiatric help and support. But what happens when you're always exposed to stress every day of your life and you're young and still developing? That's a question to which I would love having someone answer.
Can you give us a status report on the new trauma center that is opening in 2018?
ROGERS: The University of Chicago has not had an adult Level I trauma center in 25 years. So, we're starting on the ground floor — and that literally means the ground floor. The emergency department, which will be the major portal of entry of the trauma center for trial patients, is being built as we speak. The current ED sits on a footprint that can't absorb additional patients and is already constrained. The new ED is slated to be completed in January. The Illinois Department of Public Health mandates that you have to be functioning as an emergency department for several months before it will authorize opening as a trauma center. That’s the place.
And then, there are the people. Since we don't currently have any faculty besides me, I'm actively recruiting for six additional positions. We have one trauma faculty member now who will join the team.
Trauma, as you can imagine, affects every place at the hospital. It affects radiology, social work, custodial care, the morgue, OB, psychiatry. It touches everything in the hospital, and a big part of my job right now is to identify gaps between where we are now and where we will need to be by next spring so that we can provide the highest level of care for every patient who comes through the door.
And finally, we need to put in place the policies, procedures and training so that, when we open the trauma center, we are ready to go.