South Bend Tribune – South Bend, Ind.
| Author: | ALICIA GALLEGOS |
| Date: | Nov 15, 2007 |
First of five parts
SOUTH BEND — She remembers stumbling out of the truck and trying to find her bearings in the darkness.
She could feel the wet sensation of blood dripping down her neck.
After a few dizzying minutes, she realized she was in a park … Howard Park.
Wearing only a fleece jacket and her socks, Melissa staggered past the big maple tree and into the street screaming.
Cars whizzed past her on Jefferson Boulevard, none stopping for the half-naked, bleeding young woman.
Finally, a cab driver pulled over, Melissa later remembered. “I was like, ‘I’ve been shot! Let me in!’
”
When police and paramedics arrived at the scene just before 3 a.m. that April morning in 2003, they found that 20-year-old Melissa was not the only victim. To protect her identity, The Tribune is not using her real name.
Another man also was alive, shot in the head. A third person lay dead inside a nearby vehicle.
Like dozens of violent crimes, the process of piecing together the bloody picture was just beginning.
When it was over, Melissa would be far from the only person to pay a price.
Just how many people are affected by a single act of violence? The price may be too much to quantify.
But a closer look shows that the bill extends far past the intended or unintended target. It reaches into hospital emergency rooms, through police departments, into courtrooms and across prisons, ultimately digging into the pockets of taxpayers.
Annually, the United States suffers 16,800 homicides and 2.2 million medically treated injuries because of violence, according to a new study in the American Journal of Preventative Medicine.
Productivity losses and medical treatment alone cost a combined $37 billion, the study found.
But violence also carries with it an emotional price that weighs not only on victims, but on the very people working to ease the burden.
Taming trauma
Trauma, Memorial Hospital emergency room physician Mark Walsh says, is like lightning: It strikes on any given day, sometimes more than once, and sends dozens of emergency staff racing to find its cause.
Memorial Hospital’s ER was struck by 50,000 patients in 2006, an increase of 4,000 from the previous year, according to Memorial records provided to The Tribune.
In 2006, 186 of that number were considered “911 status,” meeting the highest level of trauma activation. The category includes blunt, penetrating and burn trauma.
“I think anyone that is new to this community as a physician is in for a big surprise,” says Dr. Scott Thomas, a surgeon who is director of the trauma center. “It’s frightening to look at the amount of violence we have in this community.”
Memorial has been operating as a Level II trauma center for three years. Only four hospitals in Indiana have this verification.
The status means the hospital has the ability to care for a higher level of trauma — and it is sent the worst-of-the-worst cases.
Like other high-level care facilities around the country, new advancements and medical technology have led to a dramatic increase in survivability.
That’s why experts say the best measure of violence in a community may not be by counting murders.
A 2002 University of Massachusetts Amherst study found that advances in medical care in the last 40 years have decreased homicides by more than 30,000 nationally.
“I think if you’re trying to assess the burden of violence, it’s really important to go beyond just fatalities,” says Dr. Phaedra Corso, associate professor at Harvard University and co-author of the AJPM study.
But trauma experts say the art of saving lives doesn’t start at the hospital.
It starts during the first critical moments after medics reach the scene.
The cost of violence
On a recent Sunday afternoon, all is calm in the Memorial emergency room when “lightning” strikes.
In a flash, specialists assemble in the ER. The group includes surgeons, nurses, a blood bank operator, a respiratory therapist and countless others.
The team darts confidently around the trauma room, watching computer screens, grabbing medical tools and hovering over a newly arrived patient suffering from a gunshot wound.
Police officers stand nearby, taking pictures of the woman’s injuries and asking questions about what she remembers.
In minutes, the victim is whisked off to surgery to remove a bullet lodged in her stomach.
The scenario is routine for the trauma team.
In 2006, Memorial Hospital treated 40 gunshot wounds related to an assault, as opposed to accidents or suicides, a rise of 11 since 2005, according to records.
Penetrating wounds — primarily stab and gunshot wounds — account for about 19 percent of the most severe trauma patients.
“It’s a disproportionately high number for a community of this size,” Thomas says.
But trauma experts and surgeons have become aces at following the path of a bullet inside a body and working to prevent its destruction.
Along with their medical knowledge, doctors also know their share of ballistics, Thomas says, learning the impact of trajectories and being able to identify the caliber of weapons.
“Nowadays, a .22 is a common gun,” he says, “(but) a 9 mm, it can do quite a bit of damage.”
Trauma costs vary with injury and length of treatment.
An overnight stay in the intensive care unit runs patients $2,630, a cost that can easily be multiplied by a respirator, X-rays or surgery.
For patients without insurance, it’s hospitals and taxpayers that pick up the bills.
“Nobody’s turned away,” says Dr. Tim Noveroske, a Memorial surgeon. “Who’s going to pay for it later?”
A walking miracle
The last thing Melissa remembers before losing consciousness is the cold air at the hospital and how the nurses cut off her red and black fleece jacket.
She loved that fleece.
Everyone was rushing around, and blood was running down her shoulder, soaking the gauze wrapped around her arm. Then she was asleep.
When she awoke, her whole family was in her hospital room, staring down at her.
Melissa was told that she had been shot in the head and in the arm, but that the bullet had missed any major vessels in her brain.
“They said I was a miracle,” she later remembered. “A walking, talking miracle.”
Her bills would eventually total more than $15,000, she later said, which would be paid for by victim assistance money, distributed by the Indiana Department of Justice.
While Melissa was gathering her strength in the hospital, police officers were sifting through evidence at the scene where she was attacked.
As dawn broke on April 25, 2003, investigators surveyed the violent puzzle:
Two shooting victims in the hospital, one man dead, a sport utility vehicle parked in the middle of Howard Park, and plenty of unanswered questions.
Coming Friday: Investigators begin to unravel the case — but at a price.
Staff writer Alicia Gallegos:
agallegos@sbtinfo.com
(574) 235-6368
gallegosmedia 
