1128TRAUMA Boston, Dorchester, Roxbury, Springfield, shots fired, trauma, shootings, fatalities, fatal, data, homicide, gun violence, trauma surgeon, primary care physician, victim's mother, social worker

I know the violence of homicide all too well — the images of fear-filled victims’ faces often haunt me at night. Recently, another victim of multiple stab wounds came into our trauma unit. I was immediately filled with so many questions: Who did this? Why? Is anybody else hurt? Were there witnesses? Does she have children? As a trauma surgeon, however, I’m trained not to ask too many personal questions. I need to focus on the injuries and determine if any of them are life-threatening and to ask myself a different set of questions: Is she still bleeding? Does she need a blood transfusion? Will she need emergency surgery to control the bleeding? My job is simply to save people after stab wounds. Or is it? — Tracey Dechert

An ambulance transports a victim at a shooting scene in Roxbury on April 29, 2013. The images is taken at night and the lights of the siren reflect on the houses and cars on the street. MATTHEW J. LEE/GLOBE STAFF

eports of shootings and stabbings in Boston played through the news the past several weeks — this after a long summer of violence. According to Analyze Boston, since the beginning of 2022 there have been 168 shootings with 30 homicides in the city compared to 188 shootings with 24 homicides during the same period of 2021. Homicides are up over 20 percent, reflecting the national trend that has been on the increase since 2019. However, what is often not covered is the people left in the wake — for every homicide victim there are an estimated 7 to 10 close relatives and friends left behind, in addition to neighbors and co-workers — and the ensuing trauma that plagues those close to homicide victims and generations to come.

Homicide’s ensuing trauma

Police tape is seen along Washington Street in Dorchester across from where two men were shot in January 2020. One of the victims was killed in the shooting. JESSICA RINALDI/GLOBE STAFF

By Katherine Gergen Barnett, Tracey Dechert, Lisa Allee, and Clementina Chéry

Police tape was seen along Washington Street in Dorchester across from where two men were shot — one of them fatally — in 2020. JESSICA RINALDI/GLOBE STAFF

An ambulance transported a victim at a shooting scene in Roxbury on April 29, 2013. MATTHEW J. LEE/GLOBE STAFF

Working as a trauma surgeon at Boston Medical Center for 12 years,

Caring for patients in our current medical system who have suffered from acute loss and violence can often feel a bit like the ancient parable derived from Buddhist, Hindu, and Jain texts of the blind men and the elephant. In this story, a group of blind men who have never come across an elephant before each learn and imagine what the elephant is like by touching a different part of the elephant’s body, such as the legs or the tusk. Based on their limited experiences, they are each then tasked to describe the elephant. Inevitably, these descriptions are different from each other and, in some versions of the story, the blind men come to blows over their differing perspectives. How do medical systems partner more effectively with communities in order to treat the larger health impacts of violence? One answer is to begin to frame and treat trauma as a chronic disease. Trauma — as defined by the American Psychological Association — is “an emotional response to a terrible event like an accident, rape, or natural disaster” that incurs an immediate set of physical and emotional reactions such as panic, anxiety, shock, and denial. However, the longer term impacts of trauma are also becoming increasingly clear, including chronic headaches, insomnia, pain, nausea, difficulty concentrating, anger, and irritability. Left untreated, trauma can have unintended consequences of increased rates of heart attacks, strokes, obesity, diabetes, domestic violence, and incarceration. In other words, the impact of trauma casts a long shadow of illness, disability, and increased financial burdens.

Although trauma can be understood as an organizing principle for many of the physical and mental symptoms and illnesses of individuals, it is rarely spoken about or framed as a chronic disease. While someone with uncontrolled diabetes may expect to receive multidisciplinary care — including from a primary care provider, endocrinologist, pharmacist, kidney doctor, and nutritionist — victims of trauma too often need to actively weave their care together. This journey can include recovering from trauma surgery, finding a medical home, securing a therapist, finding support in the community — a navigation that can be exhausting for any person, let alone one who is already riddled by fatigue and fear. Just as medical providers would treat someone with any chronic disease — whether diabetes, high blood pressure, or kidney disease — we must also expand our scope of services and care for patients who are victims of trauma. This means creating end-to-end interdisciplinary services — from the trauma departments of hospitals, to primary care, behavioral health specialists, police departments, detective agencies, housing specialists, and community advocates.

Part of this treatment is to deploy models such as the Louis D. Brown Peace Institute. As a mother faced with a new reality, one of us turned her pain and anger into purpose and action and, in 1994, founded the institute, which has served as a center of healing, teaching, and learning for families and communities impacted by murder, trauma, grief, and loss. Since 1996, the institute has partnered with Boston Medical Center to provide the initial, practical support for families faced with the financial and emotional weight of trauma. BMC also was the first hospital to purchase the survivors’ burial and resource guide, which was developed by the Louis D. Brown Peace Institute to help families navigate this new life after a killing.

With newly elected leadership in Massachusetts, there is an opportunity to leverage institutes such as the Louis D. Brown Peace Institute and bring new voices of change and leadership to the table to help lead these efforts. This could take the form of trauma consortiums, investing in each of the partners who care for trauma and incentivizing collaboration through a new set of healing metrics (i.e. PTSD symptom checks), and creating centers of healing and advocacy in the community. While those who hold the power, such as medical systems and governments, should support these measures, they cannot be sole leaders in these initiatives. Those touched by violence must be at the table helping to shape these initiatives. After all, it is their lived experiences that can be the true guiding lights as survivors navigate their way through dark times.

I have been front and center as a witness to the trauma and grief that impact our community. I have stood in solidarity with a mother as she said goodbye to her teenage son in the Surgical Intensive Care Unit. I have felt her palpable wails of pain. They are imprinted in my mind forever. I wonder: How will she go on? Will her other children be OK? Is it safe for her family to go home? Next comes navigating burial planning, decisions a mother should never have to make for her child. My job is to help her and her family with what’s next. Or is it? — Lisa Allee

As a social worker who has cared for trauma patients and their families for more than 23 years at Boston Medical Center,

A view of the Dorchester house where Daniel Sanders, 36, died after being shot on Oct. 22, 2022. DAVID RYAN/GLOBE STAFF

A view of the Dorchester house where Daniel Sanders, 36, died after being shot on Oct. 22, 2022. The house is dilapidated, with peeling paint, parts of the siding missing, broked rails on the porch, and crumbling brick and concrete stairs. It looks like at once point it was beautiful, with many little architectural details on the on the porch roof. A line of police tape is in the foreground of the photo. DAVID RYAN/GLOBE STAFF

I have also borne witness to the gun violence that plagues our city. I grieved with a multigenerational family who are all my patients when the father of an infant family member was shot and killed while sitting in his car. But rather than stanch the bleeding, my job in the years since the homicide has been to transition the family from acute grief counseling and services to long-term therapy, to advocate for a new place to live that did not trigger the continued grief of the loss, to ensure that the widow of the victim — already working several jobs — had the support she needed for her children, to treat the family’s ensuing years of insomnia, depression, learning challenges, and now mom’s hypertension and unexplained chronic pain. This is my job, this is my lane. Or is it? — Katherine Gergen Barnett

As a primary care doctor working on the front lines of patient care for over 17 years,

Barber Herman Maxwell Hylton was shot and killed as he was working at Celebrity Cut barbershop on Washington Street on Oct. 26, 2022. Customer and friend Ibrahim Khonteh looked at the place in the barbershop where Hylton was shot as a child’s apron covered the pool of blood. JOHN TLUMACKI/GLOBE STAFF

Barber Herman Maxwell Hylton was shot and killed as he was working at Celebrity Cut barbershop on Washington Street in October 2022. In this image, customer and friend Ibrahim Khonteh looks at the place in the barbershop where Hylton was shot as a child’s apron covers the pool of blood on the floor. JOHN TLUMACKI/GLOBE STAFF

Juanita Batchelor, founder of MORE (Mother, Overlooked, Reaching out, Empowerment), posed for a portrait at her office in Springfield on June 10, 2022. She displayed a tattoo of her son, Darrell Lee Jenkins Jr., who was killed in a drive-by shooting in 2014. CRAIG F. WALKER/GLOBE STAFF

I am all too familiar with this trauma and grief. Gazing at his lifeless body that December 1993 evening, struggling to breathe as the words “your child has been murdered” echoed somewhere in the distance, I knew my life had changed forever. Faced with no one who spoke the language that a grieving mother could understand, I went home empty, as unanswered questions came raging. What am I supposed to do? Who am I supposed to trust when my world has just been shattered into a billion shards? — Clementina Chéry

As a mother whose 15-year-old son was brought to then-Boston City Hospital’s emergency department after a stray bullet took his life,

Juanita Batchelor, founder of MORE, (Mother, Overlooked, Reaching out, Empowerment) poses for a portrait at her office in Springfield, MA on June 10, 2022. She displays a tattoo of her son, Darrell Lee Jenkins, Jr, who was killed in a drive-by shooting in 2014. The tattoo is a large portrait of a man wearing sunglasses on her upper right arm. (Craig F. Walker/Globe Staff)

Evidence tape marks where a bullet blew a photo off a wall in Dorchester on July 28, 2015, across the street from a park where Grisel Sanchez was shot to death. She was a 31-year-old mother of three. In the image, there are two remaining small wood-frames containing school and other portraits of children. One has

Evidence tape marked where a bullet blew a photo off a wall in Dorchester on July 28, 2015, across the street from a park where Grisel Sanchez was shot to death. She was a 31-year-old mother of three. JOANNE RATHE/BOSTON GLOBE

Dr. Katherine Gergen Barnett is vice chair of Primary Care Innovation and Transformation in the Department of Family Medicine at Boston Medical Center, a clinical associate professor at BU Chobanian & Avedisian School of Medicine, associate at Harvard’s Center for Primary Care, and health innovator fellow at the Aspen Institute. Dr. Tracey Dechert is chief of acute care and trauma surgery at BMC and an associate professor at BU Chobanian & Avedisian School of Medicine. Lisa Allee is director of BMC’s Community Violence Response Team and assistant professor at BU Chobanian & Avedisian School of Medicine. Clementina Chéry is president and CEO of the Louis D. Brown Peace Institute.

SOURCE: Analyze Boston *This data "contains information on shooting incidents where a victim was struck by a bullet, either fatally or non-fatally; that occurred in the City of Boston and fall under Boston Police Department jurisdiction. The dashboard does not contain records for self-inflicted gunshot wounds or shootings determined to be justifiable."

Shootings and gun fatalities* in Boston from Jan. 1, 2015 through Nov. 22, 2022

2015

Shootings

245

Fatalities

2016

226

2017

260

2018

203

2019

191

2020

274

2021

197

2022

168

through Nov. 22

Editors: Marjorie Pritchard and Amy MacKinnon Copy editor: Jessie Tremmel Design: Heather Hopp-Bruce