Recognition: A trauma of treating victims of violence

A white physician remarked sorrowfully as the Emergency Room (ER) and trauma teams finished tending to the multiple gunshot wounds of a young white man. In his voice was a mix of helplessness, distress, and surprise, as it is not the norm that gunshot victims at my hospital are white.

But for the Black doctors, nurses, techs, registrars, clerks, and environmental service workers in the ER, seeing dead and wounded Black patients has become our norm.

We see our sons, brothers, fathers, uncles, and cousins in the victims of gun violence who come in daily, sometimes multiple times a day. We hold our breaths as we pull bloody, lifeless bodies from police cars and place them on gurneys, hoping not to recognize the victim’s face. But sometimes we do. Many of the Black ER staff have experienced the trauma of seeing and even caring for their wounded loved ones while working. For one of my colleagues, this has happened twice. In one incident, he recounts working diligently as part of the trauma team to save the life of his childhood friend who had been shot. Unfortunately, his friend died in the ER. In the Black community in West Philadelphia, a large proportion of people have been indirectly or directly been victims of gun violence. As Black ER staff members, we literally see ourselves in the victims. We are witnessing the crippling of our communities firsthand.

In addition to seeing victims of gun violence who are members of my racial community, I also experience the added mental strain from caring for victims from my physical community. Last year, my now-husband bought a house in the Cobbs Creek area of West Philadelphia. His plan was to invest in a Black neighborhood and he was charmed by the sense of community he found there. I moved in shortly after and the privilege we had to choose to live in this community is not lost on me.

I’ll never forget receiving an alert on the citizen app about a “shooting in the Cobbs Creek area” on my first full night living in my neighborhood. I headed to work subsequently, pulling up just behind the police car dropping off the young Black man who had been shot blocks from my new home. I parked, dropped my bags, and quickly ran to the trauma bay to join the team in tending to his injuries.

Since then, I’ve walked a few short blocks from my house to memorial rallies of my slain patients. I am not alone in this experience of living in the same community as the gunshot victims who I treat.

For a lot of the Black staff in the ER, gun violence is not a disposable gown they can take off and discard once they leave the threshold of the hospital grounds. It is not something they can clock out of once their shift is over. It is inescapable and ubiquitous, permeating both work and home life, often leading to feelings of helplessness and detachment.

I asked several Black ER colleagues about their feelings surrounding gun violence and heard an answer come up repeatedly: Numbness. The feelings of sadness, anger, frustration that we once felt at the beginning of our tenure in the ER have quickly been replaced with an almost robotic emotionlessness. One of my coworkers told me about her surprise at feeling “almost no emotion” when one of her sons was shot in his senior year of high school. Another coworker expressed her inability to cry and emote in response to major emotional life events, which she attributed to the exposure to constant trauma at work.

Many studies have highlighted the impact of violence exposure on mental health. Significant increases in anxiety, depression, aggression and even suicide have been observed in adolescents and adults as a result of vicarious trauma. The disproportionately high exposure to gun violence fatalities experienced by racial minorities leads to a higher prevalence of mental health issues in Black/Latinx communities. However there is little to no evidence illustrating this impact in the workplace.

As gun violence has surged over the past year, we have seen an increase in violence affecting women and children. Unfortunately, the sight of wounded and dead Black men has become commonplace in our workday. However, this new victim demographic has seemingly dislodged this emotional callous that had formed from years of witnessing gruesome trauma. Seeing people who look like our wives, mothers, sisters and even babies on a trauma gurney reminds us that even the most vulnerable in our communities are endangered.

The flash of recognition that prompts a white colleague to say, “that could have been my son,” is a human reaction – but for us Black physicians and staff members standing at their side, it is too familiar to be shocking anymore. Comments like this show a lack of empathy and connection to Black victims, and they show that our non-Black coworkers cannot truly understand how deeply gun violence cuts us, too. There is a deep, complex emotional toll from constantly seeing Black wounded and dead bodies and hearing the desperate cries of their families. As we work to address the crisis of violence in our communities, this is another trauma that we must recognize and heal.

About Chidinma Nwakanma, MD

Chidinma Nwakanma, MD, is an assistant professor of Emergency Medicine at the Perelman School of Medicine; physician lead in the PPMC Emergency Department for inclusion, diversity, equity & antiracism; and director of the underrepresented minority visiting clerkship program. With colleagues Elinore Kaufman, MD, and Zaffer Qasim, MBBS, she is engaged in planning for community- and hospital-based violence-prevention and intervention initiatives.