Frustrated with gun injuries and deaths, surgeons at a Memphis children's hospital speak out

Daniel Connolly | Memphis Commercial Appeal

Show Caption Hide Caption When children are shot A trauma surgeon takes you behind the scenes to show you what happens when a child is shot.

As gunshot wounds go, the injury didn't look that bad.

The doctor remembers how the girl was about 12 years old and was brought into the hospital still talking, always a good sign. The gunshot had left a small hole.

What the doctor didn't realize was that the girl had been blasted at close range, not by a rifle or pistol, which fires a single bullet at a time, but by a shotgun, which fires many pellets at once.

Though the entrance wound was small, surgery revealed the damage from the cluster of pellets.

"When we opened her, it was like a bomb went off inside her abdomen,” the doctor said.

The girl died. That 2013 case has stuck with the trauma specialist who treated her, Dr. Regan Williams. She said talking about it still makes her sad, even years later.

"And it’s frustrating when it happens over and over again,” she said.

Le Bonheur Children's Hospital has seen a spike in the number of children injured by guns. In 2016, 40 children were treated with gunshot injuries. In 2017, the number more than doubled, to 96.

Of those children injured, one died in 2016. The following year, nine died.

Through June of 2018, the hospital has seen 33 gunshot injuries, including two deaths - a slower pace than 2017, but still above recent averages.

Le Bonheur is the only Level 1 children's trauma center in the area and serves not just Memphis, but the entire region, including cases from Arkansas, Mississippi, west Tennessee and sometimes Missouri.

Unintentional shootings play a role, but it's not entirely clear why the number of gunshot injuries has spiked.

Le Bonheur is launching a community initiative to study the gunshot problem and reduce the damage. The program is still in its early stages, but it's similar to a community initiative that the hospital launched years ago to reduce drownings.

The solution in that case was to teach African-American kids how to swim. Solving gun violence may prove more difficult. But the people who see the damage that bullets do to small bodies are motivated to do what they can - and to speak out.

"I think the most surprising thing to me when I’m taking care of these patients is how normal they look," Dr. Williams said. "They have ponytails in. Headbands. Makeup, earrings...

"They’re kids that were doing normal things. They weren’t involved in any illegal activity. And they got shot. And some of them don’t make it out of here.”

The nearby Regional Medical Center at Memphis usually treats adults, but sometimes treats teenagers who have been shot - that hospital, too, has seen a sharp increase in gun injuries and deaths among those under 18.

In 2015, Regional One saw 36 firearm injuries among those under 18, including seven deaths. By 2017, that number had jumped to 106 injuries, including seven deaths again that year.

Gunshots aren't the most common way that children get hurt in the Memphis area - for instance, falls are much more common, said Dr. James “Trey” Eubanks III, Le Bonheur's surgeon in chief.

However, gunshots come with a higher mortality rate than other mechanisms of injury, he said. “And it’s become a bigger problem. That’s why we picked up on it.”

Six men shot

Dr. Williams is 39 years old and grew up in Clarksville, Tennessee. She wears a number of pins in the lapels of her white coat, including a shiny pin that depicts the human digestive system.

"I really love the GI tract," she says.

She jokes that she's like Pollyanna, the super-optimistic character from children's literature, and that she still plans to save the world.

She was a bright student growing up, and people said she should become a doctor or lawyer. She took a high school anatomy class and loved dissection, which pushed her toward medicine. She met her husband in medical school as they dissected the same cadaver. They married in 2004.

Her husband worked as an ear, nose and throat doctor at the Regional Medical Center, which operates the area's trauma center for adults. She recalls how he'd often get called from home to come treat people who'd been shot in the neck.

The married doctors had detailed medical discussions on how to save patients, and they talked about the big picture, too.

“We talked a lot about violence in Memphis, and what our community was like, and things we could do to change that,” Dr. Williams said.

She began visiting the adult trauma center while she was still a medical student. She recalls the night when a group of young men started carrying friends into the hospital after a shooting.

“This ended up being six wounded. And one of the patients we were caring for on the floor because we didn’t have a bed. And I remember thinking ‘Oh my God. What have I gotten myself into?'" she said.

She said she must have looked at the teaching doctor with fear in her face. "And he was like ‘We’ve got to take care of the patients.'”

She stuck with trauma medicine. She likes the diversity of cases and patients, the seriousness, the quick thinking, the teamwork, the life-saving steps, starting with checking the patient's airway, breathing and circulation.

“I early on realized that my job was to save people and heal people, and so I really try not to get personal about it, particularly while we’re doing it," she said.

Later she worked at the adult trauma hospital as a medical resident. Part of her job was telling people that someone had died.

We couldn't save your child

At first, Dr. Williams had assumed that the relatives of the badly injured patients knew about the events that had landed their loved ones in the hospital.

But soon she realized they often hadn't heard many details at all. So she learned to ask first what the people knew about the incident, then describe the injury, the medical interventions, and only then say, "We weren't able to save them."

She started training at the children's hospital in 2011, joined the staff in 2013 full time and started working as trauma medical director last year.

Gunshots and other trauma are less common among children than among adults. And children are more likely to survive physical trauma than adults, in part because they have fewer underlying health problems, Dr. Williams said.

But some children still die. And Dr. Williams has modified her death notification process for the children's hospital.

Typically, more family members come to the hospital for pediatric trauma cases than for adults. Dr. Williams looks first to identify the mother and father so she can direct all the information to them.

As with adults, she sets the stage by describing what the patient looked like when they came in. She describes every life-saving procedure the medical staff did.

Then she delivers the news.

“I usually say that we did all we could but we couldn’t save your child. Or they didn’t make it," she said.

She often has to repeat the words several times before their meaning sinks in. The parents react in horror.

"Most screaming, crying, falling on the floor,” she said. “And disbelief."

Parents usually want to see the patient to make sure it’s really their child, especially if they weren’t around when the injury happened.

“Say if I’m operating on the patient and they die, the nurses clean everything up so that it looks as nice as it can," Williams said. "And then they’ll bring the parents back into the operating room so they can see their child.”

The parents usually talk to the dead child, she said.

She said she's personally handled about four fatal gunshot cases at the children's hospital.

When the young girl was killed with the shotgun in 2013, the police wouldn't allow anyone to see the body because they didn't want people to disturb evidence.

It was the middle of the night and the family wouldn't leave.

"I had a really busy night and I kept having to go see other patients, but every time I would walk back through the waiting room the family would still be there," Dr. Williams said. "And her mom just couldn’t believe that her daughter was dead. So she kept looking at me as though I was going to come back and tell her something different.

"And I had to be like, very blunt with her, which was sad, in that there was nothing that we could do. We couldn’t bring her daughter back.”

Little time to think of the past

Post-traumatic stress disorder sometimes affects people who see violence. But Dr. Williams said she hasn't had that problem. She often has little time to dwell on sad cases because other patients need her.

That said, her work has impacted how she raises her own children, two sons ages nine and six, and a four-year-old daughter.

“I don’t let them do very much. I’ve become very risk averse," she said. Her oldest son often asks questions about her work. “Was there a dog bite? Was there a sick baby?”

She sometimes talks with him about gunshot cases.

“Sometimes yes. I want him to understand that not everyone lives their life. And also the importance of safety," she said.

Solutions

Safety - particularly urging people to lock up guns - will likely become part of the new initiative that Le Bonheur is launching.

Conflict resolution training could play a role, too, Dr. Williams said. She said her research partner Dr. Nate Manley worked with police and learned many people are shot by people they know following disputes.

The hospital is speaking with a wide range of organizations within the community, including the University of Memphis and the Memphis Police Department.

This isn't the first time the hospital has done something like this. On May 28, 2008, the city's outdoor pools opened for the first day of the season. Two boys went to local pools that day and died by drowning in separate incidents in different parts of the city: 13-year-old Cameron Hogg and 15-year-old Demavius Bailey.

It was a stark reminder of the reality that African-American children are less likely to know how to swim than white children.

A safety program affiliated with Le Bonheur, Safe Kids Mid-South, launched a training initiative called "Make A Splash Mid-South" - now "Splash Mid-South" - that offers free and low-cost swim lessons, mostly to black children. Thousands have been trained so far.

Before the program's launch in 2009, the hospital was seeing around 40 drownings or near-drownings each year, including six deaths. Since the program began, the number has dropped to around 32 drownings or near-drownings each year, with about four deaths, said Susan Helms, co-founder of Splash Mid-South.

In the meantime, Dr. Williams is dealing with a big loss. Her husband of 14 years, Dr. Glenn "Blake" Williams, died on July 5 after a long illness from a brain tumor. He was 44.

"The last year was really tough at home. But coming to work really helped," she said. She also said the experience has helped her become a more compassionate doctor.

She said the effect of the new gunshot prevention program may prove hard to measure - but she's optimistic it can help save children's lives.

"And even save our community.”

Reach reporter Daniel Connolly at 529-5296, daniel.connolly@commercialappeal.com, or on Twitter at @danielconnolly.

More

Le Bonheur is asking anyone interested in participating in the yet-to-be-named gunshot prevention program to call 901-287-6795.

The hospital is also hosting a regional seminar on pediatric trauma on September 14. It's geared toward doctors, nurses, paramedics and others in health care, and focuses on stopping bleeding. For more information call 516-8933.