Children's Hospitals Today - Spring 2023 - 8

ROUNDS / FIRST PERSON
Come back stronger
After a traumatic experience as a surgeon, I started a person-centered
program for victims of violence.
BY EDWARD M. BARKSDALE JR.
T
he worst week of my professional
life occurred in October 2015 a few
years after I had moved to Cleveland as
an academic surgeon. I was in charge
of caring for four children under the
age of 10 who had been shot, and a new
victim arrived in critical condition. The
6-month-old infant had caught a stray
bullet waiting in the car as her mother
was buying candles for her father's
birthday. I'll never forget holding the
girl's heart in my hand after unsuccessfully
trying to revive her and later being
present when we shared the grim news
with her family.
This began a journey for me at UH
Rainbow Babies & Children's Hospital
to address the problem of violence from
a new vantage. In Cleveland, our child
gun violence rate during and since the
pandemic has gone up more than 47%.
More people between the age of 2 and
18 died from gun violence than from all
the other causes of pediatric death put
together in our city. And these numbers
continue to escalate.
Our children and families not only
suffer at the time of a violent injury
but also face a greater risk of reinjury,
mental health comorbidities, and
chronic health conditions. When we
looked at our own hospital experience,
we found that patients who were victims
of violence had a 30% reinjury rate.
What could we do to interrupt this
deadly cycle? I desired to go deep and to
understand the roots of violence. When
I looked further into our hospital data,
I discovered that 30% of victims would
return with a major depressive condition
or self-injury attempt. And broader
data showed that victims of violence
have a significantly higher number of
adverse childhood experiences. On top
of that, I already knew that Cleveland
high school students had the highest
child suicide rate in the country. This
all helped me understand that violence
had a tremendous effect on victims
not only physically, but mentally and
spiritually-it affected the whole
person and was part of the cycle.
So, I wanted to move beyond the
downstream efforts of simply treating
victims and releasing them. As a
child, I was fascinated by a Japanese
art form called kintsugi. After a clay
pot is inadvertently broken and is of
minimal apparent value, an artisan can
mend it together with gold epoxy. Then
this broken but repaired vessel becomes
more valuable than it was in its
native state. To me, that
applies
to the human
condition. Like kintsugi,
I wanted to make patients
stronger-in fact, " stronger
in the broken places, " creating
post-traumatic growth and
new meaning for their lives.
That's what our hospital-based violence
intervention program-which
is based on programs from Children's
Wisconsin and Children's Hospital of
Philadelphia-aims to do. Knowing that
violence affects the whole person, we use
a holistic, person-centered approach. We
start by getting to know the patient better
in their environment, meeting them in
their homes within 48 hours of discharge.
Then, working with community, civic and
philanthropic partners,
we help meet
basic needs like
food, clothing and
housing security.
We connect them to
Learn the details
of an HVIP at
childrenshospitals
.org/hvip
other services like mental health therapy,
academic support, and vocational services.
It is a one-year program, and our
average participants retain for seven
months. Only two of 56 patients have
been retraumatized.
The final piece we want to create is
a trauma-informed hospital environment,
not only for patients but for care
providers who, like me, experienced a
moral injury caring for victims of violence.
We want providers to understand
they like our patients have trauma. We
endeavor to create a healing environment
for everyone.
Edward M. Barksdale Jr. M.D.,
FAAP, FACS is surgeon-in-chief
at UH Rainbow Babies & Children's
Hospital in Cleveland.
Tell us your story. Email
magazine@childrenshospitals.org.
8
CHILDREN'S HOSPITALS TODAY Spring 2023
Children's Hospitals Today - Spring 2023

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