Doctor Used Skills Learned in 'Killadelphia' in Iraq

Dec. 5, 2007 — -- On one Saturday night in October, the trauma center at the Hospital of the University of Pennsylvania treated three gunshot victims.It was a typical night for Ben Braslow, one of the hospital's attending trauma surgeons.

Penn has the dubious distinction of being one of the busiest trauma centers in the United States. Doctors from other countries go there to learn about treating gunshot victims.

"Very often, we have visitors and guests from all over the world coming to observe," said Braslow. "We have a unique relationship with Swedish surgical teams. We've had people from Norway, South America. They hear about how busy our trauma center is, and they come here to survey, to get some insight as to how we run things, and how to really take care of penetrating trauma."

Dr. John Pryor directs Penn's trauma program and is a major in the Army Reserves. He spent months in the hospital unit at Abu Ghraib in Iraq, and he says what he sees at Penn rivals what he saw there.

"This is really the first conflict where we have learned things on the civilian side because of all the violence in the inner cities. We've learned how to take care of these gunshot wounds, and we've applied those techniques to caring for soldiers in Afghanistan and Iraq," Pryor said.

According to Pryor, what's happening in Philadelphia is a war.

Bearing Bad News

When "Nightline" visited, Braslow was treating a patient with a gunshot wound to the chest that had "nearly transected" the patient's heart. At 1:37 a.m., with his left ventricle torn in half, the victim was declared dead. He was 23 years old.

According to Braslow, young men are typical trauma-center patients. "He's the prototypical trauma patient that we're seeing, with penetrating trauma from West Philadelphia." Then comes the hard part. "I gotta go tell his family now," Braslow said.

Notifying families of the death of their loved ones is not something new for Braslow. "Over the last few months, we're doing four of these [notifications] a week, three or four a week," he said.

And no matter how many traumas he sees, it is still emotional for Braslow, especially when the victim is so young. "Twenty-three-year-old kid. I don't know if he's a good guy, a bad guy, but it doesn't matter. He's a kid."

This kid was shot in an altercation outside a Philadelphia nightclub. As a man mopped up blood from the trauma bay, the victim's dead body lay covered in a white sheet, his belongings in a paper bag on the stretcher.

Outside the trauma bay, Braslow and a chaplain told the waiting family members that the gunshot patient didn't survive.

"Their first response is always anger, and sometimes directed at us, although I think most of the people realize that we're trying to help, but who knows what's going to happen tonight [if the brother] and his friends and the patient's friends get together and start looking for retaliation?" Braslow explained.

"The police don't always get all the information, but often, the shooters are identified, and it's just not mentioned to police, because the family and friends want to go seek their own justice, which just makes us busier and busier."

The trauma center's revolving door not only sees victims of retaliation, but also, what Braslow calls, trauma recidivism.

"There's a big problem in this country right now, at least in some of the major urban centers, with what we call trauma recidivism," Braslow said. "Trauma is — we call it an escalating disease. A victim of penetrating trauma … often it's not an isolated life event, and they return with another event, and it's usually of worse severity. If you're stabbed once, you come back shot. If you were shot in the extremity, you're shot in the chest."

For these repeat patients, it's like having nine lives.

"Some of our patients are on life eight. That's another frustrating aspect of the job. You're getting people better, to go back out to probably be involved in something again," Braslow explained. "We have names that we look on the sheet and say, 'I remember him. I took out his kidney two years ago.'"

Trauma Alumni Syndrome

On this same night that one victim was fatally shot in the heart, another patient was shot in the groin.

The patient, although otherwise healthy, had been shot once before, in the hand. The victim told Braslow that he didn't see who shot him.

According to Braslow, it's those repeat patients at the trauma center who often end as fatalities.

"We have a catchphrase here — we call them our Trauma Alumni Syndrome," he said. "Perfect example here, [he got] shot in the hand [the] first time, this time presents in the trauma bay shot in the thigh — a little bit more severe. Next time, we anticipate he'll be shot in the chest or abdomen, and the last time, shot in the head. And one of them is going to be fatal if he keeps it up."

"This is an escalating disease of intensity. And that, if you're prone to be involved in trauma, at some point, you're going to run out of luck, and something's going to be either fatal or massively morbid."

For this patient, Braslow and his team performed what they call a trajectory test. "We put a sterile probe in each wound, just to see what angle the wound takes through the tissue, and when we put them in, they both sort of point to each other, so we know the bullet track is in between the two … where there's no significant major blood vessel, no muscle. And again, a lucky penetrating trauma victim."

Because there is not enough room for him in the hospital, this shooting victim will likely go home that same night. Braslow says his experiences in the Penn trauma center have made him political.

"I was a political science major in college, and that was the last time I thought about it, but you listen to policies of people who are trying to run for city politics, and see what plans or good ideas they may have to help curb this violence," he said.

But Braslow admits that he hasn't "heard anything that sounds like it's imminently going to work. We patch them up and send them back out, and hope that families and people who love these patients will help to protect them and keep them out of trouble. But there's almost an infinite supply of people."

An infinite supply of people and no easy solutions.