Dispatches from a Black trauma surgeon

Within these four walls I have wrecked the lives of far too many Black mothers.

The family room is a windowless, white-walled cell in the hospital, with hazy fluorescent lighting, hard-bottomed plastic chairs, and a worn end table with a box of tissues. Four of us have filed into this cramped space, tucked away from the emergency department’s main hallway, twisting our torsos to let the door exhale shut behind us. A public safety officer stands sentry in one corner. He is Black. Beside me, in an opposing corner, is the chaplain. She is Black. Sitting beside the two family members is the violence recovery specialist. She is Black. I am also Black: too Black for some, not Black enough for others. But still Black enough for this story to be meaningless were I anything but.

Seated across the family room, two women stare at me, their fingers intertwined in a knuckle-whitening grip. In the silence, my pristine, knee-length white coat speaks with authority before any words come out of my mouth. Louder than the phlegmatic wheeze of the older woman I feel surveilling me. Louder than the sniffling of the younger woman in her grasp. Louder than the soft scrape of metal legs on tear-stained tile as I position my chair across from them. I sweep the backside of my coat to prevent it from wrinkling as I sit to be at eye level with the two women.

“Delivering devastating news is part of my job, and a light dims within me every time I speak the words.”

Delivering devastating news is part of my job, and a light dims within me every time I speak the words. Shifting in my seat, I try to let my face reveal nothing, which, of course, reveals everything.

“I’m Dr. Brian Williams,” I say with somber formality. “I’m the trauma surgeon working tonight.” Showing deference to the elder of the two women, I confirm her relation to my patient. Yes, she is indeed the mother.

“I’ll walk you through what happened with Malik after he arrived at the hospital,” I continue. “You can stop me at any time if you have any questions.” I always use the first names of their injured loved ones, the wounded and dead who cannot speak for themselves.

Speaking in a measured monotone, I don’t use confusing medical terms, and I enunciate each word for clarity. There must be no misunderstanding of what I have to say.

“Malik sustained several gunshot wounds and arrived in critical condition,” I tell them. “The paramedics were already doing CPR in the ambulance when they brought him to us. When he arrived, his heart was not beating, and he wasn’t breathing.”

At this point, I’m never sure which is less traumatic: to fast-forward to what they already know, or to take my time, to allow them to brace for the emotional tsunami barreling toward them. I usually choose the latter, and having prepared her the best I can, I say the words no parent should ever have to hear. “I’m sorry. We did everything we could, but despite our best efforts, your son Malik died from his injuries.”

I always say it like this — “He died,” “She died” — with no Hollywood drama. Direct. Succinct. Clear. No euphemisms like “He passed,” or “She didn’t make it,” or “He transitioned.”

I’m sorry. He died from his injuries: it’s a phrase I have said hundreds of times, and it sounds hollower each time I say it. I’ve had to ensure the scores of family members I met before this woman — and those yet to come — understand they will never see their loved one alive again. I want to avoid adding trauma on top of trauma, and I strive to do it right every time.

The mother ratchets open her fingers, freeing her daughter’s hand. Her head drops into her ashen palms, which smother her face now slick with tears. Shaking her head and rocking back and forth, she leans into her daughter, who rubs her back with soothing maternal strokes. “No, no, no, no, no,” she moans without end.

She shakes. She rocks. Faster. Harder. With increasing ferocity until she plunges to the floor, landing in a heap and dragging her daughter with her. “He gone! He gone! He gone! I can’t believe he fucking gone!”

“There are invisible chains binding mothers of dead children, ones only they know and bear.”

She slaps the floor and kicks at some unseen assailant. There are invisible chains binding mothers of dead children, ones only they know and bear. A rusted weight grinding flesh and bone unlike any pain I have experienced.

Watching her flail, I do not flinch. I must remain composed. Nothing she does will surprise me because I have been here before, performed this scene and delivered this line numerous times, each time with a different mother in the lead role. Like most, this mother is devastated beyond our ability to provide solace. She wails and flails, her screams and limbs shredding the air, adding her tears to the community of past tears on the tiled floor. She reaches skyward, like an inconsolable infant reaching for her own mother, except she is now the mother, one who has outlived the infant she nurtured into a teenage boy.

I rise from my chair to give her more space, reflexively smooth my white coat, and bow my head to avoid intruding on her grief. I stand silent. Stoic. Statuesque. What more can I do? The public safety officer also stands silent. Stoic. Statuesque. He is present to serve and to protect. The chaplain and violence recovery specialist also remain silent. In some small way, we four strangers must provide some measure of consolation during her moment of grief. Right now, that looks like waiting, and we do not interrupt.

Outside the emergency department, friends and family gather by the dozens. Flashing black-and-white cruisers encircle the area, and even more police officers secure the perimeter. The potential for retaliatory violence outside the entrance to our emergency department is real.

When I’m done speaking with the mother and daughter, I will play my small role to defuse tensions by joining the violence recovery specialist and another doctor — he’s from the South Side and a hero to many gathered here — to speak to the crowd, one of whom will be shot dead weeks after Malik. Unlike Malik, he is a rising hip-hop artist whose death will become headline news. Apparently, news of the shooting circulated at viral speed before I even pronounced Malik’s official time of death, discarded my bloodied scrubs, and wiped his blood from my clogs.

I change into clean scrubs as soon as possible after a trauma. What message would I send to continue working in such a bloodied state — walking the hospital halls, seeing patients, speaking to families? Scrubs might seem a small worry on a life-and-death night in the ED, but as a Black doctor, I can’t afford any imperfection in appearance, skill or temperament. Perceptions become reality and, just as I repair a stab wound to the heart, I have no margin for error.

Black men in medicine represent less than 3% of doctors, and I know future Black men attempting to cross the threshold into the profession are depending on Black doctors like me. Patients have told me to get their “real” doctor, leave the room, remove their tray of half-eaten food, or empty the trash bin. Some have ignored me and others have spat at me. Some have prayed for me and others have wished me dead.

“No matter our social status, from gang members to doctors, Black men still serve as a mirror for people’s fears.”

I have been called a racist and a healer, a nigger and a sellout, a hypocrite and a hero. No matter our social status, from gang members to doctors, Black men still serve as a mirror for people’s fears. A screen on which to project one’s anxiety — and disgust. An endangered species navigating a world both hostile to and dependent upon our existence.

The mother of my patient lives in a neighborhood within walking distance from one of the premier medical centers in the nation, and yet she is trapped in a web of disenfranchisement and death. Despite our hospital’s noble mission, our neighbors’ proximity to first-class health care does not guarantee access to routine, preventative care. And without access, health equity is nothing more than an empty slogan devoid of any tangible transformation for suffering communities.

Shot in the head, chest and arms, Malik arrived at the hospital with his left upper arm bent at a nauseating angle from a bullet-induced fracture, a bloodied T-shirt with multiple bullet holes, and brain matter creeping over skull fragments dangling from his sticky, short-cut afro.

Despite the fact that he was dead on arrival, our team attempted to revive him. Fewer than 10% of victims with gunshot wounds to the head survive, and, if they do, they usually live in a persistent vegetative state, requiring around-the-clock medical care that may be inaccessible to families without health insurance who survive on low-wage salaries.

Conventional wisdom in trauma surgery is that gun violence is worse from Memorial Day to Labor Day. In the gallows humor that bonds trauma surgeons, “Shooters polish their guns for the summer, and lock ‘em up for the winter.” It is a trope I’ve heard countless times, one I’ve often repeated. But with more than two decades in medicine, I’ve learned the lethality of bullets is not seasonal.

“For me, working to end the epidemic of gun violence is more than an academic pursuit or my vocation.”

Black people are gunned down year-round. In treating these patients, I see myself. In comforting their families, I see mine. A few years from now, my cousin will be shot and killed in front of her three young children. For me, working to end the epidemic of gun violence is more than an academic pursuit or my vocation. It is personal.

“Doctor, please take me to see my boy.” The mother is grasping fistfuls of my white coat. On her knees, she pleads with me, then the heavens, back to me, back to the heavens. She releases her grip, leaving wrinkled, dusty handprints. “I lost my oldest last year; now this. Lord, why you do this to me?” It is less a question and more a tortured reproach.

I want to take her to see her son, but I can’t. His body is a crime scene, evidence to be preserved for his post-mortem examination, the autopsy. The chaplain eases beside me. “Thank you, Dr. Williams. I’ll take it from here.”

Her timing is perfect, for there is nothing more I can do. My expertise is medical, not spiritual. “Again, I’m so sorry for your loss,” I say. “Here’s my card. I’m here all night if you think of any questions.”

Few mothers ever call me. Like I do on every trauma shift, I move on. The trauma team moves on. The hospital moves on. I must be ready for another victim, arriving by lights and sirens. I file away this mother’s son’s death in the emotional lockbox straining to contain the feelings of injustice for the countless others like him.

In these moments I reckon with the role I play as a Black doctor in a society that devalues Black lives. I wrestle with the futile feeling that the nobility of my work does not have a sustainable impact. The essence of my job is plugging bullet holes in young Black men and women, at least the ones I can save — and then sending them back to an environment where they remain at high risk of reinjury and death.

“What is it about these neighborhoods where I have worked that endemic violence persists in tandem with health inequity?”

What is it about these neighborhoods where I have worked that endemic violence persists in tandem with health inequity? What does it say about our nation’s values that we allow it to persist?

Looking at Malik’s sister now, I can’t help but think the histories and policies designed to quarantine Black people from mainstream American society have somehow managed to reach across generations and help kill her brother.

Nationwide, young Black men aged 15 to 34 represent 2% of the population but 37% of gun homicides. Some people call my patients victims of “Black-on-Black” violence, but I remind them: Interpersonal violence is a byproduct of proximity and we live in a mostly segregated country. Since we have sorted ourselves into homogenous racial and ethnic neighborhoods, a result is that “white-on-white violence” occurs at the same rate, according to the U.S. Department of Justice.

I also remind them Black men are fatally shot by police at more than twice the rate of white people, even though white men are more likely to be armed in the same scenario. And each year, more people are shot and killed by police than in all the mass shootings combined. The extremes to which America contorts its values to minimize all these deaths are untenable.

Malik, like hundreds of others, is merely another statistic for our hospital death registry. The national news will not cover his death. The local news might. If the mother does call me with questions, the most truthful answer I can give — the one internalized yet never verbalized during my 20-plus years in medicine — would be: “Ma’am, your child is nothing more than another Black body that came to be tagged and bagged. Nobody gives a damn.”

I write, speak, volunteer and even ran for a seat in Congress, so lives like Malik’s are not ignored. I write and act to show you the world of a Black trauma surgeon, in a profession lacking role models, who routinely deals with the human toll from the epidemic of gun violence. I write and act to remind us all that if Black lives actually mattered to policymakers in the United States, they would take action that mattered.

Brian Williams is an Air Force Academy graduate, a Harvard-trained surgeon, a former congressional health policy advisor, and a nationally recognized leader at the intersection of public policy and structural racism, gun violence and health equity. He has treated gun violence victims for more than two decades. Williams has served as a Robert Wood Johnson Foundation Health Policy Fellow at the National Academy of Medicine and as a professor of trauma and acute care surgery at the University of Chicago Medicine. Williams and his work have been featured in outlets like the Chicago Tribune, Dallas Morning News, CNN, and Newsweek. This column is an adapted excerpt from chapter one of his new book, The Bodies Keep Coming and is reprinted with permission. Copyright © 2023 Broadleaf Books. 

 

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