Each year, like in most big cities, hundreds of people in Boston are shot or stabbed. Survivors often return to the neighborhoods where the violence happened. And sometimes they end up victims again.
So some local hospitals, including Brigham and Women's, are now treating urban violence like a disease. Rather than just patching up victims and sending them home, they're treating gunshots and knife wounds as symptoms of a larger illness that can be managed — and maybe even cured — with the right treatment.
At the Brigham, a central figure in this new approach is a man who's weary of attending funerals for people who died violently and much too young.
'Put The Trauma Love Down On Them'
Just about everywhere he goes in inner-city Boston, David Crump can point out where someone was shot or knifed. On the Roxbury street he's driving by now, a young employee at his own hospital was fatally stabbed last summer.
"I always say all these kids are good kids, you know? God don't create ugly, you know what I mean?" Crump says. "But he was truly one of those young men that — I don't think he had ever been in a fight before, you know what I mean?"
Crump is a former Boston street worker who now works for the Brigham's Violence Intervention and Prevention Program. It started about a year-and-a-half ago and has since helped more than 100 victims of street violence. As soon as possible after they arrive at the hospital, Crump tries to offer them and their families whatever assistance they need.
He describes his work with families this way: "Put the trauma love down on them, you know? I call it the trauma love."
One young Boston man who benefited from that now gets regular visits from Crump. Rashad, 24, doesn't want to use his full name because he's afraid for his safety. He remembers clearly when he met Crump. It was when he woke up in the hospital in late 2011.
"Like he was telling me, like basically, 'I know how it is. I'm not here to seek information. I'm just here to help you, man, I want to help you,' " Rashad recalls.
Rashad needed a huge amount of help at the time. He'd been shot twice just months apart. The first time, he was hit once. This time it was worse.
"I was getting out of my car, getting my son, taking my son out of the car," Rashad says. "Then I got shot, like, multiple times."
Fourteen times. He was in the hospital for more than a week. When he came to, Crump introduced himself and helped Rashad and his family get their lives back in order.
"To his credit, when he woke up he allowed me in his life, as in any young man that I work with, or woman that I work with," Crump says. "They've got to allow me in their life, you know? He did."
Crump took walks with Rashad at the hospital, got his car out of an impound lot, helped him deal with health insurance complications, and took him to physical therapy appointments.
Crump tries to change whatever it is in the lives of stabbing and shooting victims that may have contributed to that violence. Just as a diabetic may need insulin, maybe someone shot or stabbed needs a safer apartment or a job. Crump helped Rashad with both of those, and although Rashad didn't want professional therapy, Crump became his informal counselor.
"I felt the love from him, like he cared," Rashad says. "Cause, some people — you know, some people have jobs. Their job is to help you. That's one thing. And then some people go beyond their way just to help you. And that's love. So he showed me love. So I show it back to him in return because it's only right."
'Human Things' In The Trauma Unit
When Crump isn't with former hospital patients, he's a frequent presence at the Brigham's emergency room and its trauma and surgery unit.
"You notice it's a locked facility. We won't have their names on the board to preserve their identity," Crump explains about the trauma floor.
He remembers one chaotic day when the trauma team was busy stabilizing a shooting victim. One of the patient's family members was sitting in a hospital room with blood all over her shirt.
"So here comes in Dave, like, 'Hey, let's all kind of look at everything around, you know? Let's get the blood off the lady. Let's make sure she's got some food. She has children with her. You know, what is your plan in taking care of your child for the night? What does it look like for daycare tomorrow?' " Crump recounts. "Just all these human things that continue to go on that, typically, I don't think that hospitals really thought about."
Of the 115 patients who have agreed to work with Crump, only three have returned to the hospital with violence-related injuries.
"Before David, we really were almost flying blind, if you will," says Cheryl Ventola, who has been a nurse at the Brigham for 30 years. Before Crump came onboard, she says, the medical staff knew very little about the street violence patients they treated or how to help them, beyond stitching up their wounds.
"It was a lack of information," Ventola explains. "You were in a void. So you just didn't feel like you were doing the best that you could for this person when they leave the hospital."
And Ventola says that, thanks to Crump's extensive connections in Boston's inner-city neighborhoods, she and her coworkers are no longer as nervous with street violence patients and their visitors.
"The fear is retaliation for the patient. It's mainly all about keeping the patient safe, but we need to keep the staff safe," she says.
Asked if the fear was that the retaliation could play out in the trauma ward, Ventola responds: "It could. It could. We had one particular time where David was helpful where there were two shootings, and, because he had those resources externally, could provide us with information. And the information was, 'Let's keep them on separate floors because if the two groups of visitors come, they might get into it.' "
Treating The Entire Cycle Of Violence
Crump also helps doctors and nurses understand why some young people get caught up in guns.
"It could be that 21-year-old guy that has lived a great life and is a good kid, but he just lost his best friend, got his brains blown out — on him. Now he feels like, 'Am I a target? Do I need to protect myself?' ” Crump says.
Before the Brigham's Violence Intervention and Prevention Program started, nurses and doctors too often found themselves treating patients for repeat shootings and stabbings. Sometimes they realized during surgery that they had seen the patient before.
"It's too bad knowing that they're in the same situation, that we were unable to impact and prevent this occurring years later," says Dr. Jonathan Gates, director of the Brigham's trauma center. "I think there was a sense of helplessness, knowing full well that if we could remove the individual from the situation that created this event, that perhaps they'd be protected from future events like that."
The nursing director of the Brigham's trauma program, Matt Quin, says medical personnel can't always do for victims of violence what Crump can.
"We see patients in small segments, right? Couple days, three days," Quin explains. "That's not a tremendous amount of time to build up trust. And in some of those cases, David's able to come in and sort of help bridge that gap.”
According to Quin, Crump has shown the hospital's staff how to treat the entire cycle of violence.
"Just like with any disease, as a hospital we want to make sure that patients go home prepared to be successful at home, whether it's heart disease, lung disease, or they're a victim of violence," Quin says. "Having David sort of follow people into the community means that they have a better chance of being successful upon discharge."
That's certainly been the case for Rashad, the young man ambushed as he was getting out of his car.
"People get shot one time and they don't make it. I got shot multiple times. So it just makes you appreciate, value more about life, like what's really important in life," he reflects.
"He's committed to living life his way. And that way is good," Crump says of Rashad. "He's a good father. I admire him for that. He's a good spouse to his loved one. Treats her with respect. I mean, he's a model man, you know? That's not an easy task coming from death's door. I'm just thankful that he allowed me in his life. He knew where he wanted to go. So all I had to do was be there."
The Brigham says it's hard to measure the success rate of the Violence Intervention and Prevention Program. Not all victims of violence want help; out of the 163 patients referred to Crump since the program started, 115 have agreed to work with him. Of those, only three have returned to the hospital with violence-related injuries.
This program aired on April 11, 2013.