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  Shock Treatment

Trauma surgeon Eddie Cornwell wants to stem the carnage of urban teen violence.
His Rx: a strong dose of reality.

By Jim Duffy
Photos by Keith Weller

Edward Cornwell works on the now-or-never, life-and-death edge of medicine. He first embraced this work two decades ago, during a residency in trauma surgery at Los Angeles County Hospital/University of Southern California Medical Center, and he pursues it today as trauma chief at the Johns Hopkins Hospital.

"I can't begin to tell you how exciting this stuff can be," Cornwell says. "You don't spend your days going, 'Now Miss Jackson, I told you 25 milligrams, not 50, so you go home and take the right dose and then come back in two weeks, and we'll recheck your blood pressure.'"

Instead, Cornwell practices in emergency rooms where too many gunshot victims roll in atop too many gurneys in the middle of shifts already stretched to the breaking point. The trauma surgeon might be the last hope these patients have, especially if they've taken a shot to the heart. Even that hope can be slim: Nine times out of 10, those gurneys might as well roll right to the medical examiner's office. Too much time has passed, and too much blood is gone by the time they reach the hospital.

But every now and again, a gurney rolls in that makes up for all the lost causes.

"The thing we're looking for when we slash the chest open is a bullet injury to the heart where the bleeding has been only in a modest amount, but it's accumulating inside" the heart, Cornwell explains. "Then he's in cardiac arrest not because he's bled out, like most gunshot victims, but because the motor can't pump anymore."

If you're the surgeon at such a moment, what you do is simple yet sublime. You slash a hole in the human heart. You watch while the stopped-up blood spills out. Then you stick your finger over that slash like it's the proverbial hole in a dike, and you race to an operating room where you sew up the heart you just slashed, only by now it's thumping stronger and steadier with each stitch.

This work can strike awe in a surgeon.

"Before each day I was on call during my residency, I would stop and pray that I would be able to handle whatever was about to come into that trauma center," Cornwell says. "This is stuff that gives you a spiritual jolt."

In that jolt, Cornwell found his calling. With that calling came the beginnings of a new quest, one that would lead him back out of the trauma center, into violence-stricken streets and communities, and then out into a much wider world of politics and public policy and the media.

Here, too, the surgeon is after something simple yet sublime. He wants to make all those gurneys with those gunshot victims go away. He wants to stem the tide of youth violence.

Nobody ever accused Eddie Cornwell of thinking small. Nobody ever expected him to make a music video, either, but this quest has taken him in some unexpected directions.

One night in East Baltimore, a brave cab driver threw a 15-year-old gunshot victim into his car and got him to the Hopkins emergency room minutes later. That boy would have bled out waiting for an ambulance. He might have died anyway, if not for an extraordinary series of surgeries that enabled him to beat the odds and walk out of the hospital several months later on his own two feet.

"We call him our miracle save," Cornwell says.

"I'm still waiting for someone to say, 'You know what? My kid is a bad kid. He's the leader of the wrong crowd.'" Patient in, patient healed, patient out. This is how medicine is supposed to work, right?

"That boy's mother called me last July to tell me he'd been shot in the head while sitting in a car," Cornwell says.

No, this is not how medicine is supposed to work.

Cornwell, 49, has spent his entire career working in violence-plagued neighborhoods. After his residency at USC, he spent two years at the University of Maryland's Shock Trauma Center in Baltimore and then three in Washington, D.C., at the Howard University Hospital, the place where he was born. He returned to USC and Los Angeles County Hospital in 1993, then came to Hopkins five years later.

That "miracle save" of his Hopkins tenure was no isolated tragedy in the world of trauma practice. In Baltimore, an estimated 40 percent of patients who survive one gunshot wound eventually return to a hospital with another. With colleague David Chang, a graduate fellow in health policy at the Hopkins Bloomberg School of Public Health, Cornwell has waded through data to gauge the ultimate medical outcomes of patients who suffer multiple "penetrating injuries."

"If you come in and then get released two times, you have a higher chance of dying than if you come in once," Chang says. "If you come back three times and go back out, you have a much, much higher chance of dying."

The results came as no surprise to Cornwell; over the years he's seen more than his share of anecdotal evidence along those lines.

"I had this kid in Los Angeles who was shot twice," he begins. Then he stops and blinks, while a grim smile crosses his face. "I don't mean he was shot as in bang-bang. I mean he was shot, and I operated on him, and I'm looking at his chart, and I see that he'd been shot before."

A trauma surgeon's first job is to treat the injury at hand. Usually, Cornwell limits his conversations with patients to immediate medical matters for a day or two. Only then does he seek an opening to look a victim in the eye and try to reach deeper. This particular patient served up an explanation of events that Cornwell found unforgettable.

"I went to get my gun," the patient began, "and then he saw me getting my gun and . . ."

Cornwell shakes his head, slaps a palm to his forehead, looking skyward.

"He was saying this without any sense of irony. He was actually trying to explain to me that it wasn't his fault because all he was doing was going to get his gun. That boy is dead today. I don't know that for a fact, but I'd bet on it."

Cornwell began his career in the teeth of a national epidemic of youth violence. By the mid-1990s, the trauma center at Los Angeles County was seeing a mind-boggling 1,200 gunshot wounds a year. Violent crime rates have come down since then in most big cities, but they remain as high as ever within the demographic group of young men between 15 and 19.

Baltimore, too, has seen a dip in violent crime, but its murder rate remains stubbornly high. Johns Hopkins Hospital, which stands amid some of the city's most violence-plagued neighborhoods, now treats more than 300 gunshot victims a year. These patients are not the only victims — a fact Cornwell confronts every time he walks out of an operating room and into a waiting room.

"After 15 years in urban trauma centers, I've got my speech down," he says. "I tell the family he's lucky to be alive. I tell them he's got these bad injuries, he's got a long way to go, but he can make it."

Almost invariably, in Cornwell's experience, these encounters are marked by two constants. First, there will be no father present in the waiting room, only a mother or perhaps a grandmother or an aunt. Second, family members are sure to serve up one version or another of the same explanation for the tragic turn of events.

"They all say, 'He was a good kid, but he just fell in with the wrong crowd,'" Cornwell says. "I've heard this enough by now that I'm pretty sure there actually is a wrong crowd out there. But I'm still waiting for someone to say, 'You know what? My kid is a bad kid. He's the leader of the wrong crowd.'"

Cornwell has spent his entire career at urban trauma centers like Hopkins, where 40 percent of gunshot patients will be return visitors.

Cornwell sympathizes with the psychological dynamics at work in these situations, of course, but there are moments when his patience runs thin. He recalls one mother struggling with the question of what to do about her son's wayward ways.

She said, "He's got a problem, and we know that. He's got gang members coming to the house, and he's skipping school. We're thinking about sending him to a military academy in Georgia, but my husband found out that they do drug testing there and they have metal detectors. He thinks maybe it's a place that's really just for bad kids."

Cornwell shot back, "I'm sorry, I know this is going to sound harsh. But the son-of-a-bitch is a bad kid."

He lets a long sigh escape, then finishes this anecdote on a note mingled with equal parts regret and defiance: "I said that because I was tired right at that moment, and I said it for the shock effect — it needed to be said."

From the earliest days of his career, Cornwell has been deeply involved in community-based, violence-prevention efforts. This is a frequent undertaking for physicians in his field. In fact, the American College of Surgeons requires trauma centers to run extensive prevention initiatives in order to achieve and maintain elite Level I status.

"In most fields of medicine, you tend to sit back and wait for patients to come to you," Chang points out. "Trauma as a field is more cognizant of these prevention issues than probably any other field in medicine at this point." Chang surmises that this is in part a result of the grisly reality of trauma work, with its high number of patients who are lost causes by the time they arrive in an emergency room.

"No new medicine or advance in surgical technique will ever save a patient with a direct gunshot wound to the head," he says. "If you want to do something for that patient, prevention is the only avenue open to you."

The chance to advance that work was critical in Cornwell's decision to come to Baltimore in 1998. When John Cameron, then the chief of surgery at Hopkins, began recruiting him, Cornwell had reservations. It would mean leaving a nice promotion on the table at USC. It would mean leaving one of the nation's elite trauma centers for one just making the jump to Level I.

"I had so much respect for Dr. Cameron and his integrity," Cornwell says. "So I just told him all this, and I asked him to take off his recruiting hat and put on his mentoring hat and then tell me why I should do this."

Cameron suggested Cornwell focus his sights on his potential to make a broader impact. "Rightly or wrongly," Cameron told him, "the spotlight shines brighter at Hopkins."

His words proved prophetic. In 2000, ABC-TV News cameras at work on the six-part documentary Hopkins 24/7 followed Cornwell through surgeries and recorded his outreach efforts with the youth of East Baltimore. In one especially moving scene, he brought a group of youngsters in to visit with a patient and see firsthand the damage that gun violence can inflict.

The television series brought new and sustained attention to Cornwell's work. Policymakers, politicians, and journalists began calling him for insight and advice. Invitations arrived for speaking engagements around the country. Cornwell even landed in the pages of People magazine and in front of cameras on the Oprah Winfrey Show.

Cornwell lives in suburban Ellicott City with his wife, Maggie Covington Cornwell, and their 8-year-old son, Mike. At home, if the television isn't tuned to a basketball or football game, it's tuned to C-SPAN. A self-described "political junkie," Cornwell has always followed closely the dialogue that unfolds around violence issues on the national media stage, where he suddenly found himself after Hopkins 24/7.

This was a dialogue he held in disdain. His opinion of it had changed little since the morning in 1994 when he stepped onto a treadmill for a morning run while watching two Florida gubernatorial candidates debate crime and violence. First, the challenger accused the incumbent of being soft on crime, arguing that Florida had executed only seven people in the previous four years. Then the incumbent replied by accusing the challenger of distorting his record; actually, he insisted, there had been 11 executions on his watch.

"What they said was just so silly and so unimportant," Cornwell says. "That debate has really stayed with me over the years. It led me to see that the way we address violence in this political context is a big part of the problem."

What would a clear-eyed public discussion about youth violence look like? That would be a far-reaching affair, touching on everything from race relations to the war on drugs to family structures to gun control to health care disparities to education to the criminal justice system and beyond.

"You'd be hard-pressed to find a topic with more buzzwords attached to it that politicians find frightening than youth violence," Cornwell says. In this minefield of complexity and controversy, political leaders too often sink to the simplistic level of those Florida candidates.

"If someone starts attacking my blackness like they did to Bill Cosby when he spoke up, that's fine with me. I don't care." "This issue is so complex that it has a way of making us retreat to our own comfort zones," Cornwell says. "And then all we really have to say are things like, 'You're soft on crime' or 'you're a racist' or 'you're too liberal' or 'you're too conservative.' I'm just tired of all of that stuff."

So Cornwell is unafraid to share stages with Democrats or Republicans, liberals or conservatives. The discussion he wants to spark is one that confronts the failings of both sides of these political divides. He frequently challenges the left about the need to focus seriously on issues like absentee fathers and the collapse of traditional families in the African-American community. He just as frequently challenges the right about the need to engage seriously in discussions about reducing the availability of guns on urban streets.

"I've had this epiphany along the way," Cornwell says. "I realize now that the major advantage I have in this discussion is that I really don't care if I step on anyone's toes. I'm not looking for votes. I'm not trying to get paid. I'm not looking to be chairman of surgery at some department someday. So if someone starts attacking my blackness like they did to Bill Cosby when he spoke up about some of this stuff, that's fine with me. I don't care."

Late in 2003, Cornwell got a call from MTV. Executives at the music-video network invited him to New York to preview an anti-violence video featuring 50 Cent, a rap star known for songs laced with violent imagery.

"I didn't even know who 50 Cent was at this point," Cornwell says. "People laugh every time I admit this. I've had 65-year-old white women rolling their eyes at me, going, 'Doc, you really need to get out more!'"

Cornwell sat and watched the video in a room with 20 network executives. What he saw horrified him. Whatever limp anti-violence message the video contained was drowned in a barrage of images that made violence seem glamorous, attractive, even painless. The video's notion of depicting the impact of gunplay amounted to a scene in which a perfectly healthy 50 Cent sports a small Band-Aid on his face.

"I told them exactly what I thought," Cornwell recalls. "I told them I was offended by this as a black male, as a father, and as a trauma surgeon. We all know the NAACP would be up in arms if MTV portrayed black men in some kind of Stepin Fetchit pose, but I told them that I thought the images they just showed me were much worse than that."

Cornwell made MTV a proposal. He told the executives they should take images from their video and intersperse them with real-life scenes from Hopkins 24/7. That might show viewers just how wide a gulf separates the fantasyland of rap videos from the real world of blood-soaked gurneys and heartbroken mothers in trauma centers.

MTV told Cornwell they'd get back to him. They never did.

But questions lingered in Cornwell's mind. That trip to New York came as Cornwell and Chang were winding up work on a study gauging the effectiveness of violence prevention efforts. They brought nearly 100 youths active in Baltimore's Police Athletic League into sessions run by the Johns Hopkins Injury Prevention and Community Outreach Collaborative, where they viewed graphic videos and photographs of real-world violence and then participated in a discussion about violence.

Both before and then 28 days after the sessions, participants took a series of surveys approved by the Centers for Disease Control as valid tools to measure attitudes about aggression. The results were encouraging; after the program, participants were significantly less likely to identify with beliefs linked to aggression, conflict, and violence.

"But at the same time we realized that what a program like this is doing is really just a drop in the bucket," Chang says. "When they go home after our prevention intervention, they're going to be inundated day in and day out by all these other images — not just on MTV, but all the other music channels, too."

Cornwell talks to teens about the unglamorous reality of violence. The experience has opened Cornwell's eyes to a harsh reality about the potential impact of the work he does through the Injury Prevention Collaborative with Police Athletic League participants.

"MTV reaches 90 million kids in the time it takes me to reach nine kids," he says. "This whole thing has been another epiphany."

Frustrated by the limited political discourse on youth violence, Cornwell has become increasingly convinced that sports figures and entertainers are key to getting his message out in ways that youths will pay attention to. Last spring, he lent his support to a new campaign launched by Maryland Governor Robert Ehrlich that aims to reshape community attitudes about violence with a publicity campaign featuring NBA basketball star and Baltimore native Carmelo Anthony. The campaign will be modeled on successful efforts in recent decades to impact public opinion about smoking and seat-belt usage.

Cornwell has also set out to make the video he first proposed to MTV. Designed to air as a public service announcement and as a resource during educational sessions, it remains a work in progress, with a working title of "The Hype vs. the Reality." He has set up a nonprofit and opened discussions with prominent producers interested in the project.

"This has been really interesting in a strange way," he says. "I lost a little control of my life after Hopkins 24/7. All these people started coming in and asking how they could help, and I'd spend the first two hours of every morning trying to answer 125 e-mails. But now if someone says, 'How can I help?' I just say, 'I need $75,000 to do this right.' Then they go away. It's made my life much easier."

Can such next steps in Cornwell's quest add up to something more than tilting at windmills? Can public service announcements really make a measurable impact on youth violence — no matter how graphic the images are, no matter how brilliantly produced the messages are, no matter how widely disseminated?

Cornwell responds to such skepticism with two words: Emmett Till.

Till, of course, was the Chicago teenager lynched in 1955 while visiting relatives in Mississippi. The crime was committed by white men convinced that Till had flirted with a white woman. Back home in Chicago, Till's mother, Mamie, displayed her son's brutally beaten and unrecognizable body in an open casket at his wake. Images of this scene captured by a photographer for Jet magazine sparked national outrage and put the nation on course toward a new attitude of intolerance toward racist violence and intimidation.

To Cornwell, this is precisely the kind of transformation that needs to be sparked now, and the Till photographs demonstrate the power of graphic imagery, based in stark reality, to spark a movement toward broad social change.

"We can change the culture," he insists. "It's happened before, and it can happen again today."

No single moment from Cornwell's career captures his quest in all of its complexity. But one memory in particular stands out in his mind. He and a colleague were using an exam cubicle in the emergency room at Los Angeles County while working on a research paper about aortic injuries from gunshots. Sorting through medical records, Cornwell came across the chart of a 15-year-old whom he remembered operating on.

"The kid was born in 1982," Cornwell says. "That was the year I started my internship. He'd broken his arm as a 7-year-old, and he'd had a couple of well-child visits. Then he died. I'm holding this chart in my hands, and I'm thinking, 'That's it. That's his whole life, right here in my hands.'"

At that moment, in an adjacent exam room beyond a thin curtain, Cornwell's emergency room colleagues were with a 16-year-old patient.

"She'd had no prenatal care," Cornwell says. "No one even knew she was pregnant. She came into the emergency room, and seconds later she delivered a baby."

Cornwell pauses for a long moment.

"This baby's going out of the world," he says, "and this baby's coming into the world."

No, this is not the way medicine is supposed to work.

"So now, my spiritual jolt comes from trying to get at the psychosocial dysfunction behind all this," Cornwell says. "We've just got to find a way to change the things that leave so many of our young boys staring down the barrel of a gun at 2 o'clock in the morning."

Freelancer Jim Duffy writes from Cambridge, Maryland.

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