His Best Shot

Temple University Hospital’s trauma outreach coordinator Scott Charles wants to do everything for young gunshot victims. Keeping them from returning to the emergency room is a good start.

by Kia Gregory

Light filters through the moment someone fires a gun and the bullet pushes through its victim’s flesh, nerves and veins. It opens when the cops or emergency medical techs rush the gunshot victim to the emergency room of Charles’ North Philadelphia hospital. It opens when the army of trauma surgeons—so good at their calling that military medics want to learn from them—crack a chest, spread a rib, clamp an artery and save a victim’s life.

Trauma surgeons call escaping near death a good save.

But not Charles.

“We gotta quit being content with that,” he says. “The only time it’s a good save is if he walks out less likely to get shot or shoot someone. If you only patch him up, you haven’t given him a second chance at life but a second chance at death.”

Charles’ job as Temple University Hospital’s trauma outreach coordinator is part prevention, part intervention. But he’s not a savior. He can’t be when the city hemorrhages gunshot victims at the rate of five a day, and when utter hopelessness infects a victim’s mind.

Charles knows, though sometimes it’s bitter to accept, that even if doctors can save the 500 gunshot patients who’ll be rushed to Temple University Hospital this year, he can’t. He’s just the guy with the pocket square, he says, and compared to what the trauma surgeons do, his job is easy. But it is perhaps the most critical.

“I’m not the first person to tell them their life is headed in the wrong direction,” he says. “I’m just the one to tell them at the moment they’re most willing to listen. I’m trying to get them to see it as a turning point, as a wake-up call. I tell them, ‘I don’t want this moment to define you.’”

In that window of opportunity Charles becomes an uncle, a brother, a friend. He’s also a peddler. Unlike the trauma surgeons’ work, his job is to offer a lifeline—a hard sell, even after a hail of bullets.

His job is harder still because the moment is so fleeting. He has to keep the window of opportunity open before pain turns to anger, before fear turns cold, while life still feels fragile, still worth living.

At Temple University Hospital for nearly two years, Charles describes his job as triage in a war zone. Last year Philadelphia mourned 406 murders—and this year, with an average of more than one murder a day, the city is on pace to exceed that number.

The murders, Charles says, are just a symptom of the epidemic. The disease rages inside the shootings, which are random, petty, multiple and many.

Last year the city suffered 2,004 shootings—about five for every murder. As of April 30, there were 563. And since 2001 some 10,000 people have been shot in Philadelphia.

The victims and perpetrators of the city’s gun violence are overwhelmingly young, male and black. A 2006 University of Pennsylvania analysis found it more dangerous to be a young black man in Philadelphia than a soldier in Iraq.

Charles’ focus is on gunshot patients between 15 and 24 years old, the majority of the city’s victims. His hope is to enroll them in a pilot intervention program to keep them from getting shot again or shooting someone.

Sometimes his job is easy. Some gunshot patients desperately reach for the lifeline he’s offering. Others tell him to go fuck himself.

“It would help if I had a job for them or something tangible to offer,” he admits. “The only thing I can offer is life.”

And hope where there was none. But again, it’s a hard sell.

The prevention part of Charles’ job starts with his Cradle to Grave program.

On this Friday morning Charles stands under harsh lights before a group of at-risk students in an emergency room.

With the students huddled around a cold stainless-steel table, he brings 16-year-old Lamont Adams back to life.

Lamont was born Dec. 10, 1987, Charles begins. His grandmother, who raised him and his young brother, remembers him as a happy, fat baby. He had a beautiful smile and made everyone laugh, the Eddie Murphy of the neighborhood.

On Sept. 22, 2004, the night before he was murdered, Lamont wrote something on his dinner napkin: his obituary. It read: “Lamont Adams was gunned down, son of Daneen Adams and James Edward Mathis.”

When his teary-eyed grandmother asked him about it, he blew it off as nothing.

The next night, while Lamont was walking just blocks from his North Philadelphia home, a car pulled up and a man stepped out and shot him. Then the man stood over him and shot Lamont at least a dozen times, leaving him lying in a pool of blood.

Rumor was that in the days leading up to his murder, the high school junior was playing dice on a corner. After he left with his winnings, police busted up the game.

“And haters do what haters do,” Charles tells the students. Lamont’s 19-year-old killer thought he’d snitched to the cops.

The cops, he says, rushed Lamont to Temple University Hospital, and into a room very much like the one the students are standing in.

Charles asks one of them, a 16-year-old boy, to lie on the table. He then puts round red stickers on the boy’s white T-shirt to indicate where Lamont was shot.

Here, here, here, Charles chants, putting red stickers on the boy’s chest, arms and thighs. Then he asks him to lie on his stomach. He puts more stickers on his back and his legs.

“No one knew his name,” Charles tells the students. “No one knew the reason he was here.”

The students are stoic, quiet. A few blink back tears.

There were 24 bullet holes in Lamont’s body. Two were in his hand, which he held up in desperation.

The doctors worked on him—cutting, probing, tubing, injecting, clamping—for about 15 minutes.

“How many of you want more than 15 minutes?” Charles asks the students. They stare at the table, at the boy covered in red stickers. The ones who aren’t in shock raise their hands.

From here, Charles usually takes students to the morgue. There they see gunshot victims, stiff bodies scarred by ugly wounds.

Before the two-hour program is over, Charles hands out toe tags and asks the students to write on them the dollar amount they believe their life is worth.

Charles insists his Cradle to Grave program isn’t some type of scared-straight prevention. He’s simply trying to open a window into what gun violence looks like, outside of the glamorized world where actors treat a gunshot wound like a mosquito bite, where rappers get shot nine times and live to sell millions of records, where friends wear their guns and bullet wounds like badges of honor.

He shows the students the after—gory, horrendous and painfully tragic—from doctors cracking open a gunshot victim’s chest to the voice of Lamont’s grandmother breaking as she sobs on an audio tape about how much she misses her sweet grandbaby.

When he started the program, Charles would sit at his desk with his head in his hands and cry. He’d cry over Lamont’s life and the 24 bullet holes that ended it. “I kinda knew this kid,” he says, referring to his inclusion in the lengthy audio project Charles worked on in 2005.

When veteran Temple trauma surgeon Amy Goldberg learned of the project, she fought the hospital bureaucracy to bring a full-time intervention program to Temple University Hospital.

In those early days she even chastised Charles: Don’t cry, she said, do something. Charles accepted the job and created Cradle to Grave.

“I try to humanize Lamont for those kids,” he says. “I want those kids to see themselves in him.”

Charles, 39, married father of two, degree in psychology from Penn, five years of service learning experience, sees himself in all of his gunshot patients.

He grew up in Sacramento, Calif., as he paints it, “a biracial kid with a white single mother in a Mexican neighborhood,” and a father who loved women, including Charles’ babysitter and kindergarten teacher.

When Charles was 9, his father died of a heart attack.

His oldest brother died of AIDS. His next oldest brother overdosed in a flophouse. Another is a crack addict who’s in and out of prison. His late cousin was a pimp. Gangs ruled the neighborhood where he grew up.

“It was a real violent place,” says Charles. “You got gut-checked constantly.”

It was a world of extremes—you did real well or real bad, Charles explains. His uncle was among the first black fire chiefs in the country. His aunt and uncle own a newspaper in Sacramento, and after Charles, a recovering drug addict, got clean, they took him in.

“If it wasn’t for my uncle, I’d still be out there,” he says. “It’s one thing to tell somebody to get their stuff together. But you have to give them the tools.”

That’s what he tries to do at Temple University Hospital—open windows and hand out tools. The task weighs heavily—heavily enough that he sees a therapist, and often feels trapped between effectiveness and futility.

“I know out of 15, 20 kids, I’m lucky to have an impact on two,” he says. “The rest are contaminated by the violence around them. I’m trying to do things based on logic and common sense. But this thing is nothing like we’re used to. It’s like a monster.”

The intervention part of Charles’ job starts in the hospital rooms of those who’ve survived the physical trauma of getting shot.

“I try to make them realize there’s nothing tremendously special about why they got shot,” he says. “There’ll be 400 individuals at the hospital just like them lucky enough to survive.”

He also explains that probably half the victims are under 25. And that statistics show a one-in-seven chance of getting shot again.

Then he offers what he calls the shtick of his intervention: If you were struck by lightning, and there was a one-in-seven chance that when it rained you’d get struck again, would you go outside?

“I’m trying to give you an umbrella,” he says. “I’m trying to get you out of the rain, out of the circumstances that got you here.”

Through conversation he also tries to learn details, and whether the shooting was random or part of a feud. Universally, Charles says, gunshot victims say it was random. They were walking to the store or they were robbed.

“You can’t see the volume we see and think that 90 percent is random,” he says. “But a lot of these dudes feel stupid for having gotten shot. It means they got caught slippin’. I’m one more person they don’t want to tell the truth to. They don’t want to be judged.”

Trust takes time. After Charles promises to come back, and he does, the stories change. But in many ways he doesn’t care. For now it’s nothing but a tragedy, and the window is closing.

So much about the city’s gun violence is out of Charles’ hands, if only because of its sheer complexity.

One victim, Charles remembers, got shot in the backside. The bullet clipped his femoral artery, and he bled to death. Another victim was shot 11 times at close range, and walked out of the hospital days later.

For some of the victims, the shooting is random, like the 16-year-old who got shot in the back of the head while riding his bike, a case of mistaken identity. Days later, he’s still on a ventilator, part of his skull gone.

There’s the 19-year-old boy who was robbed at a bus stop on payday. He lives with the aftershocks of getting shot: a colostomy bag and missing toes.

There’s Ciera, 20, a shy, skinny community college student who was sitting on the step chatting with friends when her shooter ran up and opened fire. A bullet shattered a bone in her left arm. The surgeons at Temple took a bone from her hip to replace it and sewed her hand across her stomach to keep it stationary. They also reconstructed her elbow.

Eight months later, she still goes to therapy every day. She had to learn how to walk again and is still working to regain full use of her arm, which she almost lost to infection. She’s homeless, and her medical bills exceed $300,000.

On this day Charles gives her a hug, and whispers that she’s going to get through this. But Ciera still worries.

“When I’m at the bus stop, I think, ‘That could be him,’” she says of her unidentified shooter. “He could get me again.”

There’s the girl, 25, whose friends pleaded with her to go out to a club one night. She ended up getting shot outside the club, caught in a gun battle. She has severe vascular damage in both her arms and legs.

There’s the 20-year-old single father of two who’s hobbled by leg braces and a colostomy bag. The first time he was shot over what seemed like a petty dispute. The second time he was shot in the back for no reason at all. He tells Charles the worst thing is not being able to chase after his kids.

Investing in a better future: Wall Street, a former basketball star and aspiring rapper, lost a leg to gun violence.

And there’s Wall Street, 19, a former high school basketball star and aspiring rap artist. His lanky body is decorated with tattoos. The one on his neck reads: “One Man Army.” He lost his leg confronting the guy who stole several thousand dollars of his drug money.

“I can’t forget that I got shot,” he says. “I can’t forget that I lost a leg. I have regrets, but I don’t get mad. I’m really supposed to be gone for real for real.”

He sees his shooting as a turning point. “It wasn’t my downfall,” he says. “It was my upbringing. People gonna respect me more on my get back. They gonna look at me as a success, as a conqueror, not just a person who used to play ball or as a person who plays music but a person that overcame adversity.”

For some it’s a rite of passage. Like for the 14-year-old who asked one of the doctors to take his picture with his cell phone.

One 21-year-old never takes off his headphones when Charles talks to him in his hospital bed. Charles later learns he’s not eligible for the program because he’s under arrest.

For others the moment has potential. Chubby-faced David, 15, shows up at the clinic for the vascular damage to his leg. Charles has been unable to contact him for months. When he finally finds him, David’s stretched out across the plastic chairs in the back of the waiting room. Charles has to shake him awake.

“Tell me what you need,” Charles says.

“I need a job,” he responds, sleepy-eyed.

David is a high school dropout. He has an upcoming court date for drugs and a colostomy bag he hides under his baggy shirt. The last thing Charles tells him after making sure he sees a doctor is: “We gotta get you back in school.” Two weeks later, after falling off Charles’ radar, David calls, giving him his new cell phone number.

Then there are the repeats, like the 23-year-old who lost his eye the first time he was shot. Six weeks later he was shot again. He wasn’t interested in the program the first time—and still isn’t. “He’s so hardened that he’s come to see this as his destiny,” says Charles. “Some of us go to work. Some of us get shot. He pulled that straw. He looked at me like, ‘Don’t fuckin’ cry for me. Why are you wasting your breath?’

“I’m looking at him with pity. He’s looking at me with pity. And right now, I don’t know which one of us has a better handle on the situation. I’m not sure which one of us is right.”

But even for those he enrolls in the program, Charles knows this: “If we don’t change his circumstances—an apartment, a GED, so he can get a better job, so he can be more stable—there’s nothing to make him less likely to come back to us. He’s gonna keep doing what he needs to do to survive. You can moralize all you want, but as far as he knows, it’s his best chance.”

Gun violence in Philadelphia is an epidemic, simply by definition.

It affects a disproportionately large number of African-Americans, and much like the AIDS epidemic in Africa, it’s rampant and prevalent.

Charles compares it to the movie 28 Weeks Later, in which a viral outbreak makes people violent and spreads like wildfire through England. “It’s really an amazing metaphor of what’s going on in this community,” he says. “Violence is contagious, and it’s spreading exponentially in our communities. We’re in the midst of it right now.”

In the city’s most crime-infested neighborhoods, Charles says, there’s a generation being fed a diet of fear, anger and hopelessness.

There’s an utter lack of respect for anything or anyone.

There’s the failure of the education system, concentrated poverty, chronic unemployment, persistent underemployment, drug abuse, child abuse, mental illness and domestic violence.

There’s what Charles calls the materialist, aggressive and sex-fueled pop culture that glamorizes money, power and respect.

There’s the easy accessibility of guns. Between 2005 and 2006 the number of gunshot victims 18 and younger at Temple University Hospital jumped 40 percent. Charles explains the surge simply: Kids will fight with whatever weapons are available to them. And so will adults. Last year Philadelphia police seized 5,386 guns.

There’s the desperate need for self-protection. “I’m not gonna wait to find out if the dude has a gun,” Charles says, describing the prevailing mentality. “As the saying goes, I’d rather be judged by 12 than carried by six, and that just reinforces the idea that you can’t take a chance and not be strapped.”

There’s the stop-snitching mentality of the streets, and its code of retaliation.

Violence is so common in some neighborhoods resistance seems futile.

“We accept the abnormal as normal,” says Kisha Bivines, whose 17-year-old son Ivan was shot and killed five months ago.

She’s told her son’s story to students in Charles’ program, and keeps a photo she never wants to forget: Ivan lying in a morgue. “This is reality,” she says. “This is what death looks like.”

Bivines says she was a strict parent, and when her son started skipping school and running the streets, she looked everywhere for help. “When he got shot, it was like that’s what people expected,” she says. “We’ve all done things that we’re not proud of, but his heart was great. We have to tell our youth, if you make mistake, it’s okay. But when there’s no hope, we’re headed for destruction.”

All of these things create the perfect storm.

“We know what the problem is,” Charles says. “We don’t need any more public awareness. We have to do something.”

There’s the obvious: provide quality education and meaningful jobs. But as Charles says, even if you put jobs out there, how do you undo a lifetime of damage?

“You can’t air-drop hope into a neighborhood,” he says. “You can’t do drive-by inspiring. You got to plant seeds, and make sure they take root. We’re so far past kids needing a pep talk. We’ve got to have a presence in those neighborhoods, and we don’t. So until we can figure it out, my job is basically doing triage.”

Many of the gunshot victims Charles sees needed a trauma team long before they got shot. Referring to one young patient, Charles says: “It wasn’t like his life wasn’t messed up before he got shot. I’d have a full-time job just helping him with that.”

In 2005 Gov. Rendell established a commission to address gun violence. The result was a pilot program called the Pennsylvania Injury Reporting and Intervention System (PIRIS), a hospital-referral program that connects gunshot victims ages 15 to 24 to social service and intervention providers to identify effective violence-reduction strategies.

Philadelphia was chosen for the program because it has the greatest number of firearm-related hospital discharges (38.3 percent) in the state for people age 15 to 24.

The program, which launched in April of last year, works with the city’s three trauma centers: Temple, Einstein and the Hospital of the University of Pennsylvania. It’s funded through the state health department, managed by the Philadelphia Health Management Corporation (PHMC), and aided by the Philadelphia Anti-Drug/Anti-Violence Network (PAAN).

Through PHMC, each of the program’s gunshot victims is assigned a case manager to support the physical, emotional and social needs of the victim and their family.

“It’s really a holistic approach,” says Doris Spears, PHMC’s case management supervisor. “Let’s look at what was going on before the traumatic event. You never know where it’s gonna take you. It’s much more than, ‘Some young person got shot at 23rd and Diamond.’”

If the victim was an innocent bystander, Spears says, PHMC assists them in returning to their previous life—back to school, back to work. If the victim engaged in behavior that contributed to their being shot, “then we need to talk about lifestyle changes,” she says.

PHMC provides intensive, long-term case management, which means supplying a web of services: public assistance, medical assistance, witness protection, GED training, job training, resume writing, drug treatment, truancy issues and parenting issues. They even provide smoke detectors. They help victims get back to school, prepare for upcoming court cases, make doctor’s appointments and deal with posttraumatic stress.

But the question becomes, where do you start?

It’s an experiment still in its infancy. But the individual stories provide bittersweet hope. Like the paraplegic who’s getting married in May, or the once-truant student and father of two who’s graduating from high school in June.

But Spears cautions, “This is a process. Sometimes it’s as basic as helping people get their birth certificate before tackling lofty goals.”

Once the bullets are removed, Spears says, there’s an expectation that victims should be able to carry on with their lives, and most of the time that’s not the case. “Victims and families need help—not just with day-to-day problems but with the ongoing effects of their shooting. Some of them are desensitized, the walking wounded.”

Infinite patients: Inside Temple's trauma unit.

While PHMC works with the gunshot victim, PAAN focuses on the community.

“The gunshot filled the young person,” says PAAN coordinator Elisha Morris, “but it affected the entire community. The community is more afraid, more angry and more and more apathetic as it feels more and more unsafe.”

PAAN goes into the neighborhood where the young person was shot to ease tensions and foster healing. They host events, sometimes on the very corner where the shooting took place. They invite police, elected officials, clergy, neighbors, the victim and their family with the hope that someone will want to keep it going.

“The reality is most of these people can’t move, and don’t want to,” says Spears. “They’re invested in their community. But there’s not the support structure to make that community vital.”

It may mean reopening a rec center pool, extending the hours of the neighborhood library, cleaning up a trash-strewn lot, sealing up an abandoned house—all to convey the message: It was my kid today; it could be your kid tomorrow.

But there are those close to the raging gun violence who say the city desperately needs an organized response—a hotline number, a kind of Bat-signal.

Of the 500 gunshot patients who will be rushed to Temple University Hospital this year, only 150 will meet the age requirement for the PIRIS program.

Others will slip through the cracks because they’re unconscious, unwilling, under arrest or discharged before Charles visits their room.

“We’ve had violence epidemics before—the gang era, the crack era—but our response to this one has been slow,” says Dr. William King, vice president of Physicians for Social Responsibility.

Charles ties the upsurge in the city’s gun violence to the February 2004 shooting death of 10-year-old Faheem Thomas-Childs, felled in a gun battle between drug dealers outside his school.

“When that happened, there was no meaningful response,” he says. “The people in that community wanted to know that the city was outraged, that we were willing to unleash hell—and we weren’t.”

“We walked,” he says, referring to the thousands of people who marched through Faheem’s North Philadelphia neighborhood. “The very nature of our response was downtrodden. And even then, we rescheduled because of rain. We weren’t committed enough to walk in the rain. So not only was our response weak, it was conditional.”

King says part of the problem is a lack of organized leadership, politicians competing for power, and nonprofits competing for grants.

“The fundamental problem is we don’t have the services and coordination,” he says. “We are badly organized. If a mom is Googling for youth antiviolence programs and can’t find your organization in three minutes, you can’t help her or anybody else. And if she finds a million such organizations, what’s she supposed to do with that?”

The cost of searching for a solution is great. Aside from the fact that a large number of Temple gunshot victims are uninsured, adding to the hospital’s $86 million in unreimbursed healthcare, there’s the priceless social cost of lost potential.

Of the 140 kids in the PIRIS program, eight will never walk again. In the group of young participants, there’s a paraplegic, a quadriplegic and one person with brain injuries.

“Every time they pull a trigger, they’re destroying their heritage,” says PAAN’s Morris. “At some point, as long as young black kids keep shooting young black kids, we’re gonna run out of kids to kill.”

Scott Charles calls one recent Tuesday the saddest day of his life.

Before his morning coffee, he enrolled two patients in the PIRIS program, one of them a young man who came in riddled with bullet holes from his waist to his feet.

As Charles talks to him in his hospital bed, the young man trembles and sobs. He realizes how close he came to death.

He has a teardrop tattoo for his slain 16-year-old cousin. And the friend who came to visit him, who urged him to use this as a wake-up call, was shot four days later.

Charles asks him how many people he knows who’ve been shot.

More than five? Ten? Twenty?

Yes.

“Violence is all around him,” Charles says. “There’s nobody left on his block. They’re either in prison or dead. His block has been obliterated.”

Charles says victims may feel like trembling, but manifest it in other ways. “Do you tremble at the corner store or do you walk in there hard as hell? You either hit back or you fold, and this kid is doing what we wish more would do—fold.”

Before he leaves the room, Charles gives him his cell phone number.

“I want to remind him of what we talked about in this moment,” he says.

But for 17-year-old Ronald, it’s too late.

Charles has just learned that Ronald, shot last June when his program was brand-new, returned to the hospital over the weekend, DOA from multiple gunshot wounds.

Everywhere Charles goes doctors and nurses ask if he heard about Ronald.

“Yeah, I heard,” he snaps.

“I feel like people are looking at me,” he says. “Like, why didn’t you catch him?”

Charles wants to develop more programs, to expand Cradle to Grave into a full curriculum, comparing it to antiviolence education in public schools, and he’s been working with researchers at St. Joseph’s University to measure whether a window of opportunity exists at all.

But at this moment, he admits his job is overwhelmingly difficult, and if he’s not careful, his own window of opportunity will close.

“How do you get your arms around it?” he asks of the city’s violence epidemic. “It’s like digging a hole in the sand. And it’s by nature going to get worse. So how can we solve it? Somebody tell me.”

Charles does know at least one thing for sure: “If we can’t find a way for them to get more help on the outside, they’re just going to come back to us.”

Kia Gregory (kgregory@philadelphiaweekly.com) writes the ’Round About column.