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.
"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.