Scrubbing In: The cost of violence short of murder

I never knew what brass knuckles were before I moved to Philadelphia to be an eye surgeon. Now I know them all too well.

I did know what being pistol-whipped meant. Hey, I grew up near Miami and go to the movies. But I'd never met a pistol-whipping victim. Now I have.

Wills Eye residents, including me, care for these victims every day at Cooper University Hospital in Camden and at Thomas Jefferson University Hospital in the city.

These patients offer a window into the violence that surrounds us.

Anyone who spends time in ERs knows what I'm talking about. Dozens of people get violently assaulted every night, and it rarely gets noticed.

The face and eyes are frequent targets.

An attacker battered one of my patients with brass knuckles at the Mummers Parade on New Year's Day. A pair of brass knuckles cost all of $12. They seem to protect the puncher from injury while packing a more powerful punch than a bare fist.

My patient had "a blow-out fracture," meaning that one of the bones supporting the eye had buckled from the force. Luckily, he did not need surgery urgently and, in a way, the bone did its job by protecting his vision.

Another patient got brass knuckled outside a bar and bled into his brain. When he woke up, he had double vision because the blood was damaging a nerve that controls vision.

Brass knuckles aren't the only weapons. One patient had been pumping gas at night when he was stabbed in the eye by a pen-wielding mugger. His eyelids were shredded and it took three hours to sew him up.

Then there was the guy who got trapped by a mugger at an ATM and beaten in the face with the butt of a handgun. His eye was smacked so far back into his head that I couldn't see the eyeball when I opened his eyelids. His eyeball ended up in his sinus. He's now blind.

In Philadelphia, homicides make headlines. Will there be 400 this year? Or just 350?

But that's just one measure. Police statistics show that for every murder, there were 26 violent assaults, 27 robberies, and three rapes in 2008. More than 20,000 violent crimes were reported in Philadelphia last year, including 1,562 shootings.

Murders take place against a backdrop of lesser violence that's endemic. One out of 70 people, on average, is a victim of violent crime every year in Philadelphia. And even though a bad beating doesn't make the evening news, it takes a toll on victims and their loved ones, not to mention the stress on our ERs and the lost productivity at work.

Consider that the one thing people most dislike about Philadelphia is its crime, according to a poll last week by the Pew Charitable Trusts.

When Officer John Pawlowski was murdered in February, it was heartbreaking. But it also may have been predictable and preventable. His alleged killer, Rasheed Scruggs, had been arrested nine times, police said. A convicted armed robber and parole violator, he had likely been inflicting violence on the rest of us for years.

Mayor Nutter has made some strides in combating crime. He put 248 more officers on patrol in early 2008. Commissioner Charles H. Ramsey has increased pedestrian stops, which are up 58 percent in 2008, and vehicle stops, up 13 percent. Last year, city homicides were down 15 percent and the number of shooting victims fell by 10 percent. But the rate of violent crimes remains too high.

There are solutions. University of Pennsylvania statistician Richard Berk has found that a confluence of factors may help predict whether someone commits homicide and that, for example, the risk from shooters falls off dramatically starting in their middle 20s.

The city's Strategic Anti-Violence Unit works one-on-one with these offenders, encouraging them to become educated and employed. The challenge is great: Those identified often fail quickly before many services can be given.

But let's hope they keep refining their work so Philadelphia can banish the brass knuckles and return to its true self as the City of Brotherly Love.

Rachel K. Sobel, a second-year resident of the Wills Eye Residency Program

at Thomas Jefferson University, writes about her experiences every other week.

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