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Goldberg, chief trauma surgeon at Temple University Hospital, has worked on countless victims riddled with bullets. Some are repeat patients; most are young black men.
"These are not criminal masterminds; these are our children, ordinary kids," said Goldberg, who last year testified before the state's Health and Human Services subcommittee about young men destroyed by gun violence.
"I get angry," she said. "Some think it's like watching TV or playing a video game. They don't realize that they just got lucky enough to make it to the hospital alive."
The fight to save a life takes its toll. There's the emotional strain on the victims, their families, their surgeons.
There's also the financial drain on the five area trauma centers.
According to data released by the Delaware Valley Healthcare Council of the Hospital and Healthsystem Association of Pennsylvania, the city's five Level 1 adult and pediatric trauma centers - Temple, Albert Einstein Medical Center, Hahnemann University Hospital, Thomas Jefferson University Hospital and Hospital of the University of Pennsylvania - collectively lose an estimated $8 million annually in caring for victims of violence who cannot pay for health care.
In 2004, for example, 786 Philadelphians were hospitalized for gunshot wounds. About 13 percent of those victims had no insurance at all. A little over a third had Medical Assistance coverage, which reimburses the hospitals about 85 percent of the cost of care. But the hospitals must absorb the remaining 15 percent. Some of these costs are passed on to consumers through increased health-care costs and insurance premiums.
Except for a slight decrease last year, the numbers of gunshot victims have been climbing since 2004. In 2005, 883 were treated, and in 2006, city trauma wards treated 987 victims.
Last year, when 977 victims were treated for gunshot wounds, HUP was one of the most active trauma centers, caring for 401 victims.
"There have been very modest peaks and valleys, but there hasn't been a big decrease" in the number of gunshot victims over the years, said Dr. Pat Riley, vice chief of trauma and surgical/critical care at HUP. "We don't know what the cause is, really; just too many conflicts resolved with guns."
So many, in fact, that doctors on the battlefields in Iraq have come to Philly to learn better ways to treat the war-wounded.
"A number of visitors come here to learn how to care for gunshot wounds," Riley said. "It's a little sad that my hometown is proving to be an urban battlefield."
In war, the seriously wounded typically don't return to combat. The streets are different.
"We do see patients shot once, have an operation and come back again, shot again," Goldberg said. "It is very frustrating for the care-providing team."
Each time, Goldberg knows that the ending could be tragic: She may not be able to save them.
It's difficult to track how many are so-called repeaters. They may get treated each time at a different hospital, Riley said.
"But the numbers of gunshot victims coming in is substantial," he said.
"Intentional injuries, particularly those due to gun violence, exact a terrible cost on the lives and health of Philadelphia residents," said Priscilla Koutsourdis, spokeswoman for the DVHC. "Young black men have the highest hospitalization and death rates for gun-related injuries."
Koutsourdis also said that gunshot victims who make it out of the area's ERs often face a lifetime of care, including rehabilitation, which further escalates the cost.
The first hours after the shooting are the most important to save a life and make an impression on a young man struck by bullets. In these so-called "golden hours," victims reflect on their own mortality, Goldberg said.
"The surgeon has 60 minutes to reverse the shock state of someone shot," she said. "Psycho-socially, there's a window open to talk about the injuries, and to ultimately improve their outcome.
"We know that period does exist, but it will be different for someone shot in the thigh than for someone shot in the chest and abdomen."
Goldberg says that it's impossible to not bring her work home. "A death will stay with you, for sure, as it should," she said. "If it didn't, [the surgeon] is in the wrong business."
Surgeons like Goldberg and Riley can't think "dollars and cents" while trying to save lives. They sometimes see a kid's tough, street-wise exterior disappear while lying on a gurney in a trauma bay.
"Many are very frightened," Goldberg said. "They ask for their friends, or call out for their mothers. Once in that room, the kids aren't resigned to death.
"No one wants to die."
"It's definitely a wake-up call for many, especially when they are sitting there, really hurting, and contemplating their own demise," said Scott Charles, who works at Temple and heads the "Cradle to Grave" intervention program, which tries to steer young people away from violent situations before they are discharged.
"The trauma bays are stark, sterile, cold, unloving places. There is no one rubbing your head or holding your hand. You're naked and surrounded by strangers, and realize these might be the last faces you see," he said.
Those who die before they reach 18 are particularly haunting.
Like Lamont Adams, killed at the age of 16 after a dice game in September 2004.
"Lamont was very ordinary, and most kids can see themselves in Lamont," Charles said.
He was shot multiple times with a .45-caliber handgun near 26th and Cambria streets. He was taken to Temple where he was pronounced dead about a half-hour later.
"When you can't save someone, it's very disturbing and upsetting," Goldberg said.
"These are young people that would have had their whole lives in front of them," she said.
"The families' response to the death is the most intensive grief one could imagine." *
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