School shootings: Doctors were victims, too

Many physicians who were on the front lines of these incidents have resolved to spend more time with their own kids and young patients. Some have also taken steps to help reduce teen violence nationwide.

By Dennis Murray
Senior Editor

More than two years have passed since Eric Harris and Dylan Klebold shot up Columbine High School in Littleton, CO, killing a teacher and 12 classmates before taking their own lives. Since then, copycat shootings have occurred on campuses all across the nation, in poor neighborhoods and affluent ones.

Physicians have been on the front lines of these incidents, tending the wounded and counseling the survivors. But on reflection, the doctors have had difficulty making sense of the events. Moreover, these incidents have forever altered many physicians' relationships with young patients and their parents, and with their own children.

To discover what life was like for doctors in the aftermath of these tragedies, we talked with physicians in Colorado and with some in suburban San Diego, where two school shootings occurred in March.

"You're never prepared for young people to die"

Chris Colwell, an emergency medicine specialist at Denver Health Medical Center, was the only physician at Columbine High School after the rampage. Paramedics had treated several injured students before he arrived, but most of the students hadn't yet been safely evacuated.

"We set up a triage area a half block from the school," he says, "where we could still see the building but not be within shooting range. We did a quick assessment of the students who came out of the school, to determine if they had been injured. Most were so frightened and upset that it was hard to direct many questions at them."

When officials finally declared the school "clear" some five hours after the shootings began, Colwell faced the task of pronouncing the victims dead. "That will stick with me for the rest of my life," he says. "There were 12 dead in the library alone, including the two shooters. No matter how much medical training and experience you have, you're never prepared for young people to die, particularly in these numbers."

Colwell credits stress counseling for getting him through the subsequent weeks. "Counseling played a huge role in my dealing with this," he says. "I think it's an absolutely vital part of any recovery plan—for the victims, the medical personnel, and the community."

His colleague, Stephen Cantrill, agrees. Cantrill, an emergency medicine specialist at Denver Health, arrived at the hospital as the first two kids were brought in. "We were watching the live helicopter reports on television, so we had a fair idea of what was going on," recalls Cantrill, who was responsible for triaging the injured. "It was spooky in a way, because when we saw an injured kid being carried out of the school, I knew I'd be getting a call to determine where he or she should be sent."

Cantrill is still trying to shake the memory of a girl who'd lain inside the school for several hours, bleeding. "When she arrived at the hospital, she was as white as a sheet," he recalls. "I think she had nine bullet wounds, many of them to her extremities." She survived, along with the other 23 kids brought to six Denver-area hospitals.

The shootings even affected doctors who didn't directly tend the wounded. Stuart Cohen, a San Diego pediatrician, was shaken after he learned that one of his teen patients had come face to face with a young gunman at Santana High School in Santee, CA. In that March 5 incident, a 15-year-old opened fire in a restroom, killing two people and wounding 13 others.

"My patient told me he'd been taking a nasal spray for his hay fever," says Cohen. "He was embarrassed to take the spray in front of his friends, so he went into a bathroom stall to do it. When he heard the shooting, he stayed in the stall. Eventually, the shooter opened the door of the stall and looked at him, but didn't do anything."

For many physicians, including Lakewood, CO, internist Kelly O'Brien-Falls, the biggest challenge was keeping their own kids calm after the shootings. "They were so scared," she recalls. "When they went to school the next day, they were thinking about where they would hide or where they would run to if a shooter came into their cafeteria."

Bad memories that won't be shaken easily

Denver internist Judith Paley, whose daughter knew one of the injured at Columbine, remembers feeling worn down by an oversaturation of "news and pictures of weeping teens, funerals, devastated parents, and memorials, for weeks and weeks. It got to where I couldn't bear to open the newspaper and start another day in tears."

When she wasn't reading about Columbine or seeing it on the evening news, O'Brien-Falls was helping her friends deal with it. "A social worker who responded to the call for help was still crying a year later at the mention of Columbine," says the doctor, who lives near the school. "Another friend, who owns a glass company, repaired many of the shattered windows. He told me he can't shake the memory of seeing all that blood everywhere."

For the doctors who fought to save the lives of the wounded, flashbacks are a part of life. "I don't like talking about Columbine," Cantrill says. "To this day, I find the horrific nature of the incident profoundly disturbing. In emergency medicine, we deal with a lot of really terrible things—and the dead and dying commonly—but this is much more difficult, because the victims were adolescents."

Steve Berman, a Denver pediatrician and president of the American Academy of Pediatrics, continues to see the effects of Columbine and subsequent school shootings in his encounters with young patients. "The thing that has struck me," he begins, "is that middle-class teens who thought they were safe have begun to develop the same sense of a foreshortened future that inner-city kids have. Many of them have become anxiety-ridden and depressed."

Michael A. Rodriguez, a family physician in San Francisco, has noticed a similar change among the teens in his practice. Rodriguez cares for and counsels young victims of violence, and has been active in several community-based violence-prevention programs. "As a clinician, I find it frustrating to deal with these situations over and over again," he admits. "That's why it's important for physicians to advocate policies that will help prevent these incidents from happening in the first place."

The shootings encourage much-needed dialogues

In the wake of these harrowing events, physicians say they've spent more time talking with young patients and their parents, both in the exam room and in their communities. They've asked whether there's a gun in the home, where it's kept, and whether it's left loaded. They've asked whether kids are heavily exposed to violence through movies, TV, video games, and the Internet. They've asked parents about their relationship with one another, and whether they're experiencing any stress that might be having an effect on their children. (For more on how you can help spot a troubled teen, see below.)

Physicians have also re-examined their relationships with their own kids. "I'm much more interested in what's going on in my daughter's high school, especially how the kids relate to each other and to their instructors," says Stephen Cantrill.

Judy Paley has tried to spend more time with her teenage daughter, even if it means working less. "I'm now more apt to be home when she comes in from school. I want to know what she's doing and who she's hanging out with. Yes, there are things in her life that are none of my business, but there's a whole lot more that I need to be concerned about."

Some physicians, including Chris Colwell, have been so deeply affected by youth violence that they're trying to make a difference by lecturing on the subject. Colwell travels the country sharing his experiences and initiating discussions with students and his physician colleagues. Surgeon David Hoyt, director of the trauma unit at the University of California, San Diego Medical Center, one of five hospitals that received the injured from Santana High School, is involved in several community programs.

"We're looking upstream to assess the causes," Hoyt says. "We're setting up intervention programs to deal with high-risk kids, and creating partnerships with schools, police, and the local courts."

In Washington state, where 115 students were expelled for bringing guns to school during the 1998-99 school year, doctors, police, and prosecutors are making a series of dramatic presentations to eighth and ninth graders. The program, known as Cops & Docs, has reached more than 10,000 inner-city and suburban kids since its inception five years ago.

A unique program that packs an emotional wallop

During each Cops & Docs session, a physician and a police officer discuss the medical and legal consequences of teen violence. For instance, in Washington state, a minor who knows that another minor has a gun will be prosecuted as an accomplice if that weapon is used in a crime.

To hammer home the medical consequences, Cops & Docs uses slides of trauma victims. "The photos certainly get the kids' rapt attention," says Roy Farrell, chief of emergency medicine for Seattle's Group Health Cooperative, and one of the program's founders. "Many kids aren't very afraid of death, but they're terrified of pain, disfigurement, and loss of physical abilities to play sports, have a family, and lead a normal life." To further emphasize the consequences of guns, the physicians pass around catheters, chest tubes, and adult diapers to the students.

Though the photos used in the presentations are extremely graphic, the program has gotten "100 percent support" from teachers and parents, says Farrell, who's president-elect of the national association, Physicians for Social Responsibility.

The main objective of Cops & Docs, however, isn't to scare the wits out of kids. It's to get them thinking about how they'd respond if confronted by someone with a gun, regardless of the intended target. "There's a lot of give and take in these discussions," says David Heywood, a retired internist from Kirkland, WA. "We aren't just standing up there and lecturing."

The number of incidents involving youths and guns in the Seattle area has dropped in recent years, Farrell believes, a trend that has been reflected nationwide. "We don't know how many lives we may have helped save, but I think the chances are high that we've played a role in preventing some violent incidents."

Editor's Note: Cops & Docs is a joint effort of the Bellevue, WA, nonprofit organization Partners for a Healthier Community, which funds the program, plus the Washington State Medical Association, Washington Physicians for Social Responsibility, the Seattle Police Department, and the King County Prosecutor's office. Physicians interested in setting up a similar program in their community should contact Martin Fleck, executive director of Washington Physicians for Social Responsibility, at 206-547-2630, or via e-mail at martinf@wpsr.org. Health systems should contact Keith Cernak, executive director, Partners for a Healthier Community, at 206-296-9824, or via e-mail at healthpart01@aol.com.

Troubled teens: the risk factors

Spotting signs of violence in teens isn't easy. Some youths exhibit no signs of erupting, yet they feel angry, depressed, and possibly suicidal. Others may reveal several risk factors but never commit a violent act. The only way to tell whether kids are coping adequately is to spend time with them and ask questions.

Some warning signs to look for:

• Substance use and abuse.

• Family turmoil, including divorce or separation.

• Access to weapons in the home.

• Fascination with violent films or Internet sites dedicated to hate groups or gang culture.

• Wearing of military-style camouflage clothing.

• Tendency to withdraw or remain isolated.

• Absence of a close friend or mentor.

• Feelings of frustration.

• Frequent loss of temper.

• Lack of interest in once-pleasurable activities.

• Disturbances in sleeping or eating routines.

• Disciplinary action at school.

• Complaints of being picked on.

• Difficulty in dealing with sexual orientation.

• Unplanned pregnancy.

Adapted and reproduced with permission of The American Academy of Experts in Traumatic Stress, Commack, NY.

 

Dennis Murray. School shootings: Doctors were victims, too. Medical Economics 2001;13:46.