Warning: this story contains graphic descriptions of violence and death.
On a warm Friday night just before Halloween, the teams of doctors and nurses, police officers, interns and cleaners who staff the emergency department at MetroHealth, on Cleveland's West Side, are completing paperwork, organizing supplies and checking records.
They all know something terrible is coming this weekend — like it did last. Like it does most nights. They're not waiting — that would somehow imply an element of hopeful anticipation. But they're not full of dread either.
They're ready, and they're resigned.
Shortly before 8:30 p.m. it happens. An EMT wheels a man in strapped to a gurney.
He's white, in his late 30s, and has been shot multiple times.
A Cleveland police officer tells a doctor the few details he knows.
“He was just walking down the street where it happened,” he said. “Nobody knows who this guy is. It’s like a John Doe at this point — got no ID on him.”
Inside the room, a doctor’s voice drowns out the cop. “Can I get another blood please?”
The patient is unconscious, his arm dangles off the bed. A team of five doctors and three nurses don’t bother with his arm. They’re all working on his chest. Until they’re not. Their movements slow down, and then they stop.
But then one doctor springs back to action.
“We’ve got to make that decision here,” the doctor said. “I think we need to support him.”
The team begins working frantically again. And for a short time, their efforts appear to revive the man, but minutes later he’s declared dead.
This happens sometimes, said Dr. Jeffrey Claridge, the trauma director at MetroHealth, one of Cleveland's level 1 trauma centers that treat the most seriously injured patients. He said with this level of trauma, the doctors likely performed an emergency room thoracotomy or "cracked the chest" to resuscitate the patient.
The procedure gives doctors access to blood vessels and the heart to try to stop bleeding or fix other injuries, according to the National Institutes of Health.
"A fair amount of them we can get back for a short period of time," Claridge said. "But there's been so much insult to the body and heart for not having blood oxygen supply that it fails in a short period of time."
One patient, 800 hands
Gun violence increased by more than a third in the United States during the COVID-19 pandemic, according to research at the Penn State College of Medicine. Since 2020, hospital emergency departments across the country have reported 20 to 37% more emergency department visits for firearm injuries than before the pandemic, figures from the Centers for Disease Control and Prevention show.
Over the last several decades, violent crime across the country has dropped, but gun violence statistics in Cleveland are looking worse than they did 10 years ago.
This year's number of homicides exceeds the annual totals for every year from 2011 to 2019, Cleveland police data show. Between 2011 and 2014, there were fewer than 90 homicides a year in Cleveland. Since 2020, there have been at least 130 a year.
As of Nov 13., 146 people had died by homicide this year. The majority, more than 83%, were Black.
Cleveland’s MetroHealth Medical Center is rated among the best in the country for its trauma emergency services and has some of the best outcomes for the treatment of penetrating wounds, according to Claridge.
Claridge said for every patient with a severe gunshot wound that stays 25 days, they will be touched by about 400 or 500 people, from radiologists to ICU nurses to social workers.
Gun violence injuries treated in Northeast Ohio hospitals have been growing steadily and the intensity of the injuries has also increased. The Northern Ohio Trauma System, a regional trauma collaboration among Northeast Ohio hospitals, treated 1205 gunshot patients in 2021, according to its annual report. Ten years earlier, the system saw half as many patients with firearm injuries, at 557 patients. The mortality rates for gunshot wound patients are also rising, which Claridge said is due to more people coming in with multiple bullet wounds.
Studies show exposure to that increased violence is taking a toll on the people society relies on to save the lives of those caught up in rising violence.
Recent studies of all emergency room staff have found high rates of anxiety, depression and PTSD. The American College of Emergency Physicians said emergency docs are more than twice as likely as the average person to experience PTSD from what they see at work.
And it's not just doctors who are affected.
As the doctors clean up the man's body and move on to their next patient, a 40-year-old Liberian immigrant, Staley Johnson, mops the bloody footprints tracked in the hall by the doctors.
Johnson is an environmental services aid, a cleaner. He has a goatee, wears a small hoop earring in his left earlobe, and sports a pair of white Nike sneakers. He has muscular arms, built by going to the gym a few times a week, which he credits with giving him the energy to power through his regular 16-hour cleaning shifts.
Blood, sweat and chemicals
The trauma bay where the man died — number 14 — is so messy another cleaner, Shraddha Rai, joins Johnson to help disinfect it.
They start by sweeping and picking up discarded medical supplies, plastic wrappers, needles and syringes. They squirt the cleaning chemicals, OxyCide, where blood has pooled on the floor. It smells like strong vinegar.
Johnson likes his work, he said. He likes the long shifts, where he’s dreaming about his bed by the end of it. He looks forward to days off when he takes his girlfriend out to eat a big plate of king crab legs and hunks of corn at his favorite restaurant, Juicy Seafood.
But right now he’s in an 80-degree hospital room, running his mop over a thick pool of blood for the third time. Hospitals keep trauma rooms hot to prevent patients' body temperature from dropping to dangerous levels.
Rai takes off the plastic gown protecting her skin. She grabs a paper towel and wipes her forehead, under her eyes and the back of her neck.
“It's really hot,” she laughed.
This room takes twice as long to clean even with two people. There’s blood spatter on a wall 10 feet away, on cords dangling from machines, under the hospital bed.
Rai said it’s not even that much compared to what she’s used to. She and Johnson have cleaned rooms with gunshot injuries to the head.
Finally, 30 minutes after they started, the room is clean.
"We saw [gun violence] just go through the roof"
Hospital officials at Metro said they saw a dramatic increase in gun violence trauma during the height of the pandemic, and there’s been no sign it’s let up since. That’s on top of all the other traumas the ER treats.
So far tonight, the ER’s seen a busload of school kids being checked out after a collision, a drunk driving accident, a toddler with a burn on their face and chest.
It's not even midnight. A medical resident tells me he’d rate the shift just 3.5 on a 10-point scale.
The tragedy is not lost on the staff. As Johnson takes a break he reflects on trauma room 14 and the life lost there.
“I feel so bad, actually,” he said. “I feel bad for the family. Probably the person had a kid. I don't know what happened there. I have no idea. So, being human, the sorrow came to me, seeing a young man lying down, and he's gone.”
Jennifer King, the codirector of the Center on Trauma and Adversity at Case Western Reserve University, said people who work in healthcare often experience second-hand trauma, which can lead to post-traumatic stress disorder or PTSD.
She said it can be especially hard for cleaners, who may not know what happened in the room.
“So when you think about making meaning or really being able to contextualize an experience, I would imagine that that's even more challenging for the folks … who are on the scene trying to clean things up and just not having any information that could support them in finding some solace,” she said.
"The sorrow came to me, seeing a young man lying down, and he's gone," Johnson said.
MetroHealth encourages all of its ER staff to take time off and provides them with free counseling, said Marcia Emerson, an environmental services manager at the hospital.
But Johnson hasn’t taken advantage of those services in the three years he’s worked here, he said.
He isn’t disturbed by the rooms he cleans, he said. But witnessing all the gun violence has made him more careful at home. He doesn’t go out at night and won’t shop at the grocery store near work.
“I was supposed to go to a Save A Lot around Clark area," he said. "I got information that there's a shooting that went on at a store... It slows down my movement right there. I’m not going to go there, trust me.”
King said workplaces can do more to help staff process what they see, and she thinks they have an obligation to, given the high levels of burnout in healthcare. But no amount of counseling can erase the feeling that violence is around every corner.
This story is part of a series looking into the surge in gun violence in Northeast Ohio. We're talking with residents, activists, victims and policy experts to understand what's driving it, the impact it's having and possible solutions.
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