Institutions of Love

The first thing I noticed when E. walked through the doors of the examination room was the gauze somewhat messily applied around her neck. Her boyfriend, J., guided her to the chair, gently removing her coat as she sat down. E. moved gingerly, each extension, flexion, and rotation of the extremities deliberate and cautious. I observed as she sat down. Her stoic countenance betrayed hints not of acute pain, but profound exhaustion. Dr. P walked in, his distinctive smile and firm yet reassuring demeanor instantly lighting up the room. He greeted E. and J. then sat down next to them. “So, can you tell me a little bit about what happened?” As a new scribe at the Bullet Related Injury Clinic (BRIC) in Saint Louis, I began taking notes as Dr. P spoke with the patient.

E. and J. had been on a routine walk at the park when they suddenly heard a deafening bang. Disoriented, they ducked for cover, then fled back to where they had parked their car. It was only after getting in the car, E. recalled, that J. noticed the dark liquid spilling down the side of E.’s neck, already staining her shirt a deep crimson. E. had been struck by a stray bullet from an exchange of gunfire that had occurred just meters away. J. drove E. to the emergency room, where she was stabilized and received first-aid care. 

E. let out a quiet sigh as she began describing her experience at the ER. After she was deemed stable, she was discharged without guidance, support, or follow-up. Meanwhile, J. had been taken aside and questioned aggressively by the police – treatment he believed was linked to both his identity as a Black man and the stigma of gun violence. I glanced over at Dr. P, whose eyebrows were furrowed with concern. He asked E. what her primary concern at this moment was. E. responded by asking when she could return to work, as her family depended on her as a financial provider. 

I was stunned. I thought I had prepared myself for the stories I might encounter while volunteering at the BRIC, but the stark reality of the trauma I had just been confronted with still hit me like a wave. The bullet injury was the catalyst. E. and J.’s interactions with the police and hospital as Black, uninsured, and economically disadvantaged folks yielded neither justice nor complete healing, but unfortunately, further injury. As excellent and caring the staff at the ER may have been, the infrastructure to support E. after she walked out of the hospital doors simply was not there. Without any professional resources or guidance, E. was sent home to contend with an infection-prone wound to the neck, the psychological scars of a bullet-related injury, hospital bills, and an unstable financial situation. The result of these institutional-level insults was a generalized erosion of trust between patient and provider, apparent through E.’s guarded demeanor throughout the patient interview.

Fortunately, Dr. P seemed to know exactly what to say. He took the time to explain to E. and J. how the energy of a bullet not only damages the body, but also causes the body to respond to the trauma of injury in pathologic ways. He counseled E. on nutrition, sleep, and regulating thoughts and mood. He referred her to the in-house social worker for assistance regarding her financial situation. Dr. P asked me to help hold some wound dressing supplies, and we showed E. ways to dress her wound to maximize healing and comfort. 

Over months of follow up visits, I watched E. gradually heal from the trauma that had been weighing heavy over her head. In the couple of years I spent at the BRIC, I witnessed dozens of such stories of healing. Through these encounters and through numerous conversations with Dr. P, I came to appreciate the humanistic vision that informed every aspect of the BRIC’s operation. From the moment you walk through the door, the calming smell of incense, the music playing softly, the professional yet intentionally approachable dress code of the providers, the abundance of time allocated for each patient encounter, the bullet removal procedures, the care package given at the end of every visit – all carefully curated to build the trust necessary for healing. 

My time at the BRIC brought me face-to-face with the devastating violence of bullets, the systemic racism in healthcare and law enforcement, and accounts of immense pain and human resilience. It also showed me a model by which we might take a step towards healing the enormous trauma I saw in my very first patient encounter at the BRIC. Trauma exists in numerous forms, from gunshot injuries to motor vehicle accidents, to poverty, to sexual and domestic abuse. What E., J., and all the patients at the BRIC taught me is that trauma runs even deeper than such individual traumatic events – it is insidiously woven into the very fabric of our social institutions. Likewise, while acts of benevolence by individual healthcare providers are essential to the practice of medicine, they are not a sufficient antidote to the pernicious perpetuation of trauma which occurs in gaps in and through institutions themselves. The BRIC started as a collection of volunteers in a makeshift, small space. Yet, the vision of this humble clinic is a monumental one, a vision I believe should be studied and applied widely despite any practical obstacles that may arise. If we are to act against the pandemic of trauma, we must build institutions of humanism, kindness, radical generosity, and love.

From the author: After graduating from college, I spent a couple of years volunteering at the Bullet Related Injury Clinic (BRIC), an outpatient clinic for people recovering from bullet related injury. My experiences there showed me how gaps in the healthcare system intersect with social determinants of health to perpetuate trauma and distrust. In this essay, I reflect on a particularly impactful patient encounter and how it informed my understanding of trauma and healing.

Josh Kim is a medical student at the Icahn School of Medicine at Mount Sinai. He was born in Seoul, South Korea, grew up in Cupertino, California, and graduated from Washington University in St. Louis. In his free time, Josh enjoys training Brazilian Jiu-Jitsu and exploring the NYC music scene.