Viewing Gun Violence Through the Eyes of a Pediatric Trauma Surgeon
To Dr. Jonathan Groner of Nationwide Children’s Hospital, firearm deaths aren’t just a social issue—they’re an illness. It’s an idea Columbus leaders embrace.
As a pediatric trauma surgeon at Nationwide Children’s Hospital, Dr. Jonathan Groner routinely witnesses the gory, sometimes deadly effects of gun violence, though he wouldn’t use that term. Groner prefers to call it “firearm trauma” to neutralize a sensitive, politically divisive topic.
“‘Violence’ is automatically pejorative. People recoil at that,” Groner says. “‘Firearm trauma’ is a purposeful attempt to say this is a public health issue.”
Despite the terminology difference, Groner is on the same page as Columbus officials, who, in February of this year, declared gun violence a public health crisis. “We are seeing an increasing number of kids dying each year in our community from gun violence,” says Dr. Mysheika Roberts, Columbus health commissioner. “There are many of us in public health that feel like gun violence should be treated like other public health issues.”
Groner takes the public health theory to its logical conclusion. He classifies pediatric firearm trauma as a disease. “A disease has a vector, and it’s communicable. It can even be recurrent; you can get COVID twice, and you can get shot twice,” Groner says. “Handguns are typically the most common vector, and there’s a lot of them in Columbus. That’s going to be hard to change.”
But if people think about the widespread shooting of children in Columbus like an infectious disease, Groner argues, they might start funding it that way. In a 2019 University of Michigan national study, researchers found that from 2008 to 2017, an average of $88 million per year was granted to study motor vehicle crashes, then the leading cause of death for kids and adolescents. Cancer, the third leading cause, got $335 million. Yet only $12 million went to firearm injury prevention research.
In 2020, firearms eclipsed motor vehicles as the leading cause of death for children and adolescents in the United States, and the trend continued last year. Homicides also spiked in Columbus the last two years. In 2021, the city recorded its deadliest year yet with 204 homicides, 90 percent of which were reported shootings. Twenty of the 2021 homicide victims were juveniles, and 29 were between the ages of 18 and 21. The numbers were trending better earlier this year, but once the warm weather hit, Groner says he began seeing more gunshot wound victims. “Summer is always trauma season. Kids are out of school,” Groner says. “And firearm injuries definitely went up during COVID. I think that’s a testament to the fact that kids in an adult supervision situation do better.”
In Columbus, like many cities, shootings happen more often in low-income neighborhoods. Looking at a map of Central Ohio, this year’s homicides are maldistributed east-west alongside I-70 and north-south alongside I-71 (with more incidents north of the I-70 divide). Examining it through a public health lens, gun violence is a disease of poverty that disproportionately affects Black residents.
Groner, the trauma quality medical director at Nationwide Children’s, advocates for “community-based interventions” to stanch the flow of gunshot wound victims pouring into the hospital’s trauma center with disturbing regularity. His approach shies away from specific policies and legislation; rather, the hope is to “change the culture” around guns.
Commissioner Roberts sees it similarly. “Why do our youth, as well as adults, feel the need to resort to using a gun?” she asks. “That’s a deeper issue.”
Karla Harris, a co-founder of the nonprofit Mothers of Murdered Columbus Children, says the teens she speaks to tell her that getting guns is as easy as trading PlayStation games. “Never in a million years would you think that a 15-year-old you just walked past is carrying a weapon, but [often] they are,” she says. “Why do they feel like they have to do that? Why?”
Harris hadn’t heard someone refer to firearm trauma as a disease until Groner’s statements. “It makes so much sense. It gave me chills. … It absolutely is a disease, and it’s contagious.”
Groner’s beliefs, of course, have been shaped by a career spent trying to save the lives of gunshot victims. It’s a unique perspective, to say the least, and it’s easy to imagine that more people might feel differently about guns if they saw their devastating impact as Groner and his colleagues do.
The trauma center at Nationwide Children’s Hospital is always at the ready, whether it’s 4 p.m. or 4 a.m. A fully equipped operating room must be available at all times, along with staffers from multiple departments: surgeons, hospital security workers, anesthesiologists, respiratory therapists, blood bank technicians and more.
“We have a great EMS system. When paramedics get called and they hear a kid’s shot, they always hurry. They know that’s something really, really urgent,” Groner says. “I still carry a trauma beeper. If it goes off and says, ‘level one gunshot wound,’ everybody drops everything and runs down to the trauma room. … The operating room nurse will show up, and I can call him or her and say, ‘We’re coming up.’ Then it’s off to the races.”
Sometimes the wound isn’t too serious, but usually it is. “When kids are shot in the head, there’s often very little you can do. If a bullet crosses both sides of the brain, they’re going to die. It’s terrible,” Groner says. “We can save kids with abdominal gunshot wounds, but they can bleed to death fairly quickly, so it’s like watching a pit crew video: You gotta go, go, go.”
Kids tend to have robust cardiovascular systems, so sometimes they can look OK, but Groner has learned not to trust appearances. “Because their hearts are so strong, they can sometimes hide the fact that they’re actually bleeding to death,” he says. “Their blood pressure doesn’t drop until they’re just about to die.”
The first goal is to stop the bleeding. Adults have about 5 liters of blood, but kids are smaller, which means less blood. A child can bleed to death in 15 minutes. “If someone gets hit in a blood vessel that has a name, like aorta or cava, they’re not going to make it to the hospital alive. But if a bullet goes through the belly, they can still be bleeding to death from blood vessels that don’t have names, because the bullet will go through a bunch of them,” he says. “If they’ve got holes, they’re bleeding.”
Minimally invasive surgery is not an option in these cases. “This is a big incision—really big,” Groner says. “You open the belly. There’s blood everywhere, obviously. … We have something called the massive transfusion protocol, which means that if we call the blood bank and say someone’s bleeding to death, they automatically send … not just the red blood cells, which carry oxygen, but also the things that make the blood clot, too.”
Groner takes big, white squares of gauze called laparotomy packs and places them in four quadrants of the belly, holding them there with his hands, tamping and applying pressure in hopes of slowing down the bleeding. “Once the vitals look a little bit more stable, then you go quadrant by quadrant, unpacking and looking to see where the bleeding is coming from. If you can hear the bleeding, that’s really bad,” Groner says, noting that a lot of times, abdominal gunshot wounds rupture the intestines, which have a rich blood supply. “Then you just have to start fixing holes. … You can sew shut bleeding vessels, you can clamp them, you can tie them, but you got to stop the bleeding, or the patient will die.”
Kids also get cold faster than adults, and if their body temperature gets low enough, they won’t stop bleeding. So Groner and his staff have to keep the patient warm in the operating room. Sometimes, if the patient is getting too cold, Groner has to halt the surgery.
“The damage control laparotomy is where you fix everything that’s making them die the first day, and then you come back the next day, and hopefully by then they’re warmer and they’re more stable and their blood has been replaced and you can start putting the intestines back together and fixing the things that they need to survive long term,” he says. “It’s not uncommon for a patient with a gunshot wound to have more than one operation, sometimes three or four.”
All the while, Groner tries to focus on the anatomy rather than the high-stakes significance of what could be an utterly heartbreaking, emotional procedure. He’s analytical in his approach—a necessity for any good surgeon—but Groner’s natural state of being also tends toward logic and a matter-of-fact way of looking at problems and solutions. “I’m somewhere on the autism spectrum,” he says at one point during a conversation in the hospital’s faculty office building on Livingston Avenue, where vivid photographs from his travels to Africa hang on a wall opposite framed black and white photographs by his father.
While some doctors can recall certain moments that inspired them to enter the medical field, Groner recounts his background like a resume recitation, tracking his career from growing up in Chicago and going to medical school at Northwestern University Hospital to his years at the Medical College of Wisconsin in Milwaukee and Children’s Hospital of Philadelphia, plus a brief stint overseas in Oxford, England, where “nobody gets shot.” In 1991, he brought his family to Columbus (now Nationwide) Children’s Hospital, where he eventually became the trauma medical director.
“There was a change in leadership, and they needed someone to run the trauma program,” Groner says, underselling the accomplishment. “I don’t know if I’m well-suited to [pediatric trauma surgery]. But this is what I do.”
Dr. Rajan Thakkar, who succeeded Groner as trauma medical director in 2020, describes his mentor as a smart physician, a great teacher and a committed advocate for children.
“Taking care of children, you not only have to have the child’s best interests in mind, but you have to advocate for them, because they can’t voice their own concerns. Sometimes they may not be able to communicate at all,” Thakkar says. “He’s always going to do the right thing for the patient and their family. He is always going the extra mile to make sure that the child is getting the care that they should receive.”
That’s why even someone as clinical as Groner has moments where the weight of pediatric trauma work—attempting to save the life of a child who, in a just world, has decades of life yet to live—can sometimes penetrate his thoughts. “There are certain operations where I get this existential fear that the patient’s going to die,” he says. “It’s not common, but there’s something creeping in, and you got to push it out and just focus, go back to the principle: Stop the bleeding.”
The surgical interventions he performs may seem gruesome, but they’re often effective. “If someone gets here and actually has vital signs and they aren’t shot in the brain, the odds that we can save them are actually really, really good,” Groner says, though it doesn’t always work out that way. “I’ve had to talk to families when things did not go well. … That’s really hard.”
Columbus City Council President Shannon Hardin knows what it’s like to talk to parents about losing a child. In 2019, friend and community activist Jasmine Ayres challenged him to better understand the pain and damage inflicted by gun violence. So Hardin began calling the families of every Columbus homicide victim under the age of 25 about three weeks after the incident.
On his calendar, Hardin sees the victim’s name and age, the relative’s name and any background on the homicide case. “To me, it is always shocking,” Hardin says, adding that 99 percent of the time it’s the young victim’s mother taking the call. “I made two calls yesterday, one to a mother of a 14-year-old, and that just strikes me—these are really children. … These are their babies, and they’re gone. And I think that is also helpful for me as a policymaker with how we talk about these types of homicides and the compassion and empathy that we must have.”
The frequency of the calls also helps convey the magnitude of the issue. When Hardin first started dialing grieving mothers, he was doing two a month at most. “In 2021, there were weeks where I would do six or seven calls,” he says.
Hardin supports the public health approach to gun violence and Groner’s belief that pediatric firearm trauma is a disease. “This is an illness that is plaguing and that is spreading among our young people,” Hardin says. “I think it’s 100 percent the right way to view what is going on.”
Hardin also argues it’s important not to let the Statehouse off the hook. “Children are dying of gun violence in our cities and around the state, and they are doing absolutely nothing. Matter of fact, they are holding back cities and preempting our ability to do anything to protect our people,” he says.
In late June, Mayor Andy Ginther hosted a press conference touting the recovery of about 1,500 illegal guns in the first half of 2022. Both Hardin and health commissioner Roberts also mentioned several city-backed initiatives meant to address shootings, such as VOICE, a Grant hospital partnership that stands for Violence Outreach, Intervention, Community Engagement. The program is a “direct response and outreach to gunshot victims. They go into the hospitals, and they work to make sure that another [shooting] doesn’t follow,” Hardin says. “The team is having to grow because the disease is growing.”
Additionally, Roberts expresses a need for more and better data, advocating for a “community dashboard” to track gun violence metrics—an idea Groner has separately championed. “You need to find the hot spots. To find the hot spots, you need to have the data,” he says.
Compared to other public health issues, progress on firearm trauma can feel remarkably slow. Groner cites how much attitudes and behavior have changed regarding seat belts, drunken driving and smoking. He remembers a cardiologist smoking between appointments in medical school in the 1980s—an unthinkable scenario now. And just like those public health crises, Groner believes health care professionals have a role to play in talking about firearm trauma.
“I think a lot about how we responded to COVID here in town,” he says. “All of a sudden, we were testing in schools and all this stuff. What if we could do an intervention with firearms, too? Let’s talk to all the kids in school, find out who owns guns and find out what we can do to convince them not to carry them.”
He advocates for talking about gun safety, particularly safe storage, in doctor-patient situations like prenatal counseling. “Say you have a family come to the office, and you’re a pediatrician or OB-GYN,” he says. “When they’re trying to get their house ready for a new child, it’s like: Make sure the bathtub temperatures aren’t too hot; make sure the kitchen cabinets are locked. But you can put firearm safety in that as well, right? … If you consider firearm trauma as a disease, it’s just disease prevention. It’s the same thing as hot water, dangerous chemicals, car seat safety. There shouldn’t be a reluctance to talk about that.”
He also thinks about strategies that don’t work, like “scared-straight programs where you take the kids to the morgue and show them some dead body with bullet holes in it. These kids are already traumatized. You don’t need to traumatize them more.”
Despite the slow progress, the record-high number of Columbus homicides in the past two years and all the cultural battles being fought over guns, Groner is optimistic. For one, because the violence is so bad, people are paying attention to and talking about it. “We are definitely further down the road to appreciating firearm trauma as a disease than we were five or 10 years ago,” he says.
Plus, trauma care has come a long way. When Groner started his medical career in Wisconsin, “the whole intensive care unit was six beds and something that looked like a closet.” Now, state-of-the-art trauma centers are the norm. “People who [previously] would routinely die now survive,” he says. “They just have to get here with a heartbeat.”
Of course, Groner would rather not make big incisions on children and pack their bellies with gauze. He’d love to put himself out of business and never have to operate on a child with a gunshot wound again. Even with all the remarkable advances in trauma care, the best way to save a child’s life is still this: preventing a shooting from ever happening in the first place.
This story is from the August 2022 issue of Columbus Monthly.