 Good afternoon, thank you so much for coming today. On behalf of the McClean Center for Clinical Medical Ethics and the New University of Chicago Trauma Center, I'm delighted to welcome you to the first lecture in our 2017-18 lecture series. The title of the series is Ethical Issues in Violence, Trauma, and Trauma Surgery. The series will consist of 24 lectures and will meet during the fall, winter, and spring quarters. The lectures will focus on violence and trauma and how they can be addressed and reduced in cities and neighborhoods throughout the United States. Our special focus will be on the city of Chicago. Speakers in this series will include next week Dr. Julie Morita, who's the commissioner of the Chicago Department of Public Health, talking about the city's efforts to reduce violence. Several weeks after that, Pastor Chris Harris from the Bright Star Church in Bronzeville will speak. Brad Stolbeck, who's here today from our Department of Pediatrics and who runs the Healing Hurt People program will be part of the series. Arnie Duncan, the former U.S. Secretary of Education, who's come back to Chicago to work on the issue of violence and many other representatives from Chicago. We also, in the course of the series, will host many of the leading trauma surgeons in the United States, and that brings me to our distinguished speaker today. We're delighted that the keynote speaker in the series is Dr. Selwyn Rogers. Dr. Rogers is the founding director of the University of Chicago Trauma Center, which is scheduled to open on May 1st of 2018. Dr. Rogers is professor of surgery, chief of trauma and acute care surgery, and executive vice president for community health engagement. Dr. Rogers and the University of Chicago Trauma Center are co-sponsoring this lecture series with the McLean Center. Dr. Rogers will also serve as the co-editor of the book that will be based upon this lecture series that Springer International will publish in early 2019. Dr. Rogers graduated magna cum laude from Harvard with a degree in biology, received his MD from Harvard Medical School, and completed his general surgery residency followed by a critical care fellowship at Brigham and Women's Hospital. Dr. Rogers also holds a master of public health degree from Vanderbilt. Dr. Rogers served as chief of trauma, burn, and surgical critical care at Brigham and Women's for eight years, and prior to coming to the University of Chicago, Dr. Rogers had been chair of the Department of Surgery at Temple University in Philadelphia, and also as vice president and chief medical officer at the University of Texas Medical Branch in Galveston. Dr. Rogers is published widely on health disparities and the impact of race and ethnicity on trauma care and surgical outcomes in underserved populations. He's a nationally distinguished trauma surgeon and has a deep belief that trauma surgery is a necessary technical answer to the underlying and more fundamental question of how to reduce trauma and community violence. Today, Dr. Rogers talk is titled, as you see, intentional violence as a disease bending the moral arc toward justice and healing. Please join me in giving a warm welcome to Selwyn Rogers. Good afternoon. I apologize, because I was commenting to Cal-West earlier, a few minutes ago, that I'm not my best self. I'm not my best self because I'm recovering from a viral syndrome I picked up in Italy. Don't feel sorry for me. It was a great trip, but I got back on Sunday. Got sick in Rome, but continued on to Florence and Venice, and for those who get a chance to, it's all good. However, I am going to, I'm gonna move this up a little bit. I think there's a little control in the back as well. So I give you that as a framework because my voice is not gonna project very well, so I appreciate the volume control that Matt just did up in the booth. I'm gonna try to do something in the next 50 minutes and then we have about, I hope, 30 minutes or so of Q and A, where the singular, I think, will moderate the challenge that I'm gonna put before changing the hearts, minds, and souls of people in this room about intentional violence as a disease from whatever framework that you've walked into the room with today, and to share a perspective and an opportunity to tackle this incredible problem in a different way, and the opportunity to do that does require an all-hands-in-a-perch that hit a four we may or may not have done. So with respect to any talk, it's important to know your audience and I need to get a quick sense of who in this room has an affiliation to the University of Chicago making the distinction between University of Chicago and University of Chicago Medicine. University of Chicago, University of Chicago Medicine, the community, the communities, everybody's a member of a community, so that's all actually all hands. That was a trick question. So it's gonna be a bit of a whirlwind tour, but bear with me an all along the way, think about the questions that you wanna ask to enrich this dialogue even more than the thoughts I'm about to share. So this is the guideposts. I hope to frame violence as a complex disease. Secondly, I'm gonna use Chicago as an example of the interplay of socioeconomic and other factors that lead to the outcome of violence. And lastly, I'm gonna frame that in an ethical framework. Any one of those objectives by themselves should take more than an hour. I'm gonna try to do that in 50 minutes, but really be enriched by the dialogue that happens afterwards. Violence is a disease. It's important, I think, to first start with definitions because I think it's easy to actually not be on the same page with what we're talking about. But before I define violence, I think it's important to define health. So if I walk across this floor, I don't have one of those clickers, but I'm gonna ask this room, show our hands. Yes or no? Am I healthy? At least one person thinks I'm healthy. Nobody, everyone else thinks I'm sick. So with this definition of health, I'm gonna say to this room that no one in this room is healthy. This is an aspirational goal because who in this room has a complete 100% state of physical, mental, and social well-being and not just the absence of disease or infirmity? I don't think anyone can make that claim and if you can, you would just be born. Because we all struggle every day with some component or many components of this definition. But this larger definition of violence is even more challenging because we all can recognize violence when we see it. Well, at least we think we can. And these are both definitions of health and violence defined by the World Health Organization in 1948, decades and decades ago, and there's still the definitions that are applied today. So if you take violence as intentional use of physical force or power, threatening or actual against oneself, another person or against a group or community that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation, that's a very all-encompassing definition of violence. And so in some ways, when we see economic disinvestment in some communities over others, that's a form of violence too. We often think of violence in one and one, one person and another person. Well, as I showed early today with the McClain Ethics Fellows, my six-year-old punching my nine-year-old at the time 10 years ago in the mouth because he kept calling him Velcro Boy. That was created because at the time, my six-year-old was now 15, couldn't tie his shoes so he had Velcro sneakers. And he got teased over and over again and he got mad. And the response in a hotel room actually a hotel lobby to that being teased was to punch his nine-year-old brother in the mouth and lead to significant bleeding on the lobby floor with blood everywhere. And I, the trauma surgeon, just wanted to shrink and disappear. But it also was a teachable moment about how you resolve conflict, a teachable moment about what violence is and how it affects people because he felt sorry afterwards. But it was not the end of that story because the story continues and they still spat but it still spats now. It's not physical. The challenge is when there is a presence of violence, how can one possibly be healthy? It can't even be an aspiration because it's a hard state to get to if you're surrounded by violence. So that's a first premise. This is a complex model that I'm gonna leave out, not to walk through, but it's just one model of the interplay of many factors that can lead to the outcome of violence. Individual, social, economic, availability of guns, laws, policies, racism, social structures, disparities, segregation. All of these things are interplaying, interconnecting aspects, factors, that can lead to an end result of violence. But overwhelmingly our narrative in our society hardly ever mentions any of these things in the context of the outcome. I'm actually a comfortable enough speaker and staying on time, if people want to interrupt, I'm good with it. And if not, I'll keep going because I know where I'm gonna end up like in a good talk, I know where I'm going. So we have put together an incredible, I think just incredible series of talks over the next year. And I gotta give the Seagler credit, he and Dr. Angelo sitting up there, it was literally day two. I showed up January 5th, 2017 and I'm out in my own business trying to figure out where the next bathroom is because I still was getting confused about the offices, did I go left or right to get to the newest bathroom? There was a request for a meeting and I'm thinking to myself, no one should know me. Why does anyone want to meet with me? I just got here. And turns out I had to do all of this onboarding stuff that everybody knew through the institution. Anywhere you go has to do onboarding. And it was a lot of things. And so I showed up on a, I flew in 70 degree Delta between Galveston, Texas where it was 75 degrees Chicago where it was five degrees. And I said to myself, I am committed because I was on the beach two hours ago and here I am in Chicago. And I forgot that your feet get cold if you're not wearing boots. And I had to go get some boots. I also didn't have a pillow because my furniture hadn't arrived. So I was looking for a bad night of sleep. And I said I can't meet, but Dr. Siegler persisted. And so Friday we met. And I knew he was committed when it wasn't Friday at eight a.m. at noon. It was Friday at five p.m. because that's the only time that I had a bill. And he and Dr. Angelo showed up and told me that he was actually trying to sell me something. And the pitch was I have this great idea. You don't know me. You don't know about the McLean Center for Clinical Maths College. You don't know anything about the institution. You still say, but I got this great idea. And the pitch was this, but it was just an idea. And that idea is what you're gonna see over the course of the next year, focusing on violence, trauma surgery, and the ethics of trauma care. And I can't think of a more important series on the framework of ethics with respect to trauma care than this one at this time of this context. And I hope those who are local, and I think all of you are, if you get a chance to come back for some of these distinguished speakers from across the country and locally, you're gonna have an incredible intersection from faith healers, to legal, to advocacy, to public health, governmental, non-governmental, to address what I hope to this point, you all believe is a complex problem. And it's really these interlocking circles are the only real way forward to sustain a goal of no harm from intentional injuries. So I gotta frame this in the local context because I think many people in this room are aware of the local context, but it's important to kind of start from that framework. Point of works, perfect. So this kind of got national attention once it kind of did. In my nine months here so far, the gestation of a child, I'm not pregnant. In the gestation of a child in the past nine months, I've had some interesting interviews, talks, meetings, dialogue. One of the most interesting ones to me was LaMoune, which is one of the world's national, I mean global newspapers, Paris, Parisian newspaper, flew over here to interview me about violence in the city of Chicago. And my initial response was, I don't wanna be interviewed. I know nothing, I'm humble, I'm just here, I just showed up. But they wanted to interview from the perspective of trauma as a disease, violence as a public health issue, and I said, this is a great opportunity to change the narrative, I thought it was, would add value. And at the time, Lorna Wong, who may not be here, she was like one of my early, and I have a lot of them now. I'm north of all of them, house, I mean, house meeting, hospital, spouses, you know, people who just, they have to lift you up because there's so much work to be done, so she's in communications and she said, you should do it. So I said, okay, fine, I'll do whatever you tell me to do. That's kind of what I do in my fiancee background. We're going to Italy, yes, honey. And he wanted me to introduce them to gang bankers. And I said, what? She said, yeah, go take me to some gang bankers, I wanna interview. And I said, yeah, and by the way, this was after me giving a framework of process disease complex into play, public health, all of that. His line, a story that was never written, was he wanted me to facilitate his interview with gang bankers. So it turns out that story was never written, which is why you haven't heard about it until today. But the narrative is so powerful because it dictates everything. The words we use, how we use the words, they have meaning and that meaning transforms into actions, those actions transform into policies every day. And this became very powerful because it became part of a national narrative during the presidential election. I don't know how many tweets there were about Chicago and violence, but the city of Chicago became emblematic of violence in urban America. So much so that people became associated with it too as if they were unique to the city of Chicago. But I challenge this room to say, why was this number any more powerful than this number, this number, this number, this number, those numbers? Because each of those numbers represent a lost life to homicide, 97% gun violence, and not just the individual who was lost, but the impact that had on every single one of their family members and their close contacts. And that story is often not told about the impact to individuals, close contacts, secondary contacts, what happened in schools. February 14th this year, Valentine's Day for some, there were two homicides of kids less than the age of 10. And the thing that was just incredible, sad about that is that in classic fashion, obviously the kids had nothing to do with it, right? They were just bystanders, but they weren't really bystanders. They were victims of their setting. They were victims of their neighborhood, their community, their proximity to violence, and the both traversed them and ended their lives. But we don't hear those stories beyond the sensational day or two or three. About a month later, there was a story about three young men all in the early 20s, three, all found dead a day later after their homicide in the back of a car. One was found in the front seat, bolt went to the head, the other was found in the back seat, and one was found in the trunk with a bolt went to the head, three young men. That was a powerful story. I don't know how many people in the room remember that story. Next week, Chicago Tribune ran a story about one of those men. And the story that they ran was about the fact that that young man, who's now dead, you know, as a February, 10 years before, a decade before, wasn't in the news. But he wasn't in the news for a different reason, because he lived in Cabrini Green, and his younger brother, two years younger than he, fell to his death at the hands of two other teenagers when he was let go on a candy shakedown. And the thing that was really powerful about that story, to me, as a father of three African-American men, boys, boys to me, boys to men, but the thing that was really powerful to me was I really wanted to know between the time that young boy witnessed his brother, little brother, drop, and then he ran down the flyer stairs to catch him. I really wanted to know what happened in those intervening 10 years. What mental health counseling, what services, how to use school, what's the social connection. I really wanted to know that, but I never got that story. And the challenge that this story, and this number has, is that we're on a pace to do the same thing this year in this city. The problem is, in my mind, is that if this was isolated in Chicago, maybe we could do the wall thing. We'll just bury up a wall. No, I was kidding, that's a joke. But the reality is, Chicago is not unique. Before this talk, would people in this room know that the murder capital in the United States of America is indeed St. Louis, by rate. That's suburb, four hours south of us. Actually that's what Chicago thinks about St. Louis, I understand, the Cubs and the Cardinals. But that is amazing to me, but look at Detroit. By the way, I lived in New England for 30 years of my life, and until I really got into this work, living in Boston, I would not have put Hartford, Connecticut in the top 20, and it is. So the problem is not unique to Chicago. The challenge, and I think the reason why this became such a national story, is because it seemed to be new. If you could read the caption here, published September 17th, 1985. Croming the ghetto, everybody pays a price. Blacks suffer the most, but urban terror touches us all. September 2017, Chicago hit 500. October 4th, or is it 5th? Today's October 4th, I'm pressured, I wonder if I had October 4th, we had 530 homicides. So how do we respond to that? One of the opportunities going beyond patching people up and sending them back into the same environment in which they were shot, stabbed, or assaulted. We often focus on this element, to traumatic event. In many ways, that's what the trauma center here at the University of Chicago Medicine will address. But oftentimes, that focuses on pre-hospital care about Chicago Fire Department and inpatient care, post-acute care. We have some element, some impact upon rehabilitation, because at the end of the day, from the perspective of someone who's been a victim of trauma or violence, the outcome is not measured by whether or not you survive. In fact, many people think that survival is actually sometimes worse, because of what else happened to a victim, losing an arm, losing a leg, losing function, losing the capacity to think, to feel, to love. Beyond that, the other person that was injured and how that affected that person who was left with nightmares and post-traumatic stress disorder and hyperarousal and never the same again. The question is, how can you actually focus on that recovery? And that's really hard work, because that's not restoring physiology. That's not fixing damaged blood vessels. That's not repairing the iliac vein. That's restoring someone's soul. That's really hard work. I actually gonna go back for a second, because I focus right away on this. And that's what myself, Dr. Vrakash, Dr. Wilson, Dr. Bendick's left, Dr. Cohn, our new trauma faculty, Dr. Anna knows away, but that's what we got trained to do. And we're very good surgeons. But what if you spent all that emotional, physical, psychological investment restoring someone's physiology and the outcome after they walk out the door is that they get returned to the morgue. Have you done anything? Have you made any impact? Have you made any difference in that person's life? And that's often driven by the built environment and lived experiences. So when you look at the built environment, that means where you live, work, and play. And some, when you look at the aspect of healthcare disparities and disparities in mortality, if you live in Chicago, within the loop, your average life expectancy is 85 years of age. If you live in Washington Park, half a mile from where I stand, your average life expectancy is 69 years of age. 16 years, eight miles in a great city called Chicago. But that doesn't even tell you anything about the lived experience, the quality of one's life. It just tells you a number. And there are so many overlapping parts of the lived experience. If you look at elevated blood levels and housing, they parallel the western south sides of the city of Chicago. And one would say from the lived experience, this is the highest level of mouth-thoves hierarchy of needs, self-actualization. However, you can't get to self-actualization if you don't have physiological stability, blood pressure, heart rate, ability to think. But the next one is safety. Nobody would be in this room unless you felt safe. It's foundational to this aspirational goal. And if you look at the impact of poverty, and if you accept that poverty is not random, and poverty is a marker, socioeconomic determinant of one's health, those who are poor are affected in their reading achievement. Intentional intelligence quotient. And disproportionately, black and Latino people, black and brown people of the city of Chicago are poor. And this is what I shared earlier, that the distribution of health slash illness is not random. Geography matters. And with a traumatic event, this is a framework I'm gonna share with you, so you take, and this example gets repeated over and over and over again in every urban setting in the United States of America. You can change the age of 17, you can change the ethnicity from African-American to Hispanic, usually male. Change to 25, 35. Cigarette wound to the neck, posterior triangle for those non-autonomous, it's a kid that took care of what it was in Nashville. And he kept screaming for mommy. After he screamed for mommy, I'm not scaring your dog, am I? So after he screamed for mom, he actually checked it okay. He had one of those magic bullets, it was fine. But was he? And I'll share with you that, I actually decided to admit this kid because at the time my kids were teenagers and I just had the soft spot. I couldn't just imagine, just send this kid home. We didn't have healing hurt people, there were no psychologists or therapists, but I just knew that I just didn't feel right if I just sent this kid home, even though he was physiologically fine. And I thought I built a relationship with him and we had a discussion, I was looking forward to seeing him and follow up on clinic and I really, I felt like I'd done something as a doctor. And the question is, after all of the classic things, you gotta find and let him go, right? I can't adopt him, am I gonna bring him into my house? He's not gonna become my child. So he went home, what should have happened? That's a rhetorical question, don't answer it. We'll do it out of Q and A. But nothing else happened. What interactions should have had with his family? Again, this is a true story. It's still down to bullets. Six weeks later, up until those six weeks, I actually had forgotten about the kid because I went through a whole bunch of other stuff, right? Trauma surgeon, busy, work, writing papers, doing grants, getting a massive public health advantage, blah, blah, blah, blah, blah. And then the kid's on my schedule. I recognized the name, but didn't remember the face. But as soon as I saw the face, I remembered the kid. It just all came back to me, oh, doop. And I went back to that place and I remember the bond that I felt I was baking. I said, hey, you hear the, get me to take a look at your neck. You know, I thought you would be here like two weeks ago, I mean, actually four weeks ago. I thought, well, you know, anything going on? I said, hey, I mean, what are you talking about? That's what he said to me. What are you talking about? I'm like, I mean, you're here to get your neck wound checked, right? He said, I'm here to get my staples out. In those intervening six weeks, you've been shot again in the abdomen, in the liver, in the small bowel, and I said to myself, have I done anything to make a difference in this kid's life? And how many times do we repeat that story across country? And the outcome is actually not as gratuitous this kid. But actually, I don't know what happened to this kid. So with respect to the ethical frameworks, there are four guiding principles. Respect for autonomy, self-determination. You can debate whether or not a 17-year-old, even a 21-year-old, my kids are 21, 18, and 15. My 21-year-old does not have self-determination. I'm still working on it. But there's a personal rule of self for those who have self-autonomy. That is free from both controlling interferences by others and from personal limitations that prevent meaningful choice. And that's secretly taking notes, but I think these are all the questions that I would love for us to explore in the Q&A. How does poor mental wellness and toxic stress be fuddled, the ability for agency and autonomy? And what is our responsibility as healthcare providers, nurses, doctors, any interaction with the health system? What is our responsibility? Benefits, actions that are done to benefit others. I would say that we're all challenged to provide the best possible care for every patient who walks in the door. Do we achieve that? Knowing what I've shared with you thus far. Non-malfeasance. We have an obligation not to harm others. And this may be the controversial one. Do we further harm if we only treat and street victims of intentional violence? This one I can have a lot of debate about, not myself, but with whoever disagrees, because to do it, not to act is not to do. And then justice. We have an obligation to provide others what they are owed or deserve and to impose no unfair burdens. And in this age, I have so much concerns about income inequality, healthcare disparities, discrimination, racism, white privilege. This gets really touchy in a pluralistic society to have dialogue about, because it gets at the issue of values, which is really hard to legislate and really hard to adjudicate. This is my only science-y slide. This is a science-y room, but everyone doesn't come, I know former FBI guy, this may not be the science that you're used to. This is what we call a Kaplan-Meier curve. And it's used to look at survival over time. So survival is on the y-axis up-down, x-axis across, and years is this charge, is what the parameter is on this axis. But this is not a chemotherapy or radiation therapy intervention trial. This is an observational study done by one of my colleagues from the program. Who looked at universal Maryland shock trauma data over a decade, and the two curves here, top curve, the solid line, are the people who have been the victim of violence once and only once. And the bottom dotted curve is people who have been the victim of violence two or more times. And the striking thing about this separation of curves, by the way, you want to be on the top line if you had an option. You don't want to be in either line. And we'll get to that in a second. But if you're gonna be in either one of these lines, you want to be on the top curve. But the interesting thing is that the people who died on the bottom curve, even though they're victims of the second or third or fourth or fifth, or more violent episode of trauma, didn't all die related to that trauma. In fact, across the country, and we have a very recent study example of this, where 527 people, one day, 15 minutes, were injured by gunfire. That's where 59 of those people died. That's a case fatality rate of just over 10%, which is actually not uncommon, because unless you really intend to kill someone and shoot them point blank in the heart, correct me? Or in the head, people actually do survive. But we also don't think about what's left behind, what the impact of that survival is, what that life experience is afterwards. So the question here is, is there an opportunity to intervene in the lives of people after they've been injured, as will become the University of Chicago Medicine, and change the arc, so they go from the bottom curve to the top curve. But also part of this conversation that we are gonna have is what's the role of never being shot in the first place? Primary prevention. Because at the end of the day, the best trauma center is the one that's like a firehouse. You're glad it's there, provides this degree of safety for bad things when bad things happen, but you never need to use it. That would be the ideal trauma center. This is a study I did a couple of years ago that looked at this other issue of recovery, and the thing that's striking about recovery is that you can survive the hospitalization, and in some ways we often think about trauma as one of the purest forms of health care delivery. No matter how you get injured, no matter the contacts you get to the hospital, you're gonna bleed the same, you're gonna get the same operation, you're gonna get the same outcome. But that's not really true because anyone who's ever suffered anything traumatic, recovery doesn't end because you get discharged from the hospital, because the important role of rehabilitation. And really from the person's perspective, the most important form of recovery is return of function, especially return of function around loving, living, playing, praying, doing all the things that you could do before. And oftentimes, other part of this that we don't address is what's the emotional, psychological, social impact of that traumatic event. That's the thing, that's the real, real hard work that we've mastered anatomically exposures to trauma. We've figured out that doing a 12-hour operation in someone who is hypothermic, quagmopathic, that means they're the blood students, thin, they're too cold, doing a long operation in that person almost invariably needs a death. And we've learned ways, approaches, techniques to address that problem. And we can weather a lot of people through some really bad stuff. But this stuff, healing the mind, the spirit after the trauma, we don't know how to do this. At least we don't know how to do it well. And hospital-based violence recovery programs, and this is a bit of a long definition, but it's an operational one. It's a multidisciplinary approach to offering support, ongoing case management, advocacy for victims of violence in their close contacts, note the close contacts because violence affects everybody around them, not just everyone around them. But during the hospitalization and beyond, it's the beyond part that we often fall down. We don't continue the accompaniment of that patient on their recovery. And those efforts can include things like, before discharge, are you safe? Can we help you find a safe place to be? Vocational training, mental health counseling, and social support. Those are what one would think of the fuzzy things, but in some ways, the things that matter the most because these are the scars that are invisible that continue to linger in the lives of people when victims of trauma. And the city of Las Vegas is gonna be traumatized, and the secondary trauma to every healthcare worker in that context is gonna be lasting for decades to come. This was just a quick slide to let you know that University of California, San Francisco has a wraparound set of services called UCSF wraparound. And they basically looked at over time in the city of Chicago, which has a county hospital system where all trauma patients go to San Francisco General, and basically found that the investment in these programs, not only save lives in terms of preventing recidivism, but also saves money. And the facility recovery across systems requires breaking down traditional silos. So this is a complex slide, but there's a role of violence interruption, programs like C-SPIRE and Teamwork Anglewood, addressing educational issues, criminal justice, issues that are foundational like housing, legal community, job training, advocacy, substance abuse, and use, all of those things are important components, but the University of Chicago Medicine or any health system can't take all those on. That's an important role of partnerships, breaking down silos, in many ways, being a convener of set of services that meets people where they are and helps them on their continued journey to recovery. And finally, my challenge to all in this room and beyond is that our proximity is our call to action. Within 10 miles of us, at this proportionate amount of intentional violence and gun violence happens every day. And part of this, I alluded to when I made the comment about the 18, 19, and 21-year-old who were killed in that car. We often hear narratives about gang bangers, about bad people. There's a moral failing component that they're isolated. I heard something very somewhat disturbing where apparently on the NPR there was a story yesterday about the Las Vegas shooting and the psychologist was being interviewed at NPR. And the host was really trying to get the interview, or the psychologist to answer a question. So horrific. 527 shootings, horrific. Not people dead, all the time, 50 minutes, horrific. But he brought up a 764 in Chicago last year. And why wasn't that equally horrific? And the response was that is background noise. Background noise. It's an NPR. Because they come across isolated events, two here, two here, one here, one here, one on Thursday, one on Friday, five on a Saturday, compared to the bolus that is national. Again, I'm not mitigating the impact. I just said this is gonna have lasting effects in the city of Las Vegas. 764 last year, 530 so far this year. And overwhelmingly, the focus is on punishment and locking people up and in track. And I hope I don't come across wrong. Crime is a problem for everyone. And crime should be punished. You'll learn that as a golden rule. That's how our judicial system is set up. And I hope that you can provide some questions, comments. However, that leads to a framework where this, that we witnessing for 30 plus years is intractable, unsolvable, and just the way it is. And as long as it's not in my backyard or my kids, it's not my problem. So what if it's actually a learned behavior? You know, I tell you about my nine-year-old in my six-year-old. They've had adverse childhood exposure to trauma. The biggest trauma was that my ex-wife and I divorced, and that was pretty traumatic for them. But they've lived pretty idyllic lives, otherwise, photographer, panelist here from the maroon is classmates with my middle son. She's actually housemates with my middle son. I need to talk to her in order to get to him, by the way. Because he doesn't talk to me anymore. He's so busy in college, she says. Is he in college? But it's also norms, right? What's normal? If I had normalized that, just hit your brother when he offends the. What happens with the next time when he gets teased about Velcro or whatever? Is it contagious? Now, there's a lot of study, one of the more compelling ones, to me besides the work of Kira Vales, Gary Slotkin, and others, is a study that came out this year on January 1st of this year in JAMA, Internal Medicine. I'd looked in the city of Chicago at co-offenders. Co-offenders are people who get arrested for the same crime on the same day at the same time. And they look over time what happened to those people. And it's like my grandmother now passed, used to say to me, you're known by your friends. The power of your social contacts is powerful. And so if a co-offender was shot, that was one of the highest predictors of their co-offender being shot as well. And if it's contagious, if it's contagious, I'm making the argument it is, then it's possible that there could be elements of disease control. And disease control, to me, looks this way. If I suffered a heart attack today based on epidemiological risk factors and knowledge acquired from large data sets like the Framingham Heart Study, I know, and my doctors know, and my nurses know, got to reduce my risk factors, control my diabetes, control my hypertension, adjust stresses in my life, eat well, avoid a secondary lifestyle, avoid gaining weight, and just chill. I got to do those things to improve my longevity after a heart attack. Currently, what do we do after a violent episode where someone is a victim of violence? I'm not going down the path right now of someone who is a perpetrator of violence, but a victim of violence. We patch them up, get them back in the environment how much they can. No risk factor has been addressed. And if we take that framework, then perhaps we may have a solvable problem. And the burden of the conversation really pushes us around this issue of breaking down our traditional silos, because it's really the intersection. Your daughter is asleep. I was going to say SAS. SAS, I'm going to use a word called intersectionability. It's the intersectionability of all of these aspects that actually can lead to a sustainable solution. SAS, for those who don't know, is SH blank T, academic say. But it's really impactful, because it's about the ability of these different sectors, built environment, social, cultural context, economic and educational environment, and how those things together, working in synchronously, leads to the outcome of violence. And they become opportunities of intervention. And that's the big idea that we have before us. And we often talk today, because we've advanced our knowledge so much in the biomedical model around DNA, RNA, messenger RNA, DNA splicing, cloning. All of that basic science has transformed us with an ability to now talk about and sometimes do precision medicine. One in eight women in this room, epistemologically, will develop breast cancer. None of you who develop breast cancer will be treated the same. Because of your individual genetic markers and phenotype, we have figured out the right mix of interventions to prolong your life. We don't do that with violence. We don't do it with an intentional follow. Treat everyone exactly the same, no matter how they got there, and no matter what their needs may be. And this is a part that I think is one of the more underdeveloped sciences, which has to do with how our environment and our experiences shape us. That's a neurocognitive impact of violence. And adverse childhood exposure to trauma and structural violence, like the impact of segregation or racism, discrimination has upon us over the course of our life cycle. And this is really unknown territory in terms of how do you measure it, how do you impact it. And a question that I think many people would love to know, how do people experience bad things in their life, horrific things in their life, and become resilient? They don't break, but it becomes a source of strength. How does that happen? What happens in the brains of those people? How do those experiences mesh? What's different about the phenotype, the genotype? There are epigenetics that makes that experience really, really bad, painful, but propels them forward, but doesn't hamper them. So in our discussion, these are things that I'm going to have Dr. Siegler come forward. And he's going to actually moderate. These are things that I like to think about. Because it turns out, I love complexity. That's why I'm here. Everything that we're trying to do in New York's Drug and Medicine with respect to this travel program and the impact in community is complex. But violence is complex too. But it's really only through shared working together that we're going to make an impact. And that's really hard work. If we agree that violence is a complex disease and we know that our community is at increased risk for death, what is our responsibilities to mitigate these factors and when does it end? How far do we accompany people on their journey and then let them go? What is a bundle of services needed to make a real impact? And how do you measure that impact? And that last comment I made about resilience, bad things happen to lots of people. But it doesn't break everyone. And some people are really informed by those bad things. And at least for me, I've been really blessed by failure. I've learned the most by failure. I've grown the most through failure. But how does that actually happen? That does happen in some and not in others. So I have always been pushed by words because words are powerful, which is why I've spent so much time starting off with definitions and also used my words carefully. Because when you use certain words, they can transform the action. I think the opportunity that we all have in this room is to inform some of the great words about the King Jr. The arc of the moral universe is long, but it bends toward justice. That's it? Five minutes over. Thanks for your talk. What will happen to your patients from the trauma center when they are discharged? So we're right in the midst currently of doing two things. I said I put up three fingers, so three things. The first is to identify assets in the community that are doing this work. So what's this work? This work looks like on vocational training, mental health services, advocacy. There are some big NGOs and there's some small what I call Mama Pop NGOs. They're doing good work on the street corners and the blocks in their neighborhoods in a trusting way that people in the community value. We're trying to asset map those and sort out who are our natural partners and where can we, when we can, lift up their work. That's one. The second is culture. Some of this talk, some of the things that I've been doing in terms of meeting, greeting, people where they are, is identify where we are as an institution, as an academic medical center and start addressing some of the culture that we need to meet people where they are and that we would help them to be, which is actually hard work. And then advance our ability to help them on their journey to recovery. And then the third is actually more about people. We've got to develop the right model for case management, mental health services, community-based services that at times are non-traditional, because not everyone wants necessarily, quote unquote, go and see Frasier. Frasier was a shrink, right? I can't remember. I mean, so not everybody wants to go sit down with the psychologists and give them their 10,000 phobias. But the mental wellness piece is real. So when someone tells you, every time I'm back in that corner, I freeze. Patients tell me, after traumatic, particularly gunshots, every time I hear the backfire in a car, I drop to the ground. I can't control it. And even on top of that, how people relate to others changes. Reverend Harris, who speaks next, or in a couple of weeks? Yeah, a few weeks. So he is a Bronzewell pastor who has an NGO focused on the communities in Bronzewell. They did a survey in partnership with the School of Social Service Administration. And with that survey of 4th to 8th graders, 30% of the kids had subclinical or clinical depression. I mean, what do you do with that? Because it's not like you can learn well if you're depressed. And the challenge is, what's the source of that depression? And it's clearly currently an unmet need. So there are lots of things going on in our communities that are all around us that are relatively unmet needs, that we can't meet all of those needs. But we can be advocates. We can be conveners. We can be connectors. And I think that's the opportunity that we have. Does it make that thoroughly answer your question? And it's also in development. I got nine months, so bear with me. There's a question right there that may have been first with the mic, but yes, that's so bad. So I'll just make this one quick, because I'm sure I'll have a lot to ask and say as long as we're here. But this is about ethics. And your question was, what is our responsibility? So my question is, in this context, what is the first person plural we're talking about? Who are we talking about? Who is, what is our? Who's our? Who's we? Whose responsibility are we talking about? So there are two ways to ask that question. I'm going to say the thing I learned in Texas is all y'alls. And I'm being facetious, right? This is really an all of us problem. We got to care about every kid, every adult that gotten killed in the city of Chicago last night, the way we care about someone killed is related to me by blood. And the problem is, the reality is we don't. And the challenges, because back to the ethical framework, should we? And actually, that's a dialogue that I think I would like to hear multiple voices up. Because I actually think that I do have a responsibility beyond myself and beyond my three children. But does everyone feel that same way? And we have a national debate going on about this very thing. You can look at health care, you can look at security, you can look at a lot of things. Clearly, we have a difference of opinion about that question. So I'm going to push a little bit. You're pushing? Yes. So you're talking about how we feel and what we believe, right? Yes, values. So what about we? Does we include the institution? Because the institution doesn't feel. It doesn't care. It's not a human being. It's an institution. Is that part of the we? Is that the main we? I think the main we is people. It's all the less in the room. I think institutions are at some level uncaring, because they're institutions. But at the same level, we can influence institutions in the context of policies, procedures, values. Those things are being shaped every day. And I think we're in the midst of evolution. I'm actually going to have my senior colleague speak to that question a little bit, if you don't mind. I agree with you, that institutions speak through the people and personnel who are within them, as well as by virtue of the programs, they develop encourage and support. And you and I have spoken already about the many years that have gone by between the time that the University of Chicago had a trauma center 29 years ago, and the fact that we are creating a new one to begin in May of 2018, I think begins to speak to an institutional level of responsibility and commitment, and the fact that you're the leader of this new program can only indicate that the institution's perspectives are clearly moving in the right direction. Yes, with the mic. You moderate. I apologize. I'm showing the surgeon in me. I'm taking lead. I'm just an intro. Please. Thank you. You have a next. I've been holding it. That was a really good presentation. Thank you very much for it. I'm very glad to see you taking such a broad view. I was somewhat active in the trauma center movement over the last five, six, seven years. And I hope there's other people here from that movement. I don't know if they were contacted about this series. If not, I hope they were. Anyway, my question really builds on those first two, which were the broad questions I was going to ask. So let me get more specific on that. Do you have any specific plans yet for what the university itself and the trauma center itself will do in regards to wraparound services, recovery services, post-acute services? I know that there are a lot of community organizations that will be involved, but I don't know what the university itself is going to do. Oh, I'm sorry. I'm looking for a mic, and I already have one. It shows my cold as tick goes to my head. So we already have a balanced recovery program manager hired and here for six months. And like me, who's been here for nine, one of the things that's a strength and a weakness is I'm an outsider. I say that fondly, but I don't have any baggage. I just showed up. I'm a chief implementer in charge. I have no hard feelings, bad feelings, ill feelings. I'm just here as a humble servant to be the best servant leader I can be. With respect to that, there's a lot to learn about Chicago. It's a lot to learn about the University of Chicago. There's a lot to learn about the University of Chicago Medicine. There's a lot to learn about institutions. There's a lot to learn about the South Side. I read a lot, but no matter how much I read, it gets more complicated. One of the things that I was tasked with early is to read every single story about the reason I was here. I'm saying that actually what I'm saying, two things happened within the past 24 hours that's part of the massive plan. One is there was a internal town hall community-wide within the community of the University of Chicago Medicine to start a culturating University of Chicago Medicine. And this is just part of many, many such things around what trauma means here. But part of that was also this conceptual framework about violence recovery and not just focusing on physiological restoration for people after they're being victims of trauma. So that's a frame shift. That's an important frame shift. But the other part of that is learning who all of the actors and actresses are throughout the South Side. Because one of the things that I have sensed since being here as an operational word is a word silos. And breaking down silos is going to be foundational to make a lasting and sustainable impact. Because one of the things that has to happen is that bubble hair, bubble hair, doing similar work or complementary work would be better as a bigger bubble. And especially since so much of this intersectional, some small NGOs, big NGOs, would be really good at vocational opportunities. Some may be really good at mental health services. Some may be really good around advocacy. Some may be really good about legal stuff. How can we actually get that all together and get that individualized, tailored program for an individual just right to help them on their recovery? The larger issues around prevention, around stressful violence in our society, around segregation, those are big, long, historical, national issues that aren't going to be fixed by the university. But we could all be part of the solution. I hope that begins to answer your question. There'll be greater clarity by May 1. But I got time. I know I feel like running out because the baby is coming and it's going to birth. But I got to, I really, really, really know that the only real, sustainable solution to this complex problem is partnerships with the community. Us doing stuff that the community ain't going to work with, likely will work, co-definitely will work. I guess relevant to that question, one of the things that struck me when I moved to Chicago is that relative to other academic medical centers I've interacted with, it seems like, and this could have been an incorrect perception, that UChicago has relatively sparse engagement in and just a physical presence in Woodlawn and Englewood. You don't see outpatient special clinics there. You don't see a ton of primary care there that's part of the UChicago network. And that limits our ability to provide people with care after they're discharged from the drama center. Do you see that changing during your time here? I certainly hope so. You can give me a better historical framework. I'm even touch-based with Jason Heeler, chief operating officer. We are looking at exploring partnerships with St. Bernard's Hospital in Englewood. There is a, in some ways, a philosophical shift or a strategic shift that there is much more outward reaching. So I think, again, not being here, but just looking at the history. For a while, we were a relatively insular medical center. We're here. We sat here. People came to us. And I think some of the things happening in Enlil's and Enlil Park is starting to do this. What you're proposing is getting closer to where I was around the neighborhoods. And I think that's a strategic shift. I don't know if, Mr. Keeley, you want to comment? Microphone here? I think that we've been talking about required resources. Our first move off of the Hyde Park campus was to a place like Enlil Park and South Loop to generate revenues to be able to support programs like trauma, which is not going to be something that makes the organization money. So we have to have strategic programs to support that, to reinvest in important community benefit programs. As Selwyn mentioned, we have, over the last probably year, year and a half, had a tremendous amount of outreach to the other health care providers in and around the vicinity. St. Bernard's being probably one of the most prominent, knowing that this is going to take more than just University of Chicago to be able to support it, and it's going to require the resources of the local health care community, but also the community at large. And I agree with Selwyn. I think, as you talked to Brenda Bowell and others, there's a lot of community work being done, but it is being done in silos. And it's going to be critically important that there's a convener, likely could be us, to convene those resources and ensure that we as a community are solving this problem. When I say community, it's the city of Chicago. It's the state of Illinois. It's ensuring that there are resources to fund a problem that is big. Question here. Mike. Mike Masal, Developmental Pediatrics. I'm so glad you talked about silos. And I work at 61st and Ellis in the Woodlawn Early Intervention Outreach Program, which has been a tradition of the section of developmental and behavioral pediatrics for over two decades. And I was recently struck, because there's a tendency to say, this doesn't apply to very young children. And what you said about silos reminded me of it. I was seeing a young boy who was 2 and 1 half. The mother was concerned that he had speech delay. And he was more intense in his tantrums. And I just, matter of fact, said, is there anybody he reminds you of? And she said, he reminds me of my younger brother. And all of a sudden, she started crying. And I said, well, tell me about your younger brother. And she said, oh, he had ADHD, struggled with reading. He didn't do so well in school. He was expelled numerous times. He started doing more things on the street. He started getting involved with the gang. My older brother tried to steer him right. But the gang said my older brother was evil. And so when I was 12, the mother of this child that I'm seeing, she's now 25, the younger brother shot the older brother in the house at the request of a gang. And this mother said to me, I am worried that my son is just going to be like my older brother, who's changed because of all of this, who realized he did wrong. And the reason I emphasize this story is what I can't say to the mom about the younger brother is there are no behavioral health services on the South Side for preschool children. Our child psychiatry and child psychology services do not have enough human power. There are many kids like this. The city of Chicago does not have school counselors or behavior health, importantly for adolescent and pre-adolescent depression. There are no social workers in many Chicago public schools. The structural problem is protean. And we have to put this on the table and break down the silos. Thank you for all of this. And I echo that. And I'll share that this is one of those arenas where our voices as advocates for that relatively voiceless 25-year-old mother is one of the things that we can do, and we must do. There's a question here, but we'll get the question in the back, please. Hi, I'm sorry. I'm coming down with the code. I must have what you had. No, I got mine in Italy, unless you were in Italy. I'm a first year graduate student at the School of Social Services Administration. And what we're learning primarily in our core curriculum is our role as people, even as social workers, to address the concerns that are happening within our communities. What can we do to alleviate the issues that poor people or even people that are dealing with trauma? What can we do to alleviate those problems? And I wanted to address the trauma center. I guess from what you've mentioned, the trauma center would do tremendous work in addressing some of the issues in the community. And I'm wondering, in particular, how do you see the trauma center working in tandem with the community? And in addition to that, what sort of examples can you give of a patient coming into the center who has had a gunshot wound? How do you address the services that they receive, what types of services will they receive, and how can they go back into the community being contributing members of society? So that's kind of a follow-up question to the woman in orange shirt. I guess one way I can answer the question is framing it this way. Personas give you a linear narrative of what our compassionate, evidence-based, ethically bounded, socially conscious trauma center will do, as we put all the pieces together. Person gets shot 61st and what was the address of 61st and Woodlawn, all right? So our service area, they're 10 minutes out. High functioning, this is maturing trauma center. Not only will we know that person is coming, but our outreach program, violence prevention program, will either know almost in a real time or shortly thereafter that that person was injured. There will be a dispatch in conjunction. Again, police are doing their thing and there's ideally better coordination than relationships with policing doing their thing. But the violence disruption piece is around preventing retaliatory violence or that person who may be injured. You gave me the chess example, but there are thousands of people who are injured and their immediate response after being the victim is I become now our perpetrator. So that's one issue. But that person is shot. We, that's Dr. Prakash is on call. The person loses their vital signs. She opens her chest, rushes them to the operating room. Within 20 minutes, they have a blood pressure again. They go through a long hospitalization, but they survive. During their hospitalization, as they recover, physically, we start addressing their mental health needs. Healing her people, psychologists, psychiatrists who have dealt with what they need, cognitive behavioral therapists, peer support, interfaces in their life with their needs. And if they are not involved in the criminal justice system, because that obviously goes on a different path, they're going to get to a point where they need rehabilitation. But in addition to that rehabilitation, they'll get a tailored plan to address the needs in partnership with the community around what are the set of unique things, services, programs that we could plug that person into to help them on their journey to holistic recovery. The opportunity there is tremendous because it does two things, ideally. Prevents recidivism. Prevents transformation of that victim to perpetrator. Saves lives, saves money in the holistic society perspective, and potentially it's a better Chicago. The other opportunity there is one of the things that we don't often talk about, which is wasted human capital. When someone is a victim of violence and they don't fully recover holistically, what do we lose as a society? And the next question I'm going to ask is what if we prevented them from getting shot in the first darn place? What could that person's life cycle be? No, I'm going to. Before I thank Dr. Rogers, I just want to remind the audience that next week we'll be hearing from the Commissioner of Public Health of the City of Chicago, Dr. Julie Morita. And some of the numbers and statistics that Dr. Rogers showed us indicates the deep level of concern in the city and nationally for the level of violence here. And so Dr. Morita will come and I've asked her to talk about what the city's efforts are in regard to working to reduce violence. I don't know what to say to Dr. Rogers, except to welcome him to the University of Chicago, to tell him how excited and delighted we are to have him as a colleague and leader of the new University of Chicago Trauma Center, and to recognize that his view of trauma surgery as an end stage in a process that needs interventions at earlier stages is very powerful, and works then both at the beginning in the preventive way, but also in the rehabilitative and restorative way beyond just the techniques of surgery. So it's a great pleasure to thank you and to welcome you.