Sitting in her office at San Francisco General, Dr. Rochelle Dicker remembers the young man who sparked the idea for the Wraparound Project. The year was 1995 and Dicker was fresh from medical school; armed with a white coat and pager, she set out to meet the gurneys bearing the city’s grievously wounded into San Francisco General’s emergency room. On one of her first days on the job, a young man, just 16 years old, was wheeled through the sliding doors with a gunshot wound to the abdomen.
As Dicker helped care for the young man through his recovery, she came to know him. He told her stories of gang life and the brutality of the drug trade, and Dicker grew concerned. He would survive his injury, but how much time would that buy him before his already marginal luck ran out again?
Dicker found the answer to that question soon enough. Just two weeks later the automatic doors of the emergency room opened and on the gurney lay the same young man. This time the bullet had pierced an artery and the doctors barely managed to save his life.
“It suddenly didn’t make sense to me that we were treating only the immediate trauma when one in three violence victims will show up again with new injuries,” Dicker says. Repairing the internal damage and sewing up the wound don’t change the social forces that put victims at risk. But, Dicker adds, “if you consider someone with a violent injury as suffering from a behavior related disease, you can view their time in the hospital as what we call a ‘teachable moment.’ As with people after a heart attack, the injury creates a period when the patient is open to change.”
The Wraparound Project, which Dicker subsequently founded, has been running for three years. It employs a small team of three counselors who rush to the bedsides of those injured by violence, often just moments after the patient has been stabilized. According to Wraparound counselor Javier Antezana, what ensues is a “very intense conversation” about what’s happening in the young person’s life and, critically, what will happen next.
The Wraparound counselors follow their high-risk clients for an average of six months, and often for much longer, gaining an intimate knowledge of the social currents in play. They learn which friend is pulling the client back into the gang world. They cultivate the out-of-town uncle who might be able to offer a stable home environment and refuge. Counselors help the client find job training, mental health services, safe housing, even tattoo removal. Meanwhile, they try to help the client avoid the one bad decision – the one bad night – that could spell the end of his or her second chance. A study recently accepted by the Journal of Trauma reports that only four percent Wraparound clients are reinjured — far fewer than the 35 percent who don’t receive the intervention.
Those impressive statistics are more than matched by the stories of those who’ve been helped by Wraparound. On a fall afternoon, Antezana made a home visit to a former Wraparound client who asked to be identified only as L.T. Two years ago, L.T. had entered the emergency room with a gunshot wound to the head. For a month after, he was unable to walk or talk. Antezana quickly deduced that L.T. was at high risk for future injury; he’d had gang affiliations and had suffered gunshot wounds several times before.
Convincing him to accept help wasn’t easy. “I have some trouble trusting people,” L.T. says. “But Javier wouldn’t take no. He just kept coming back.” With Antezana’s help, L.T. entered trauma therapy and eventually enrolled in City College.
His recovery — both from his head trauma and from the social forces that put him in harm’s way — is far from complete. Every day at around noon he experiences excruciating headaches; occasionally he suffers seizures. Sitting on the edge of his bed in his cluttered room, L.T. admits that after completing a couple of semesters, he’s taking a break from college. His lack of short-term memory makes studying a Sisyphean task.
But he has a dream he’s holding on to. While in the hospital, L.T. became interested in the work of the radiology technician who’d examined his wounds with X-rays and the CAT scans. “I watched those guys work and I thought, ‘I could learn to do what they’re doing,’” L.T. says. “I could help people.”
Ethan Watters is a frequent contributor to The New York Times Magazine, Wired, Discover, and other magazines, and is the author most recently of Crazy Like Us: The Globalization of the American Psyche, which was published in January by Free Press.