Shock Treatment

It’s another busy night at the trauma unit at Washington Hospital Center in Washington, D.C. A group of visiting inner city high school students is watching as a shooting victim is rushed in. As the patient deteriorates, doctors and nurses work frantically to try to repair the damage from the bullet. The young people look on in awe as the patient’s chest is cut open, the spreaders are placed to expose the chest cavity and the heart is massaged through the newly cracked-open chest.

“No anesthesia is used—there’s no time,” explains Allen Wolfe, RN, BSN, clinical manager of the hospital’s MedSTAR Trauma Unit. “To see the expressions on these kids’ faces when that happens is just…priceless. You know they really get it.”

This may seem like pretty strong stuff for teenagers to be witnessing. But that’s exactly what Wolfe had in mind when he created the hospital’s Shock Mentor Program, an unusual community outreach project designed to teach disadvantaged African-American youths to avoid dangerous life choices by bringing them into a real-life hospital trauma center to observe the effects of violence first-hand.

While the teenage and young adult years have always been challenging, they are particularly difficult for minority teens growing up in low-income urban neighborhoods stigmatized by poverty and high rates of crime, gang activity, drug use and violence. Because inner city schools do not have the same resources for educating youngsters as their suburban counterparts, their dropout rate is higher. And because many inner city children are brought up in single-parent families, they often lack the opportunities for parental support and guidance that are readily available to young people from more affluent backgrounds.

During the years of identity creation, teenagers tend to be to believe that they are invincible. “It can’t happen to me” is a prevailing attitude among this group. Teens who make life decisions based on this false premise often find themselves in trouble at school or with the law; they may wind up in drug rehab, in jail, seriously injured or worse. In fact, homicide is the leading cause of death for young people between the ages of 15 and 24.

While some teens are surprisingly mature for their years, too many others lack the life experience to understand that they have the power to make choices, and that the results of the choices they make have a direct impact on their lives and on the lives of others. When decisions are made based on the premise that consequences do not apply, the results can be catastrophic. All it takes is one bad choice for a promising young life to be tragically altered forever.

Making an Impact

The impetus for Wolfe’s program began in 1999, when the D.C. chapter of Concerned Black Men, Inc. (CBM), a nonprofit national organization whose mission is to encourage African-American young people to be proud of their heritage and to be socially conscious and responsible, approached Washington Hospital Center’s Community Relations Department about creating an outreach program for local at-risk teenagers.

Inspired by a successful Shock Mentor Program at Prince George’s Medical Center in Maryland, the CBM leaders believed that inner city youths in the District of Columbia could benefit from a similar intervention. They also felt that Washington Hospital Center would be the ideal facility for such an effort because it is the District’s primary public health facility, serving more than 80,000 uninsured residents of the city, and also has the largest trauma center in the DC area.

Agreeing that the Shock Mentor Program would provide a valuable community service, Dr. Marion Jordan, director of the hospital’s Burn and Trauma Center, assigned the project to Allen Wolfe. One of two African-American nurses in the trauma unit, Wolfe has worked at Washington Hospital Center since he graduated from George Mason University in 1984. He started out on the medical/surgical unit, then advanced to the ICU. Nursing is a family tradition, Wolfe notes proudly–his mother is a nurses’ aide and his four aunts are all nurses.
In 1990, Wolfe transferred to MedSTAR, the hospital’s trauma center and medevac rescue service. As a helicopter flight nurse, his duties included flying out to the sites of car crashes, shootings, fires and other tragedies to transport seriously injured victims back to the hospital for treatment. He was promoted to clinical manager of the MedSTAR unit in March 2001.

To this seasoned trauma nurse, developing a Shock Mentor Program seemed like an exciting opportunity to help the local black community—and one that he could relate to personally. As a high school student growing up in Alabama, Wolfe remembers seeing “Scared Straight,” a film designed to deter young people from criminal activities by showing them the harsh realities of prison life. It left a deep mark on him.

“I didn’t face the same obstacles growing up as kids do today,” Wolfe adds. “My father made sure of that. I was too scared of him!”
Based on his own experience, Wolfe was well aware that fear can be a powerful motivator for getting teens to stay on the right path. “I wanted to affect these kids in a profound way,” he explains. “Giving them information allows them to make better choices. To develop our program, I looked at what Prince George was doing and then expanded it further. I added a slide show and a trip to the burn unit and the morgue, to make even more of an impact.”

A Night to Remember

The Shock Mentor Program Allen Wolfe developed for Washington Hospital Center brings inner city teens from neighboring high schools up close and personal with the often grim events that take place in a busy urban trauma center. A group of three to four students visits the center from 6 to 9 p.m. twice a month. They tour the MedSTAR unit and the helicopter, they have dinner and then they sit back and watch as events unfold. A glass window is all that separates them from the patients that arrive. Drunks, stabbing victims, people with gunshot wounds, amputations, accident victims, burn victims—the teens witness everything. There is no interaction between the visitors and the patients; they are simply there to observe.

“The focus of the night,” says Wolfe, “is for these kids to witness first-hand the effects of violence. They see for themselves what happens when people make a bad decision. If a kid plays with matches, they see the kid and perhaps a family member come in with burns.” If there is time, the teens visit the burn unit and see what severely burned patients look like wrapped up in their bandages.

Throughout the night there is much discussion with the students about what they witness. Wolfe put together a show of slides he has taken at trauma sites over the years—hard-hitting, graphic scenes of gunshot wounds to different parts of the body, hangings, amputations, stabbings, pedestrians hit by cars, and more. One particularly gruesome slide shows a victim who had been thrown out of a car and was impaled on a white picket fence.

The “soundtrack” for the slide show is the familiar rap song “Life After Death” by the late Notorious B.I.G., himself a victim of gun violence. The song’s lyrics—“Somebody’s got to die/Let the gunshots fly”–evoke chills as the teens watch the vivid images of death and catastrophic injury.

Then it is off to the morgue. Here the young people see again what death looks like—but this time it’s for real. They see the yellow body bags and experience the coldness and lifelessness that prevails in the room. The bags are opened. The teens see young people and old, babies, aborted fetuses, amputated limbs. “Afterwards, the kids are debriefed,” says Wolfe. “We discuss abortion. We discuss outcomes. It is all about making choices.”

The program makes a powerful statement to the students that the decisions they make can affect their lives—and the lives of others–in ways they don’t always anticipate, and that one bad choice can make the difference between life and death. “To see the faces on these teens when they see kids their own age come in [to the trauma unit] after being shot or burned is incredible,” Wolfe reports. “You know they are stirred by what they see.”

Chaperons remain with the teenagers for the entire evening. Along with Wolfe, a representative from Concerned Black Men is always in attendance, as is Johnette Wilson, program coordinator for the Youth Mentoring Program of the Community Affairs Department at Washington Hospital Center. As the teens watch, Wolfe describes what they are seeing and answers any questions that arise.

But Wolfe’s program does more than just warn at-risk teens what not to do. It teaches them about positive options as well—specifically, the benefits of pursuing careers in the health care field. Wolfe pitches a strong career education message as the high school students are introduced to the different professions in emergency medicine. Nurses, physicians, anesthesiologists, respiratory therapists, paramedics and pilots all speak with the young people about their jobs and what it takes to get into the field.

Attracting Attention

Since its inception in 1999, some 120 young people between the ages of 14 and 18 have participated in Washington Hospital Center’s Shock Mentor Program, and the word about Wolfe’s innovative intervention is starting to spread. Some of the hospital’s employees have even had their own children, family members and neighbors go through the program. The high school students come from Roosevelt Senior High School and Eastern Senior High School in D.C. Although a few non-black teens have participated, the program is designed to serve an area that is primarily a minority community, with a population that is 60-70% African American. The teenagers going through the program are representative of their community.

At the high schools, teachers and counselors identify students as potential candidates for the program, focusing especially on those young people who have good grades and are planning to go to college but may be starting to form relationships with kids who are considered a bad influence, such as those who are not focused on higher education or are involved with gangs. However, the teens volunteer to attend Shock Mentoring; the program is not mandatory. Many ask to attend after hearing about the program from someone else who has gone through it. Some of the teens who have taken it once have asked to return.

Once candidates are identified and have expressed an interest in participating, the counselors approach the parents. Due to the very graphic nature of the program, the parents must sign a waiver. The teens are taught about confidentiality, what it means to not share information with others. They discuss the possibility that someone they know may come into the hospital; that person, they are told, has the right for any information about their being there and why to be kept private. The students then sign a confidentiality agreement.

Recently, the project came to the attention of a group of judges from the D.C. court system. They approached the hospital about the possibility of enrolling juvenile offenders into the Shock Mentor Program. While the program may eventually evolve in that direction, says Wolfe, the hospital declined at this time. The program as he conceived it is designed for prevention, focusing on kids who are targeting college but who may be hanging out with the wrong crowd or who are wavering in their commitment to higher education, rather than teens who are already in trouble with the law.

“It is a small program, intended for community outreach,” he explains. “We are not prepared to make it bigger at this time.”
While the events of September 11 have put the program on hold for the fall semester, Wolfe hopes to restart it when the students return to school in January.

A Community Hero

Has Shock Mentoring really made a difference in these young people’s lives? While there is no specific feedback system in place, the hospital has hired some of the participating teens as summer interns. Many of the kids who have attended the program have made a point of approaching Wolfe to personally thank him—a measure of success that he finds particularly rewarding.

“I don’t want to change just one kid’s life,” he declares. “I’d like to see an entire class graduate from high school having witnessed and been positively affected by the Shock Mentor Program. People say that if everyone does a little to help a child, ‘each one teach one,’ then the world will be a better place. Well, I have learned that you can’t depend on everyone to do a little, so someone has to do a lot. I’ve also learned that today’s kids are not as bad as people make them out to be.”

For other nurses who may want to start a similar program at their hospitals, Wolfe offers this recommendation:  “Make sure you have a plan before you start, a network of volunteers to help, and support from your facility.” Currently he is focusing on expanding his program throughout the hospital. Surgeons and anesthesiologists have expressed interest in participating, so that the youths will only get to see what happens in the trauma center but then follow the injured person to surgery so they may witness the full spectrum of saving the patient’s life–from start to finish.

Washington Hospital Center is very grateful for Wolfe’s work and his exceptional dedication to both the hospital and the community it serves. In January 2001, he received the hospital’s community service award as Mentor of the Year after one of the Shock Mentor students nominated him.

“He is awesome,” says Johnette Wilson, the hospital’s liaison with the schools and Concerned Black Men. “The kids love him. ‘He understands,’ they say. The program really brings the message home. And they tell their friends all about it

“By showing them how much effort the trauma center staff goes through to save just one person’s life, Shock Mentoring gives these kids so much appreciation for how precious life is,” continues Wilson. “It is a very powerful message. And Allen is so humble, so willing to serve. His commitment is unwavering. It has been a blessing and a privilege to know him. ”