Jerry Lawler met Ricky, then 13, shortly after he’d been removed from his latest foster home and placed in another residential institution. “His foster care mother basically said, ‘I can’t deal with him anymore,’” Lawler says.
A volunteer with the Baltimore nonprofit CASA, acronym for Court Appointed Special Advocates, Lawler was assigned to Ricky by the Baltimore City Family and Juvenile Court. He was supposed to get to know Ricky, floundering seven years after being taken from his mother because of neglect, and serve as another set of eyes and ears in his life. He would represent Ricky’s interests in court hearings, the educational system, and the medical and social service communities.
A clinical psychologist by profession and father of two grown children, Lawler was nonetheless nervous before their first meeting.
“I think all the volunteers wonder, ‘What if I can’t relate to my kid? What if they don’t want to see me? What if they yell at me or get pissed off at me?’”
Ricky didn’t yell or get angry. He barely spoke.
“He was guarded. Withdrawn. No swagger. Just ‘I’m not going to tell you anything,’” Lawler recalls. “I’d ask how he was doing and he’d say. ‘Okay.’ I’d ask if he wanted to go to McDonald’s, ‘Okay.’ Want to go to the Inner Harbor? ‘Fine.’
“It was six months before we’d be driving somewhere that he’d tell me what he’d done the previous night. Another six months before he’d tell me anything he was feeling,” Lawler continues. “This was a kid who’d learned not to trust people because they’d let him down so much.”
Foster kids often move from placement to placement with few belongings, even photos of their siblings and families of origin. However, one possession Ricky allowed Lawler to view offered insight behind his silence.
“He kept a compiled ‘book’ of himself, awards from completing different programs, and he had family pictures in there,” says Lawler, adding Ricky’s had 16 various placements since entering the foster system, including stays with five different sets of foster parents. He had pictures of each foster family, two dogs he loved at one home. A professional picture of himself as a baby, pictures of his half-siblings, his grandmother. And a photograph of his mother, a heroin and crack addict, and North Avenue prostitute.
“It’s heartbreaking,” Lawler says. “He’s proud of her, believe it or not. He wants her to get clean—to be a mom—and be with her more than anything.”
The honorable David B. Mitchell, then Administrative Judge of the Juvenile Division of the Baltimore City Circuit Court, established CASA of Baltimore in 1988. The program, operated by the University of Maryland School of Social Work before becoming an independent agency, pairs volunteer advocates with foster children in crisis. Today, CASA volunteers impact the lives of more than 200 children each year. Children’s names in this story have been changed to protect their anonymity.
Opening a thick, three-ring binder on his South Baltimore kitchen table, Lawler points to meetings with ever-changing Department of Social Services caseworkers, group home supervisors, school counselors, therapists and family involved in Ricky’s life. CASA volunteers learn the child’s history in order to build a relationship. Lawler files status updates and make recommendations at court hearings as necessary. He shows up for important events.
“Last year, I attended his junior high graduation,” Lawler says. “That was a big deal.” This year, he helped him through his freshman year of public high school. Over two years, he’s become the constant in Ricky’s life.
“He passed everything but algebra, which he’s taking this summer,” Lawler says. “He’s reading at grade-level. There’s no way I can back out now.”
Downtown
Greene Street
Sept. 3, 2010
6. Golden Hours
Several minutes before the helicopter’s estimated arrival, two nurses take a dedicated elevator to the roof. At night, they can spot the helicopter a dozen or more miles away, watching as a small light comes into view. If the accident occurred in southern Maryland, for example, it will appear off in the distance past M & T Bank stadium. On a bright, glaring day like this, the medevacs pop into view more suddenly, dropping down upon R Adams Cowley Shock Trauma Center with surprising swiftness.
Not unexpectedly, on this Labor Day Weekend, accident victims, assault victims, and transfers from other hospitals begin arriving Friday afternoon.
At 2:51 p.m., it’s a 48-year-old man, crushed by a tree. At 3:40, it’s a patient who fell from a tree while intoxicated. At 5:14 p.m., it’s motorcyclist, found in the woods with a severed leg, who is flown in. His leg arrived next to him in a cooler, but could not be saved. Four minutes later, a 36-year-old female arrives. An unrestrained backseat passenger involved in a car accident, she’d been ejected from the automobile.
Later, an 81-year-old woman arrives. She’d fallen while riding a bike. One minute after her, a 22-year-old woman who’d been pushed from a car come in on a stretcher. At 8:30 p.m., a pedestrian is flown in after being struck by a tractor-trailer. At 10:35, a gun shot victim, with bullet wounds to the neck, is brought in after being found unresponsive in alley. He died two hours later.
By 10:45 p.m. Friday, 15 people had been admitted. By 5 p.m. Saturday, another 24, including a 15-year-old who been shot in the face below his left eye.
As the boy is wheeled into a bay, accompanied by police, conscious and wide-eyed scared, blood dripping from his face, neck swollen with fluid, a dozen and a half doctors, fellows, residents, nurses and trauma technicians surround his stretcher.
In a well-rehearsed choreography, the teenager’s clothes are cut off by one nurse as another asks for his mother or father’s phone number. An I.V. is started. His blood pressure is checked. Blood is drawn. Doctors examine him for exit wounds. Blood is suctioned from his mouth. An anthiesolgist begins to sedate him, so he can be intabated. Stable at the moment, he’s readied for X-rays.
“I see where it is,” Dr. Deb Stein says, minutes later, examining
three-dimensional images on her computer screen and staring at a bullet lodged in the teenager’s lower neck/upper chest area. “But how did it get there?”
Fortunately, the bullet richotted down after entering his face and not into his skull.
Fifty years ago, Dr. R Adams Cowley, a pioneer in open-heart surgery, developed the first clinical shock trauma unit in the country, putting together a small staff and equipment—including two, and later four, beds—at the University of Maryland Medical Center. It was known as the death lab, at first, until patients given up for dead began to survive. Cowley’s credited with coining the idea of “the golden hour,” or as Dr. Thomas Scalea, Shock Trauma’s physician-in-chief and the driving force for the last 13 years, explains, “the concept that trauma is a time-related disease.”
By the end of three-day weekend, the total was 107 patients. Many were discharged within a day or so, but the 104-bed hospital remained filled. As usual.
Most U.S. trauma centers typically treat about 3,000-3,5000 patients a
year. Shock Trauma treats more than 8,000 annually, the largest facility of its kind in the U.S.
Ultimately, Labor Day Weekend proved not so dramatically different than other summer weekend. The 13 trauma resuscitation bays routinely and critical care beds often get filled, with patients doubling up.
“We all have very definitive roles and I think as a result, we provide a very high level of care,” says Stein, who has been at Shock Trauma since 2002. She also stresses the second pace, while not for everyone, fits her personality.
“Some people like knowing what to expect, I like not knowing what is going to happen every day,” she says. “But the other thing, I love, too, is seeing people get better.”
M&T