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“A gun is the vector of violence.”

SEEING MORE THAN 1,000 patients a year with gunshot wounds makes a person an expert on street violence and Dr John Barrett uses a medical analogy when talking about this week’s gun crimes in America.

“Guns are the vector of violence. Malaria is spread by mosquitos. What we say in this case is, ‘Control the vector – control the thing that spreads it and then you control it’. The same is true for weaponry.”

Dr Barrett is no ordinary voice on this issue.

The Cork native headed up the trauma unit of Cook County Hospital in Chicago for decades. That name may trigger bells in your head – it was the inspiration for ER’s County General in the same city.

Think of Dr Barrett as the Dr Peter Benton (but less angry, more personable and, well, more Cork).

As the director of the trauma unit for the majority of his surgical career, Dr Barrett saw only patients with intentional injuries – victims of gun violence, stabbings and vicious assaults.

During a visit to Ireland this week – to receive a prestigious alumni award at UCC – the surgeon sat down with TheJournal.ie and the conversation inevitably turned to how the US is struggling with its current laws.

Now in his 60s, Dr Barrett says he still does extensive work in the area. On returning to Ireland, he is surprised that there is a growing prevalence of gun crime and warns, “Once it starts, its hard to get rid of it.”

“I don’t want to see a total gun ban enacted [in the US]. People who are allowed to own guns should be put through background checks. There should only be certain types of weapons allowed. There should be training and safe storage requirements.”

It’s not an easy sell though because of “money”.

“The gun manufacturers are strong, powerful and vocal.”

A stricter regime is only step one though, he adds.

“I heard someone once say that the best solution to a gunshot wound is a job – and there is truth to that. Poverty is the underlying problem. But, for the moment, we can deal the violence by controlling guns. It is a faster solution.

“I used to see patients coming back into me – they had the scars that showed I had operated on them before. We were sending them back to the streets – and they were getting caught up in gun crime again. It is emblematic of the violence in our society. In the US, the gun is rampant in households. When people become agitated and upset, they reach for the weapon. To me, the solution isn’t surgery but it is to control the violence.”

Most of Barrett’s patients were from the west and south of Chicago – areas of disadvantage, poverty and unemployment.

“We only saw patients who were so severely injured there is a chance they could die,” he recalls, bringing up the television show for the first time.

“The door is brushed open, a guy has been shot, blood pressure is dropping. Sort of like the ER series, there is no time for meditation or discussion. We ask, ‘How many times was he shot? Is he allergic to anything?’

“We don’t know if he was the assailant, the victim or an innocent bystander. We are just focussed on keeping him or her alive. It is only afterwards that you discover the background of what happened. But it never matters to us – guilty, not guilty.”

The buzz of the Emergency Department that was portrayed by Drs Green, Ross Carter and Benton in ER during the 1990s was also pretty accurate, according to Barrett. (In the early years, anyway, the later years got a bit ‘soap opera-y’ and the interpersonal relations were perhaps a little overblown).

I watched the earlier programmes and it was a fair portrayal. It showed the grittiness, the excitement, the blood. The medical parts – the symptoms and the treatment were correct.

“When you’re actually doing it, it is exciting. There is an adrenalin rush. You need to be cognisant that this is a human being – not just another gunshot wound.

“I do remember this guy who tried to hold up a gas station but somebody was passing by, saw him and called the police. They came and surrounded the place. The raider comes out and he has a gun. He won’t drop the weapon so the policemen open fire.

“Sixteen bullets. That’s the largest number of bullets that I’ve ever seen in a person who has survived. We counted the holes and matched them with the retained bullets. Those two things have to match or else there is one lodged somewhere that will show up in x-rays.

“That man survived but sometimes one, simple stab wound can kill.”

From Cork to Chicago

Life could have been very different for Dr Barrett.

Graduating from medical school in Cork in 1969, he fully expected to become a GP in Ireland. But a well-placed conversation with a mentor, Dr Paddy Kiely, sent him in another direction.

“He told me that there was the ‘making of a great surgeon lost’ in me.

“I thought about that and I did enjoy working on people who had been in accidents. First I thought I would go into plastics – stitching people up – but on going to America, I realised plastics was more about cosmetics. While there, and before returning to Cork to continue my studies, I began to develop an interest in gunshot wounds.

“It was really an interest in acute traumatic injuries. Treating the injured rather than the sick.”

Working as a surgeon in Cook County meant 24-hours shifts during which he would look after every surgical trauma patient from triage to aftercare.

“Most of the action was at nights and weekends,” he adds. With such a busy lifestyle – one that is portrayed well by the likes of ER and Grey’s Anatomy – Barrett always promised he would retire at 60. In 2002, he did just that.

“I had set up an integrated trauma system in Chicago where patients were taken to the appropriate hospital in the appropriate timeframe.

“The trauma centre needs to make commitments if a patient is going to bypass another hospital. Elective surgeries get disrupted but there is a constant emergency surgery room available fully stocked with blood. That is a huge infrastructural commitment.”

The integrated system he set up included the pre-hospital staff who Barrett singles out (with nurses) for particular high praise.

“I have the greatest of respect for paramedics. It is one thing to manage a patient with lights, nurses and all the appropriate equipment but it is another thing to ride on an ambulance or treat someone in the middle of the street. It’s a totally different scene. Sometimes they could be surrounded by people who are not very happy.

“Paramedic discretion is a recognised triage criteria. We don’t second guess them. They are the ones on the scene. They are the ones who know whether they should be brought to us. We never say they were wrong, even if they just say, ‘He didn’t look right’.

“The nursing staff are the same as in they are not often recognised fully. The Emergency Medical Staff depend on them.”

So, scenes like this would not happen under his watch.

A return to his hometown

Dr Barrett describes his own medical education as “solid”.

“What I achieved was built on the foundations of the training I received. You can’t advance or get better unless that is there. I am very touched and proud to receive the Alumni of the Year Award from UCC.”

The Cork man is also satisfied with his own career and teaching record.

“I was good at it. I did a lot of teaching. One thing I’m very proud of is the fact that I was able to recruit female surgeons. There are even fewer of them who do trauma. But at one stage, we had more had more females than males and when I retired, the person who took over from me was also a woman.”

Dr Roxanne Robert came up through the ranks after Dr Barrett, first as a resident and then a veteran consultant. She now runs the trauma unit.

“People ask me if I miss it and I do,” Barrett continues. “But I had seen people begin to lose it after 60 and that’s not fair on themselves or their patients.

“I don’t feel that I want to go back and do it. I remember my wife once asking, ‘Are you going to do it when you’re 80 years old? It was a wonderful time. But there comes a time that you can’t do that anymore.”

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