The Deepest Well: Healing the Long-Term Effects of Childhood Trauma and Adversity—A Transformative Guide to Understanding Childhood Trauma and Health

by Nadine Burke Harris

Dr. Dowd decided to do a chart review of all the pediatric firearm injuries in Kansas City for that year, looking for any factors that might be a common thread and possibly preventable. She obtained the health records, hospital admissions, EMS records, and coroner’s reports of every child who had been killed by gun violence in the preceding year. What she found was that their medical histories revealed a pattern that repeated itself with tragic consistency. A typical story looked like this: A patient first comes in as a nine-month-old baby with a suspicious bruise, and the case is referred to Child Protective Services. The investigation is inconclusive. The next notation in his chart is from his pediatrician and details several missed visits for immunizations. At age four his preschool teacher complains that he won’t sit still, has frequent tantrums, and hits other kids when he gets upset. He is diagnosed with ADHD and put on meds. At age ten, he’s fighting and disruptive in school. This time, he’s diagnosed with oppositional defiant disorder and put on more meds. At age fourteen he comes into the ED with a fracture of the fifth metacarpal, the bone in the hand that forms the knuckle of the pinky finger. Doctors call it a boxer’s fracture because that’s the bone that typically breaks when someone punches an object. The final entry in his medical record is at sixteen when he’s brought into the ED for multiple gunshot wounds. This time he doesn’t walk out.