THE AFTERMATH OF VIOLENCE
Surviving a gunshot is less than half the battle
By Scott Johnson, Oakland Tribune

A year ago last August, two men walked up to the car where Jabar Thomas was sitting and started shooting. Jabar was hit seven times. His friend, the intended target, died instantly. Jabar was taken to Highland Hospital. That he survived at all, his doctors later said, was "miraculous."

In late September, after 13 months of intensive therapy and rehabilitation, Jabar was released. As he struggled for several minutes to negotiate the two feet between his wheelchair and the car seat, his mother, Candice, looked on joyously and said, "This is the first day of the rest of your life."

But as is true for many victims of violence, the rest of Jabar's life has become immeasurably more difficult, more expensive and more uncertain in the wake of the attack.

These days, Jabar -- whose name has been changed in this story to help guard his safety -- is largely confined to the bottom floor of a two-story apartment. There's a bathroom where he can change his colostomy bag, and a kitchen where his friend and daytime caregiver Marie makes his food. Several times a day, Jabar rolls his wheelchair to the kitchen sink where, with Marie's help, he hauls himself unsteadily to his feet and grasps the counter to exercise. He stares out the window at a small park and some buildings. "I just want to walk again," he says, as beads of sweat roll down his face, "One day at a time, one day at a time."

VIOLENCE'S HIDDEN COST

For residents of the East Bay whose lives are afflicted by gun violence, the experience is often footnoted in one of two ways: jail or death. However, there is another, often overlooked fate that has claimed thousands over the years: survival.

It is not death, really, nor is it jail, but a sinister combination of the two -- a violent trauma followed by a lifetime of physical and mental injuries that take a terrible toll and can cost hundreds of thousands of dollars per injury just to manage, let alone heal.

For every gun-related death in Oakland each year, there are five or more cases of survival. From 2006 to 2010, Alameda County Emergency Medical Services transported 2,486 survivors of gunshot wounds, an average of 487 per year. However, hundreds more are taken to hospitals by friends, drive themselves or seek treatment elsewhere, making an exact countywide tally difficult to determine. Dr. Greg Victorino, head of Highland's Surgical Trauma Center, said that of the 3,829 cases of gunshot wounds seen at Highland from July 2001 to July 2011, 3,298 survived -- roughly 86 percent.

The majority of these cases involve the uninsured, which means tens of millions of dollars of medical bills are being passed on to the taxpayer year after year in the county and across the East Bay.

Survivors, meanwhile, often spend years in rehabilitative therapy, plagued by injuries, complications and follow-up surgeries. In addition to being physically painful, the complications may be embarrassing and uncomfortable. Victims may have to wear colostomy bags for years. Others may feel paralysis or numbness in limbs for the rest of their lives. Many more are left quadriplegic or paraplegic.

"People don't think about being quadriplegic when it comes to gun violence," said Stefania Kaplanes, a social worker at Highland Hospital who is familiar with Jabar's case and is deeply involved in the care and maintenance of gunshot victims. "People don't always think about the fact that gun violence could leave them alone, unable to talk, unable to care for themselves for years and years."

For Jabar and his family, the full effect of the emotional, psychological and financial aftermath of his injury is only now beginning to be felt. In addition to more than $1 million in medical bills, the psychological toll will be felt for years to come as Jabar, his parents and his longtime girlfriend and mother of his two small daughters, all continue to make the adjustments.

Some changes are small; others are huge. But there is no doubt Jabar's recovery will shape the rest of their lives. "The worst day of my life," Candice wrote in her journal after the shooting, "My man child was down an not by the Loard (sic). Got the call no mother wants!"

SLOW RECOVERY

The first days were touch and go. One minute he was stable, the next his vital signs would start to waver. As the days and weeks passed, Jabar started to improve. He would move his legs or hands in tiny increments. When his daughters came to visit, his face broke out into a huge smile. On the day of the shooting, Jabar weighed 187 pounds. Upon his arrival at Fairmont Hospital, where he did most of his rehab, he weighed in at 127. Candice thought he looked like "a little old man."

But the weight loss had more serious implications. When Jabar was shot, the doctors had cracked his chest open and removed most of his organs to make sure there was no debris left over. They had replaced the organs, but the surgery left what amounted to a big hole in his stomach, which they had covered with medical plastic while he recovered. His weight loss made it impossible to sew him up properly. Doctors cut flesh off his thighs and grafted it to his stomach to bridge the gap. But the graft didn't take. Jabar started bleeding from his stomach. Doctors rushed him to Eden Medical Center in Castro Valley, and performed an emergency surgery in which mesh was grafted onto his stomach to make him whole again.

HARD ROAD AHEAD

After several months of rehab, Jabar started speaking again, single words at first but then longer and longer sentences. But then came another blow. A doctor told Jabar there was a chance he would never walk again.

"That got me down," he said recently. "That was a tough pill to swallow."

Even before the shooting, Jabar didn't smile often; now he smiled even less. He started to ruminate on his life. "I kept everything bottled up," he said, "I didn't want to get nobody else down with me."

With his stomach in tatters, Jabar had to relearn how to project his voice. When Candice asked him something, he would nod or shake his head. "I can't hear you," she'd say, and he would push out a meek "Yeah." Candice wanted Jabar's voice to strengthen. She wanted him to "get his masculinity back."

At Fairmont, Jabar was surrounded by people in similar stages of recovery. One of them was a young gunshot victim who was quadriplegic, paralyzed from the neck down. As the weeks passed, the two became friends. He told Jabar that he was hoping to get a new spinal cord. Jabar thought this was crazy. One day he told Jabar he wished he had died instead. The reality of his friend's life, frozen solid in a bed for the rest of his life, shook him deeply.

"It was a changing point," Jabar said. "I wasn't going to give up; he had lost all faith in God. I looked at him, and I got a lot of strength."

Jabar had been a good swimmer in junior high. Later, he had played basketball. And then he got to high school and started getting in trouble. Eventually, he got picked up on charge of selling fake cocaine and went to prison. He got out, but it wasn't long before he would go back in.

The shooting changed him. "I don't miss those streets at all," he said, "All the violence, the shooting, the robberies, every time you look around it's something, it's like what y'all doing?"

But it has also changed the lives of his family and close friends forever. His girlfriend, Jennifer, 31, remembers how they used to go out for dinner at Red Lobster, or walk through Jack London Square. They have been together since they were 12 years old. She has stayed with him through his years in prison, his year of recovery and has no plans to leave, she said. Still, she struggles to explain to their daughters that their father can't play with them on the jungle gym the way he used to.

"I'm worried if he's going to walk again," she says, "It would really help with the kids."

And she also misses him in other ways. "I miss him, I miss going out, things are limited with him right now," she says, "But we're working on that."

Marie, Jabar's daytime caregiver, sees just how much the family is struggling. "He has to live with Jennifer and she's low income and he hasn't got any benefits and he can't get up and go to work and it's making him feel bad," she said. "He can't do what he used to do. He looked at me the other day and just said, 'I want to walk so bad.' "

His father, Malik, says the shooting brought them closer. "He used to think I didn't love him," he said. But Malik can't talk about that day in August without breaking down into sobs. "My son just turned 30, but it's like having a newborn baby. I love him so much."

THE REST OF YOUR LIFE

Although at times clear and lucid, Jabar floats in and out of memory and sensation. Mention the shooters and the upper half of his body tenses up. Last week, another friend was slain in a park where Jabar used to hang out, and the killing has re-triggered his own trauma.

The doctors at Highland, Fairmount and Eden saved his life -- time and time again over the past year. But in May, Jabar received a bill from the Alameda County Medical Center for $760,770.42, the first of several. Medi-Cal will pay for all of it. Multiply this by thousands, and the cost to society starts to emerge. But there are other unanticipated costs that continue to build up. Last month he was taken off Social Security. He and his girlfriend have gone on food stamps. He doesn't know when, or even if, he will ever work again.

It will be years before Jabar recovers some semblance of his former self. He will be in a wheelchair for the foreseeable future. He will wear a colostomy bag for years. The smallest details of his apartment-bound life -- the positioning of a table, how and when to move from the couch to a chair -- become enormous challenges.

"He doesn't need his kids bouncing all over him," Candice said. "Does Jennifer understand this? I don't think so." But both women love him, and neither has all the answers. So they'll have to work together.

Jabar's gaze flickers from recognition to vacancy and back. His eyes go blank for long stretches. "My memory ain't too good anymore," he says, "It knocked off my whole equilibrium, but it changed me, it gave me a whole new perspective on life."

Jennifer is thinking of taking him for a ride around Lake Merritt. "That would be nice," she says, "I'm thinking of doing that."

*****
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