Q & A: Selwyn O. Rogers Jr., MD, MPH, Founding Director of UChicago Medicine’s Level 1 Trauma Center

At the five-year anniversary of the opening of University of Chicago Medicine’s adult Level 1 trauma center, we sat down with Selwyn O. Rogers Jr., MD, MPH, Professor of Surgery and founding director of UChicago Medicine’s trauma center, to discuss how the team is caring for the community, preventing violence and their hope of reducing trauma.

Q: You were appointed founding director five years ago to help build the center, its team, and its programming. Tell us about your mindset in those early days.

Before being asked to look at this position, I had actually never been on the University of Chicago campus. In that context, I was really struck by the absence of an adult Level 1 trauma center on the South Side. When I interviewed and when I talked to people, I realized it was going to be a very heavy lift to develop one. Partly because it had not been done for three decades, but also because of what I sensed from the community – that a center was a long-standing desire, and that there must have been significant resistance. It became a spiritual journey. That's why I’m here. That's why I have persisted and that's why I have survived and thrived in this role. For me, it’s a passion and it’s spiritual.

Q: The need for a Level 1 trauma center on the South Side of Chicago was clear. What challenges did you face in the beginning?

The trauma center is not an emergency department. It is people, policies and programs working together to create a system of care to take care of the most severely injured. It was clear to me there were going to be many challenges — some logistical, some resource-related.

What I didn’t realize was the other side: building trust with the community in solidarity to stand up this Level 1 trauma center. When I was meeting people in the community, I was faced with extreme hostility. People felt the University had turned a blind eye to the needs of the community for so long that the relationship was damaged, tattered and broken.

So humbly, I just said, “I just want to listen.” I think that set the stage for how we developed the trauma center, how I recruited faculty and staff, and how we’ve advanced certain programs and initiatives to address the needs of the community we serve.

Q: How did the mission of serving the community guide your processes?

I wanted to recruit the best of the best. Type A personalities. Folks committed to social justice, who are committed to something greater than themselves. And individuals who at the core were good people, but also great surgeons. This is not a job for the weak of spirit and it's not for those who lack courage.

We did an analysis of what needed to be bolstered and did tabletop exercises and training about how we get a trauma patient from point A to the operating room or ICU. We created policies about what to do in different situations. What do we do with patients from a motor vehicle crash? What programs do we need to develop a high-functioning, high-touch passionate trauma center that is community- facing? This is where listening to the community was so vital.

Q: The trauma center takes a holistic view of recovery. What programs have been created to promote this recovery? And what role does the trauma center have in preventing violence in the community?

UChicago Medicine developed a Violence Recovery Program (VRP) to run parallel to the clinical care the trauma team delivers to patients and their families. The program addresses wraparound services like psychological safety and support for victims of violence (as well as their families). We started out with two violence recovery specialists. Today the VRP team has 18 people.

But how do you create a sense of primary prevention so that people aren't shot, stabbed and assaulted in the first place? That is really hard. You're addressing poverty, racism, discrimination, historical injustices, redlining and governmental policies. Those are really tough things to solve. But just because they are tough doesn't mean that we shouldn’t try to solve them.

Q: UChicago Medicine’s trauma teams have cared for more than 20,000 patients in the last five years. What has that care meant to the community? What has it meant for the trauma team?

We opened the adult Level 1 trauma center on May 1, 2018. The initial projections were that we’d see 3,000 or so trauma activations per year. The first year, we had 3,500. Second year, 4,000. Third year, 5,000. Trauma persisted during COVID-19 and our numbers went up to 5,500. But we’re a learning organization. We learn, we improve, we tinker. That has led to great care despite the challenges.

My three decades of providing trauma care gave me a shield that allowed me to bear witness to some of the most horrific things to which a human being can be exposed. That is, injury intentionally delivered to another human being that leads to their death. Then you relive it immediately when you have to tell that family and their loved ones, who left their house alive, is now dead and will never come back. It’s heavy lifting with a heavy heart. And you hardly ever get a chance to debrief afterwards, because you’ve got to get ready for the next patient. Here was my blind spot: that everyone was affected beyond just the medical team. Sometimes even our own staff actually knows the victim.

In partnership with the Department of Psychiatry and Behavioral Neuroscience, we incorporated training and touchpoints to help address employees’ own secondary traumatic stress. I’m pleased — not that we fixed this — but that we recognized it and are taking steps to try to address it.

Q: You’ve testified before Congress about gun violence as a public health crisis. Why is it important to be an advocate at the national level?

I hope I provided a cogent, passionate perspective as a trauma surgeon who cares for people who have been traumatically injured by firearms. We need change in this country. I’m not taking away anyone’s right to bear arms. However, we have made cars safer. We have made living and working and traversing our spaces in this country safer. But there’s been no technological evolution in firearms in 100 years to make firearms safer. They are weapons of war that we have on our streets, in our churches, in our schools and in our homes, doing incalculable damage every day.

Q: Can you tell me about the research that has been conducted at the trauma center?

Research leads to discovery. Discovery leads to innovation. Innovation ultimately leads to improved health and improved lives.

Some of the research we’re doing is critically evaluating our Violence Recovery Program to see how well we are doing. What needs are we meeting of our patients and our community with respect to addressing those factors like poverty, racism and discrimination that affect health outcomes?

That data led to us embedding a legal clinic as part of our recovery program for victims of violence. We have National Institutes of Health funding to study and evaluate it to see if it can be a national model for others to replicate.

Q: As you look back at the last five years, what’s been most successful?

We’ve seen nearly 22,000 patients and we have lifted all boats. We’ve made the hospital health system more efficient. We’ve brought a degree of compassion to the work that we do with integrity. And I think in some ways it has helped change the hearts and minds of how some members of the community view the University of Chicago. I think that’s an incredible success story.

Our medical students and our residents have been impacted by this. An incredible joy to me is when a medical student says to me, “I'm going to be a psychiatrist, but because I have been on this rotation as a third-year medical student, I want to be a psychiatrist that focuses on trauma care.” That’s powerful and transformative.

Q: What does the future hold? How do you hope the center’s efforts will help put an end to an epidemic of violence in Chicago?

Building a trauma center is kind of like how we view firehouses today. At the start of the 1900s, fires were a common cause of death in America. Then we created public health measures to address safety features and added fire stations everywhere and in every city in America. Today, there aren’t that many fires and far fewer people die from them. But we want to keep our fire stations open.

What if trauma care was like that? You want to keep a trauma center open because you never know. But what if we, as society, really committed ourselves to reducing trauma? That would be a beautiful thing.