Precious Lives: A surgeon's plea
Ashley Luthern
John Densmore, a pediatric surgeon and an associate professor at the Medical College of Wisconsin, was pumping gas two days after Christmas when his work pager buzzed.
He glanced down and saw the text: a 1-year-old boy had been shot and paramedics were rushing him to Children's Hospital of Wisconsin.
Densmore called his surgical fellow, who would assist in the procedure, and went over the massive transfusion protocol — preparing huge quantities of platelets, plasma and O negative blood.
One detail gnawed at him: The age.
It must be a typo, he thought.
He asked the fellow if the patient really was an infant.
Yes, she replied.
Densmore had treated roughly 50 kids and teenagers for gunshot wounds in his career, but none this young.
"What does it say about our city?" he wondered.
"Forty-one shots into that house, where this young innocent child was playing Legos with his family. A complete disregard for human life." — Milwaukee County Circuit Judge Jeffrey Wagner
The patient, Bill Thao, was barely three feet tall and weighed 32 pounds.
Densmore's surgical fellow, already certified to operate on adults and now specializing in treating children, stood on the pink footsteps painted on the floor of the emergency trauma room. The words "team leader" were printed inside the footsteps, a reminder for her to observe, analyze and direct the more than 20 doctors, nurses and technicians working to keep the baby alive.
Densmore walked into the room briefly, seeing firsthand how very small Bill was, and how very injured. Tubes and wires stretched from machines, measuring the baby's heart rate, blood pressure and other vital signs.
Densmore rushed upstairs to the operating room. A surgical technician had filled two trays with every instrument he might need and prepared the room, kept at the optimum 80 degrees, for the rest of the team: an anesthesiologist, two anesthesia technicians, two nurses, a surgical scrub technician and an intern.
Densmore and the anesthesiologist, whom he likens to a co-pilot, immediately faced a critical decision: When to begin surgery. Starting too soon or too late could mean the difference between success and failure, life and death.
The infant was in shock. He had lost a tremendous amount of blood, causing his veins to collapse and making it impossible to use an IV. A tube had been inserted into the center of his leg bone in the emergency room.
But the blood flowing into his body through it was not enough to compensate for the massive blood loss.
Densmore stepped away from the operating table and consulted with several team members.
They needed to find another way to pump more blood into the tiny body.
"The fact that we have shots being fired in residential areas on a night-by-night basis doesn't even make the news, but it should. It should be something that we need to stop." – Assistant District Attorney Antoni Apollo
In a matter of minutes, the team made a decision: They would try to place a special catheter into a vein in Bill's neck or arm.
But Densmore couldn't get it in place, and he didn't have the luxury of waiting.
He started surgery.
Major vessels — arteries and veins — carry blood from the heart throughout the body. The bullet, which had entered the infant's stomach, had an incredibly unlucky trajectory, tearing through a set of arteries and veins tasked with transporting blood to his legs.
Densmore and his team worked feverishly to control the bleeding and isolate the injury, but there was something they couldn't see because of all the blood.
The bullet had hit a second set of blood vessels.
Seconds ticked by, and Bill got worse. The bleeding did not stop. They lost his pulse.
Bill Thao died Dec. 27, 2014, at 9:45 p.m.
Almost two years later, Densmore still struggles to put that moment into words.
"You become abruptly human and you become a dad," said Densmore, who has two young sons.
"And then you become the imparter of the worst news in the world."
"The years go right past. My son — myself, my wife is hurt. It's a hurt more than I can say." — Somboon Thao, Bill's father
Watching a soul come unstitched.
That's how Densmore describes telling Bill's parents their child was gone.
After, he headed back to the operating room, passing his friend, the surgical technician who had been in the operating room with him. The woman, a 40-year hospital veteran he had known since his internship 16 years ago, had slumped down a wall and was sitting in a hallway, exhausted.
"A place like Children's is not a sterile box where the injured go and they either make it or they don't," Densmore said in a recent interview. "There are people, human beings, in that box, making it happen."
A debrief weeks after the surgery was too analytical, not accounting for the waves of emotion people felt. Learning the extent of Bill's injuries, and that the medical probability of him surviving was zero, provided no comfort.
Bill was among 12 gunshot patients treated that year by Densmore, who is one of 10 pediatric surgeons at Children's Hospital. Between November 2012 and August 2016, about 200 gunshot victims were treated there.
"It has me feeling, whether or not it's true, that the problem is becoming more exaggerated or, worse, spreading," Densmore said.
When he first came to Milwaukee as a newlywed and intern at the Medical College of Wisconsin, Densmore and his wife purchased a home on the city's northwest side.
He remembers his neighbors: a bus driver, another medical resident at the college, an electrocardiogram technician. He remembers hearing about a nearby shooting wounding a young man who was Hmong.
More than a decade later, Bill was shot in the same neighborhood, blocks from Densmore's first home.
Bill's family had emigrated from Laos, seeking an escape from violence. Instead, it found them here when a drug dealer shot up the wrong house in a dispute with another dealer. The shooter was sentenced to 50 years in prison; he never admitted responsibility for the shooting.
Densmore has thought about the shooter, how he must have had no regard for his own life, let alone anyone else's.
And he considers how hopeless those who pick up guns must be. These young men, he reasons, have lost hope for myriad reasons: geographic isolation, "economic depravity," loss of mentorship, loss of parents, loss of a culture that shows a way forward and includes people willing to take risks to help others.
"The loss is too great for this city, it's too great for this nation, it's too great for this world," he said.
"If we're unable to protect that child as a community or as a society from these type of acts, we all need to take a step back and consider the circumstances that we're in." — Assistant District Attorney Antoni Apollo
As a surgeon, Densmore analyzes problems and thinks several steps ahead to try to solve them.
He has carefully considered how to prevent children from becoming his patients.
He supports efforts by his church through Southeastern Wisconsin Common Ground to press gun manufacturers to invest in developing smart guns, which can only be fired by their owners.
He thinks it's smart to have a citywide plan to address youth violence — one is in the works now — and he believes the state should take similar action. National attention and funding would help bolster after-school programs, improve child welfare systems and other efforts proven to prevent violence.
"I know there are already people doing wonderful work; my only plea is more, more," he said. "We need more help. It's not a simple thing, it's many things. And it's expensive."
Every time he cares for a gunshot patient, Densmore sees the opportunity to intervene. A successful surgery could lead to an "80-year cure" for a child — unless they are shot again.
Densmore has personally had three patients return to him with second gunshot wounds. Not all of them survived.
"You know, when you're a teenager, you think you're invincible," he told the mother of a recent teenage gunshot patient. "And what we hope for is that this is his turning point."
The woman told the doctor about how her son fell in with a group of friends she was wary of and how her long work hours kept her away. Densmore gently asked if moving was an option. It wasn't, the woman replied. A parent, she sighed, can only do so much.
It was something he had heard from other parents.
Densmore mentioned Project Ujima, a hospital program that provides a wide range of services, including counseling, for families after a violent injury to a child.
"I think it's important to know you're not alone and that the struggles you feel, many others have felt," he said to the mother.
The patient's mother later decided to cut back on her work hours so she can take her son to and from school. But it's probably not a sustainable solution. Densmore worried about seeing this patient again, treating him for another gunshot wound.
But he knows the future is out of his hands.
"I have a lot of hope because that patient has someone who loves him and that's the first step," he said. "If you've got that, then you've got something to work with and then the community needs to figure out ways to support them."
Precious Lives senior producer Emily Forman contributed reporting for this story.
How we reported this story
The family of Bill Thao gave permission for John Densmore to discuss Bill's medical treatment for Precious Lives. This story was constructed from interviews with Densmore, archival news articles and court records. The italicized quotes come from a transcript of the shooter's sentencing hearing.
More from Precious Lives
For past stories in the Precious Lives project, which looks at the causes and consequences of youth violence, go to jsonline.com/preciouslives.