WALLA WALLA -- The topic seemed far away as an exhausted Tom Underhill tucked into a breakfast of yogurt, fruit and grains at a downtown Walla Walla restaurant recently.
The medical director of the Walla Walla General Hospital emergency department has been treating local trauma since 2004. That was back when the results of gang violence landed in the hospital's ER rarely, if ever, Underhill said, refilling his coffee mug after a night of doctoring.
"When I started I didn't see any of this. It's increased dramatically in the past two years."
And by "this," the physician is referring to what he calls "The Knife and Gun Club."
From a medical perspective, the local gang situation is multidimensional. Probably the most visible layer is what ends up in the media, the stories of dramatic gang fights, the physician pointed out. "That's when they need direct intervention. Or they will die."
He sees the signs of a gang-life "birth" more, Underhill said. "I see a lot more of the 'jumping in,' kids with the split lip and banged up."
Either situation, and all degrees in between, bring another spectrum to his emergency department.
When injured gang kids arrive at the hospital, Underhill can discern their age before he looks at the chart.
"The young kid is scared," he explained. "The older kid is belligerent."
And, nearly always, "there is a parent, somewhere, crying loudly."
The subcategory -- the adult gang members with their own children -- are worse, the doctor said. "You can tell the kids are affected. You can tell their home life sucks."
Bad results come from bad behavior, a fact that is not sinking in with most gang kids, Underhill expounded. "Shy of the grace of God, I don't know what a wake up call is."
Such a call doesn't come soon enough for many in Walla Walla. A gang-related beating with a baseball bat in early March left a 15-year-old boy with significant trauma, he said. "It was the largest brain bleed my colleague (at Providence St. Mary Medical Center) had seen. That's huge, that's lifelong impairment."
The drug culture embraced by gangs has a similar impact, but takes longer to do the damage.
"So many of the drugs don't kill you. Meth just rots you away after 20 years," Underhill said.
Drug use is "exploding faster" than ever before in Walla Walla, he believes. "Heroin use is profound. I'm seeing things I didn't expect to see."
There's one example from his practice underscoring his perception. It's called "skin popping," and it's horrible to see, the doctor said. The guy showed up in the ER, the top of his arm covered in "black skin, like road tar."
Twenty years of shooting up had done that, Underhill said. "Heroin arrives here in black tar form, and it's dissolved and shot into the vein. Or under the skin if there is no vein. You don't expect that here."
Watching Walla Walla's crime and drug-use rates climb is scary, as a community member, physician and a father, he said. "I don't know the answer. As long as gang behavior is tolerated, how do you get this malignancy in society out? What can the good 50,000 people do about the 500 not-so-good?"
Everyone pays the price. In addition to changing the nature of a community, gang behavior taxes area providers.
"Who's going to take care of the CAT scans? Who will pay for it? On a local level that cost is absorbed by the hospitals ... how long is that sustainable," Underhill asked.
"Walla Walla is unique in that there are so many really good, really invested people" to answer that question, the emergency medicine doctor said. "Yet, again, how long and how much?"
Underhill is cynical about the effectiveness of using a canned approach or standardized program in the schools to tackle the issue. "Local cops in discussions, that's where the education needs to come from. Not a cutesy poster with 'Ruff Dog.'"
He tries to make his own children aware of the problems associated with gang lifestyle, Underhill said. "But how do you do that for a 6-year-old? You don't. You send them to play in the sandbox and say a prayer."
Underhill doesn't worry for his own safety when he's working in a gang violence situation. "If I need support in the ER, I have it in two minutes. And our brothers in blue? Are great," he emphasized.
"Do I feel scared in the ER? No. Do I feel angry in the ER? Yes."
Yet, at the end of each incident, it comes down to seeing the patients behind the violence.
"They are still a kid or adult, a brother, a son. When you see a mom crying ... she loves her gangbanger as much as I love my son," Underhill said. "When you remember that, it's easier to be nice."
Sheila Hagar can be reached at firstname.lastname@example.org or 526-8322. Check out her blog at blogs.ublabs.org/fromthestorageroom.