The best medicine

Do you ever sit across the table from a client and wonder why you are on one side of the table and they are on the other? I have this terrible anxiety that I shall come back to earth in another life and find myself as a career criminal, from a young age destined to spend much of my life behind bars or at the police station, and being spoken to through the wicket by a harassed duty solicitor or being advised by someonewearing a wing collar and funny white bands and a horse-hair wig. I worry that I will be the one bewildered at the back of numerous courts not being able to hear properly what is going on and being sent down for years at a time. I have represented people my age, and I always wonder how it was that I grew up to sit on one side of the table and my client grew up to sit on the other. It all seems to be about chance.

The other day there was an excellent programme on Channel 4 about the London Hospital and its daily encounter with the consequences of knife crime. It made grim viewing. There were shots of flesh looking rather like the butcher's shop, with bulging incisions and fat and muscle gorging out. There were young men lying face down on the trolleys being wheeled about. There were blood-stained sheets.

Random consequences

Knife crime '“ like kicks to the head '“ is truly scary. Talk about chance: the consequences of a knife attack are usually entirely random. It is only in war films that the commando silently kills his enemy with a precision cut '“ there is a faint moan and the sentry crumples to a heap instantaneously. Everything is intended, there is no gurgling or moaning or clutching or clinging on. But in real life it is all down to chance. It all depends on the angle of the blade, where it strikes and what sort of clothing the victim is wearing. Does the blade nick the aorta or plunge into the liver and cause a massive haemorrhage? Or does it just make a cut?

The difference between a murder trial and a wounding is down to the arbitrariness of fate; strange then in such trials, where your leader does the cross-examination and you think that only last week you were doing exactly the same. The issues are no different; it's just that this time the victim did not make it by a millimetre or two.

Random then as it is, it was arresting to hear the consultant on the TV programme regard knife crime as an illness. He said we should be treating the causes of all these horrific injuries as the consequences of illness. We therefore should be looking at the aetiology of the illness: what causes it? Why are young people carrying knives? Why are they being attacked by others carrying knives? It is not just a policing problem or a government problem; it should also be a medical problem, like drug addiction and alcoholism.

So, as we have to look at diabetes, where the cause may lie (though not exclusively) in obesity or smoking, we have to look at all these woundings and treat the causes. How do we break the cycle of people carrying knives for protection? How do we explain that if you get a knife out and wave it about and cut somebody, you could be going down for life? Why do we have a part of society that celebrates and condones a knife culture; in the same way, why do we have a part of society that condones burglary and prostitution to fuel drug abuse and why do we have a part of society that considers child pornography is an acceptable way of making money and achieving sexual gratification?

Does it all come down to not seeing the consequences of what we do? We all are guilty of this '“ anybody who does 90mph on the motorway is acting selfishly and it may take a road accident to make us realise it. Internet paedophiles do not see their crimes as having a victim, they just see a photograph. Knife carrying is seen as a deterrent from being attacked with knives '“ somewhere on the spectrum where in the end we all have nuclear weapons.

Beating the illness

It comes back to education, as usual, but it must also be about getting rid of the need to carry knives. Carrying knives is not new, but the scale of it is. Treating illness, be it lung cancer by education about smoking or cholera through better sanitation, has an honourable track record in improving the lot of society. Child mortality, death in childbirth, heart disease '“ so many perils of earlier generations have been or are being addressed.

So, let us turn the problem over to the medics as well as the police and the courts and the teachers. We should think about these injuries as a result of illness, and we may find that there are simple things that we can do that might over time mean less young men are bleeding to death in ambulances as they rush through the night with blue lights and sirens to yet another trauma team.

And, on top of that, the truth probably is that the sternest and most impressive lessons to be learned are often not from the lawyers and the courts, but in the harsh lights of A&E '“ where real fear and vulnerability and helplessness is writ large, where it is not liberty but mortality that is at stake. These professionals are the real tough guys, and can reach the parts that the rest of us simply cannot. It is all about respect, and the trauma team have got it. Let's hear what they say '“ everybody's listening.