On call for all traumas

Her official role is director of a violence intervention program at Boston Medical Center. Her real role is to try to help victims avoid becoming victims over and over again.

That can mean steering them to mental health programs, or helping them find lawful employment. Sometimes, it involves counseling the siblings of victims who often fear becoming caught in a web of attack and retaliation.

In the city’s busiest emergency room, caring for victims has come to be defined beyond simply providing trauma care. The larger goal is to help victims learn how to put distance between themselves and crime.

Her client base is up in this violent summer, putting a strain on the hospital’s celebrated trauma unit, and the programs like hers that support it. Hers is hard, often-heartbreaking and absolutely essential work.

James has been at the hospital for 20 years, much of it in a role that didn’t exist when she was in medical school. Her fascination with emergency medicine grew out of her empathy for the victims she came to know. She grew up in working-class Alexandria, Va., and attended Hampton Institute, one of the first in her family to attend college.

“I never considered any specialty other than emergency medicine, not ever,’’ she said yesterday. “I looked at the people in the emergency room, and I asked myself how they were any different from me. And they weren’t.’’

At what was then Boston City Hospital, she came under the influence of Dr. John Rich, the MacArthur “genius’’ winner who pioneered the idea that treating the wounded had to entail more than just fixing their injuries and sending them back into the same unstable environments. His notion was that victims of crime bore psychological as well as physical scars, and that their trauma often touched everyone close to them, exacting a toll on entire families. Rich has moved on to Villanova University Medical School, but his ideas live on in Boston.

“He’s still the first person I call when I’m trying to figure something out,’’ James said

The recovery of a shooting victim named Chris Johnson illustrates what success in James’s world means. Johnson’s brother was working in James’s unit, advising victims, when he thought he heard familiar voices in the ER one night in 2006. Familiar they were - his brother had been shot, and taken to the hospital. Johnson would lose the use of his legs. His career as an auto mechanic was done, but the care and counseling of the hospital staff helped him pull his life together. Though a paraplegic, he works as dispatcher for the city’s Department of Emergency Medical Services.

“I was strapped - mentally, emotionally and otherwise,’’ Johnson said. “They helped me get my life back together.’’ Now he talks to youth about the effects of crime, and about his own PTSD. “I’ve actually expanded my life since I got shot.’’

I asked James about the added stress that comes when shootings are up, as they appear to be now.

“Sometimes it’s overwhelming, but my staff has never folded under it,’’ she said. She said it took years to fully appreciate the toll that working with the walking wounded exacts from the people who work with them. Some recuse themselves from cases that hit too close to home.

Her favorite part of her job is teaching medical residents - many of whom have little direct experience with victims of street violence. “Nobody teaches this in medical school,’’ she says. “This gives them a huge insight into who these people are.’’

Her work, she believes, is public health in the broadest sense of the term. “The crazier it is, the more I like it,’’ she said. “I just think everyone deserves a peaceful space.’’

Adrian Walker is a Globe columnist. He can be reached at walker@globe.com.