MEDICINE: COUNTY-USC PHYSICIAN'S BACKGROUND AS A POLICE OFFICER COMES IN HANDY IN THE EMERGENCY ROOMLos Angeles Times -- It's striking how much Dr. Marie Russell still thinks like a cop. Inside the emergency room at County-USC Medical Center on a recent afternoon, she worries almost as much about preserving the bullet that pierced a shooting victim's flesh as she does about his physical discomfort. After urging the physician's assistant to remove the bullet without any metal tools that could mar the markings crucial in a police investigation, she then gently asks the patient for permission to see and photograph his wound and his tattoos. The 32-year-old man, shot six hours after being paroled, obligingly pulls up his shirt so she can examine the massive discolored bruise that is developing where the bullet lodged after missing his spine. "You lucked out," she tells him. "You could have been paralyzed." Then, as he rolls up his left shirt sleeve, she leans in for a closer look at the multicolored peacock on his inner arm. Knowing full well that peacocks and dragons are commonly tattooed inside the arm to hide signs of drug abuse, she nonetheless asks why he chose the design. Acknowledging that he has used heroin, the man doesn't mention the fresh puncture indicating he likely injected earlier that day. Without expressing any judgment, Russell takes a few snapshots of the tattoo as well, then steps from behind the examining room curtain. "The injection site is something I don't have in my photo collection," she says, sounding like a butterfly collector who just snagged a prized specimen. The former Malden, Mass., police officer, who traded a uniform and walking shoes for scrubs and sneakers years ago, has an unusual resume in this world of inner-city trauma care. On top of police skills, she has honed her trauma skills within two miles of 30 East L.A. street gangs and studied forensic pathology under L.A.'s famous former coroner, Thomas Noguchi. She has shot more than 750 photos of tattoos, and hundreds more of unusual wounds to help her understand how they're inflicted and how they heal. Russell incorporates the photos into lectures she delivers here and abroad to medical students, law enforcement and forensic societies. She shares medical and sociological insights into sexual assaults, domestic violence, child abuse, and the drug use and prison histories of gang members. "She is certainly single-handedly developing a new field of what you call clinical forensic medicine," Noguchi says. "We only have one Marie Russell, but we need at least a thousand such persons to serve major communities." County-USC faculty noticed Russell early in her residency because of her multidisciplinary skills and recruited her for a permanent faculty spot, says Dr. Kathryn R. Challoner, an emergency room doctor and fellow faculty member. "It's a joy to have her around. The first person I would go to for questions about tattoos or forensics or ballistics or gang affiliation or pathology information would be Marie," says Challoner, who turns to Russell on touchy cases inside the hospital's jail unit, such as suspected cruelty or child abuse. Moses Remedios, the physician's assistant who asked for her advice on whether to remove the bullet from the flank of the tattooed gunshot victim, says: "She's got that total cop street-smart going, plus she's a good doctor." He then extracted the bullet with his gloved fingers, as requested. She Always Knew She Wanted to Be a Doctor Although she began her career as a police officer, Russell, 45, says she always knew she wanted to be a doctor. A native of Woodside, N.Y., she was one of five children raised by a father who worked for the railroad and a mother who did clerical work. Russell remembers as far back as the second grade admiring her family doctor, a woman who later gave the teenage Russell some of her medical journals. A good student, Russell spent a year at the Massachusetts Institute of Technology, but moved home when her mother developed cancer. After her mother's death, she returned to Massachusetts and began taking courses in criminalistics and criminal investigation at Northeastern University. Then, on a dare, she took the police exam and passed. Although she hadn't set out to become a police officer, Russell knew that there were funds available to help officers further their educations. So she completed police training and became the first female officer in Malden, Mass., north of Boston. While on patrol there, she pursued her bachelor's degree in psychology. An emergency medical technician course and a stint as an emergency room clerk got her hooked on emergency medicine, so she applied to medical school at the University of Massachusetts. By 1983, which she recalls as "the hardest year of my life," she was 28 years old and juggling first-year medical studies with a full-time police job 50 miles away. In her second year of medical school, she was introduced to pathology, and found herself torn between doing advanced training in that or emergency medicine. She could only do both at a big-city medical center with an affiliated coroner's office, so she headed to County-USC in 1987 for her residency. While examining gunshot and stab wounds suffered by patients from surrounding neighborhoods, she became fascinated by their tattoos' meaning. "The more I asked, the more I became interested," she recalls. Studying the Markings of the Various Gangs Understanding the forensic significance of the symbols has helped shape her handling of patients, especially shooting victims. For example, before County-USC doctors understood gang tattoos, they inadvertently put members of opposing gangs in the same treatment areas. "Sometimes that created problems," Russell says, such as gang members threatening and verbally abusing each other. So the hospital staff began limiting visitors to gang members' mothers and at times admitting the patients under pseudonyms to keep rival gangs from trying to come after them. "There have been incidents in this hospital where gang members have tried to come into the hospital and finish the job," she says. Russell has become alert to the distinctive markings of black and Latino gangs and white supremacists who come through the doors, learning about symbols and numerals that are a mystery to most people. At one time, Russell asked a patient if his ?" tattoo signified his ZIP code, since she knew some L.A. gangs had 213 area-code tattoos to identify their home turf. The patient responded that the five digits represented the penal code for being under the influence of a controlled substance. Since then, Russell has learned to recognize many symbols of a prison past. The number of teardrops tattooed below the corner of the eye can indicate how many years a patient has been in prison. A Salvador Dali-like image of a melting clock means the person has "done time." And prominent images of the Madonna or Christ tattooed on the back are used to deter prison rape. Some tattoos influence her medical decisions. An unexplained fever in a patient with symbols of drug use may indicate the possibility of drug-related infections; prison watchtowers or symbols of homosexual acts may make her suspect HIV or hepatitis. Despite her demanding schedule in the emergency room, where she's as apt to help a patient untangle an intravenous line as she is to mobilize a trauma team, and teaching at County-USC and Cal State L.A., she is also managing to raise a nephew, 14, and niece, 18, now married. "Bringing up children is the hardest thing I've done," she says. It also made her give up the guns she's had since she was a police officer. "The guns moved out of the house the day my children arrived," said Russell, who is by her own admission a fanatic about safety. She's been known to annoy her family by giving smoke detectors for Christmas. Russell knows she inhabits a different world than that of most people, a point driven home one day at her niece and nephew's school when she suddenly realized that an incident that disturbed the nuns there was "minor compared with what I hear and see everyday." "It occurred to me that crime and violence are not part of their life. My life is so different. My life centers around violence." Even at home, she spends many hours scanning her forensic photos into a computer. In her prized time off, she manages to put the darkness aside to swim or camp, although she does admit her preferred recreational reading is true crime.