Thursday, September 17, 2015

In moments, trauma unit turns into "war zone"


     I clearly remember the moment, my hand on the old brass doorknob of my apartment at Logan and Mozart, the telephone ringing through the dark wooden door. 
    "Don't answer it," I told myself. 
    It was Friday, my day off, since I worked Sundays, and I was heading to the gym. 
   "Just leave," I thought.
     But being a reporter is a calling, like a priest. I sighed, went back inside, answered the phone. The City Desk, of course. The Tribune, they said, was running some big piece on trauma centers, starting Monday. Trauma centers were expensive to run, and closing down. I was to go to Christ Hospital, soon to be the only Level 1 trauma unit on the South Side, and spend 24 hours in their emergency room, then write a piece. 
    For Monday. 
    Okay, I said. Being a newspaper reporter is a calling, like a...
    I got Christ's PR person on the phone. 
    "I'm going to have to talk to the board," she said. 
    "That's fine," I said. "But do it quickly. I'm heading to the hospital right now, meeting a photographer there. You can either let us in or have us arrested."
    They let us in. A different era. The problem I faced was that very little happened for the first 20 hours I was there. I caught a few winks on a stainless steel table in an examining room, worried as I drifted off that I'd wake up being operated on. 
    To show how long this has been an issue, this article is more than 25 years old. Holy Cross, at 68th and California, which gets bypassed by the ambulances in my story, announced last week it is spending $40 million to upgrade to a Level 1 trauma center. 
     
     Everything changed at 1:35 p.m.
     After hours of coffee, pizza, chat and routine treatment of cut noses and sore throats, the call came into the Christ Hospital emergency room Saturday afternoon: Two men with serious gunshot wounds were on their way.
     An operating room at Christ, soon to be the only hospital serving the South Side with an advanced trauma unit, was readied for surgery. Specialists whom another hospital might take hours to find were immediately contacted and put on alert at Christ. Doctors, interns and nurses gathered to map out plans.
    "Why don't we make the chest wound the 99?" said Dr. Joe Mueller, giving priority to a 33-year-old man who police told them by phone had been shot just above the heart.
     Other patients were wheeled away. Supplies were laid out: intubation tubes, packs of syringes, gauze and gallons of medical fluids.
     Paramedics soon rushed in with the first victim. In agony, he tried to jump off the gurney. A dozen doctors and nurses held him down. Nurses slit off his pants while doctors began the "90-second-survey," rolling him on his side to check for other wounds.
    The big man, with homemade tattoos, cursed the doctors, then cried out in pain.
    "Hold my hand, hold my hand," he said, and a nurse gripped his fingers.
     Paramedics who had wheeled in a very old man stood waiting for attention. They were brushed aside by another group of paramedics with the second gunshot victim, a 19-year-old.
     The shooting victims had wounded each other on West 69th Street over a dice game. Twenty-dollar bills still lay on a gurney.
     The ambulances carrying the men had bypassed two other hospitals — Holy Cross and St. Bernard — because they are not part of Chicago's shrinking trauma network. Instead they came to Christ Hospital, at 4440 W. 95th St. in Oak Lawn.
     Even as the trauma team divided itself between the two gunshot victims Saturday, nurse Cheri Aardema put down a phone and announced: "We've got another one coming in. IV drug user with multiple stab wounds. Used heroin two hours ago. Here in 10 minutes."
    By 3 p.m., one resident described the emergency room as a "war zone." A technician, arriving to make a scan of the victims' hearts, took one look and left the room to pass out.
     The key to understanding the difference between a trauma center and a standard emergency room is one word: readiness.
     Any hospital could have inserted tubes to drain the gunshot victims' chests, taken X-rays or cut into their ankles in search of the saphenous veins to hook up lines to pump liquid into their shocked bodies.
     But as a trauma hospital, Christ had to be prepared for whatever happened. If an aneurysm suddenly burst in a brain, neurosurgeons were ready. Cardiac surgeons were standing by in case bullets had damaged a heart.
     It follows that since trauma hospitals must be ready for almost anything, usually their capacities are not needed to their fullest. In fact, for three solid hours earlier that day, from 3 to 6 a.m., no patients were treated in the unit.
     Other "Code 99" trauma calls Saturday were false starts. A "gunshot wound to the left chest" arrived at 12:40 a.m. The trauma team assembled. The operating staff readied.
     But the bullet had been deflected by a rib; the only time the patient was in real danger was when he lit a cigarette while an oxygen tube was taped under his nose. The trauma team bandaged him up, replaced lost fluids and told him to put out the cigarette.
     One hundred six people came into the emergency room Friday, the day before. They were a varied group: an 18-month-old boy who drank bleach, a 93-year-old woman with a fever of 105, a man with a sore throat, a drunk with a blood alcohol level of 0.436, several victims of minor car accidents, a hurt wrestler, a fireman who inhaled smoke, four people who breathed hydrochloric acid fumes at a factory, and dozens more, none in danger of dying, none a trauma patient.
     Despite the high cost of trauma care, Christ joined the trauma network in 1986 "first, (because of) what it does for our educational program," said Dr. Gary Merlotti, head of emergency services. "You cannot run a surgical residency without trauma.
     "It's important for prestige. If you want to become a community hospital, that's well and good, but if you want to be more than that, you need to provide trauma services. Also, the concept is consistent with our philosophy and vision."
     The network started out with 10 hospitals but will soon be down to six when Michael Reese ends its participation next month. As hospitals drop out of the network, the time it takes to get patients to the remaining trauma centers grows longer, cutting into the "Golden Hour," or crucial period after an injury occurs when trauma care is most effective.
     "With all the trauma centers closing down," paramedics have to struggle to keep people alive longer until they can receive trauma care, said paramedic Jim Gleeson, who brought in one of the wounded men from the dice game.
     Merlotti said there are enough trauma centers in the network, as long as they are evenly distributed. But since trauma centers cannot be moved, he said, redistricting is needed, or new centers should be opened. Whatever happens, Christ Hospital will stay in the network, he said.
     "If we leave the trauma system, it will collapse," he said.
     As a trauma surgeon, Merlotti was called in when the two gunshot victims arrived at Christ. After they were stabilized, he checked their heart scans.
     Suddenly, at 3:40 p.m. the room was quiet again. Merlotti gazed at the pile of bloody material left by the gunshot victims, who had been moved upstairs.
     Musing on the huge financial losses that have forced hospitals to drop out of the trauma network, he estimated that the bill for the gunshot treatment could be $2,000 for each patient, though he doubted that the hospital would ever get the money.
     Many trauma patients are uninsured and cannot pay for the expensive care, adding to the financial burden carried by a trauma center.
     "We could charge them $20 and have difficulty collecting," Merlotti said.

                        —Originally published in the Sun-Times, Jan. 15, 1990


 

11 comments:

  1. I have yet to figure out why those screaming for more trauma centers on the South Side refuse to demand that Cook County open one in the mostly unused, county owned Provident Hospital on 51st St just east of King Dr, on the North end of Washington Park.

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  2. In the old days, those gunshot victims would have been driven past the nearest hospital because they were (I presume) black. Now, they're driven past because there's no money for an adequate network of trauma centers. Racial progress apparently means different reasons for the same old shit.

    By the way, Neil, good for you for having the chutzpah to bull your way past the PR person. I wouldn't have, which is why I could never make it as a big-city reporter.

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  3. The Ghost of Christmas PastSeptember 17, 2015 at 9:43 AM

    Medical care should be free. Period. Like public schools. No one should be charged a penny, ever, for anything.

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    1. This may be a side effect of too much allergy meds, but I'm agreeing w the ghost on something. Medical care should be free.

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    2. Nothing is free. While I would be ok with it, You would have to pay something through taxes. We only do that now through medicare tax

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    3. For those without insurance, medical care is free (for them) because a hospital can't turn them away and rarely collects payback. That is why, when people scream about Obamacare costing taxpayers, they are clueless on the fact that we are already paying for them.

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  4. Nikki, try Claritin, it won't make you drowsy. ;)

    Informative blog today on the trauma centers.

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  5. So, the cement will go into trauma if the water isn't ready and waiting? Is there a clever connection between today's top photo and the story, as there usually is, that I'm missing, or you just liked this picture, NS?

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    1. I just liked the picture, and knew I didn't have one that connected with the story. It was also fresh -- I took it yesterday afternoon.

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  6. "I got Christ's PR person on the phone." Would that be Francis by any chance?

    Tom Evans

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  7. A gunshot trauma episode only cost $2000 in 1990? What a BARGAIN! *sobs pathetically in the corner*

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Thanks for commenting. As soon as I vet your remarks, they'll be posted, assuming they aren't, you know, mean and crazy.