In the Line of Fire

NBC’s hit TV series ER, in which crisis follows crisis with barely a break and doctors deliver one miracle after another, won eight Emmys this month, largely on the strength of its hectic impression of realism. But TV’s emergency room, with its nonstop heroics, shouldn’t be confused with the real thing. “My wife and I argue about it every week,” says Dr. Jeffrey Kann, an orthopedic resident in the emergency room at Chicago’s Cook County Hospital, the model for TV’s ER. “Everything is so patterned and works so smoothly on the show—it isn’t normal.”

But what is “normal”? During one 24-hour shift at the Cook County ER earlier this year, Chicago bureau chief Giovanna Breu and correspondents Luchina Fisher and Ana Rhodes witnessed, amid the routine heart attacks, flus, broken bones and overdoses, a gritty human drama that would be lost in the glare of the television camera. The day—with some 35 doctors and 75 nurses—begins at 10 a.m.

Registered nurse Kim Washington stands by a hospital cart at the entrance to the Cook County emergency room, cheerfully stopping patients as they come in. It is her job to weigh the gravity of the patients’ afflictions.

She has sent a dozen of them with less serious problems to the waiting room while urgent cases are seen immediately. Bryan Ralph, a 19-year-old in a Pearl Jam T-shirt, reclines in a plastic chair, his left foot propped on his crutches. He has been here since 9 a.m., waiting to see a doctor.

“I was shot in the leg two weeks ago,” says Ralph, who came to Cook County because he had no insurance. “I was at a friend’s house, and when I went to go home, I got caught in the middle of a cross fire.” A bullet pierced his ankle, but never exited. Doctors at the first hospital Ralph went to decided to leave it in and allow the bullet to exit on its own. But Ralph now wants Cook County to remove it to improve his chances of joining the Navy.

11 A.M. A frail elderly Hispanic man accompanied by two women approaches nurse Washington’s cart. “Has he lost any weight?” asks Washington. One woman translates. “Yes,” she replies. “Has he been sweating at night? Coughing?” asks Washington. “For like three months,” says the woman.

“He has all the symptoms of TB,” says Washington, after she covers his nose and mouth with a surgical mask.

12:05 P.M. Bryan Ralph finally gets to talk to a doctor. “He’s going to get an X ray,” says Dr. Sharad Pandit, 35, a second-year ER resident. “How deep the bullet is will determine whether he gets operated on.”

12:50 P.M. “It will be a busy day,” predicts Dr. Eric Clymer, 30, a second-year resident from Oklahoma. “When you have a warm spring day after a cold siege, you can almost guarantee something bad will happen.”

Dr. Seth Krosner could do without any more excitement. “Yesterday I had a patient who looked me in the eye and said, ‘Help me. Will I be okay?’ ” says the 33-year-old attending trauma surgeon. “Imagine looking into a patient’s eyes and saying you are going to take care of him and then having him bleed to death in the operating room because someone had an advanced weapon capable of shooting him four times in a very short period.”

Krosner once belonged to the National Rifle Association. No more. He is outraged by the NRA’s campaign to repeal the federal ban on assault weapons. “Those legislators who want to make it legal to purchase weapons designed solely to kill people,” says Krosner, “let them come here and put bandages on bleeding wounds. Sometimes you have to throw out your underwear because your clothes are filled with blood.”

This said, Krosner walks to the other side of the unit and helps suction the throat of a 40-year-old man. The newly arrived patient, hooked to a welter of machines, fell from a housing project window.

3:15 P.M. For a couple of hours, things have been quiet in the trauma unit. Two small children, Abby Ubilla, 2, and her brother, David, 4, who were in a car accident with their mother, Lori, are getting needed sleep.

Suddenly the calm is broken by a commotion in the ER. A disheveled, disoriented man has left his wheelchair and is pestering the staff. Dr. Ardena Flippin, 48, the senior attending physician of emergency medicine, learns from a resident that the man has had a seizure but wants to sign out.

“Have you been taking your medication?” asks Flippin.

“I’ve been taking it,” the man says. “But I’ve been drinking.”

“Who is the President of the United States,” Flippin asks.

“Hillary Clinton.”

4:15 P.M. “I’m getting tired of this,” says Bryan Ralph. “They told me they were admitting me; now they’re not.” Ralph has learned that a bone in his foot has been shattered but the bullet remains intact. “It’s not necessary to take it out,” says Dr. Pandit. “It’s not an emergency.”

4:45 P.M. From inside the trauma unit comes a ghastly scream. “That does not hurt,” says orthopedic resident Jeffrey Kann to Jesse Porter as he lifts Porter’s left arm. Drunk, Porter, a transient who has been hit by a car, screams every time Kann comes near him, frustrating the physician’s attempts to determine what’s wrong. Kann touches the man’s arm, and he howls again. “Act like an adult, for Christ’s sake,” says Kann.

6:45 P.M. X rays show Porter’s left clavicle is cracked. The residents will later marvel at his blood-alcohol level, which is three times the legal limit.

7 P.M. Guarded by two police officers, Jerry Dean, 23, is lying in a bed in the trauma unit. Hours earlier he panicked while driving and ran over 11-year-old Curtis Speed, who was walking home from a party. Dean told police he had pulled up next to Chicago Vocational High School to pick up his sister when he heard shots and started to speed away. Dean was charged with striking a pedestrian in the roadway, driving without a license and without insurance and for failure to stop at a stop sign. Brought in with multiple injuries, he is listed in fair condition.

9:40 P.M. A Latino family crowds around the bed of Jose Gutierrez, 39, whom they have just found after a two-week search. He was brought to Cook County after having been hit by a car. But for two weeks he had been unconscious, so no one was able to talk to him—until today, when Erik Swenson, 30, a surgical resident, asked him to write down his phone number. “Ten minutes after I called,” says Swenson, “eight family members were waiting to come into the ICU.”

10:30 P.M. There are now so many patients in the ER with assorted ailments and broken limbs that all 17 cubicles are filled and hospital beds line the corridors. “It was a quiet day until 3 p.m.,” says nurse Michelle Samuels. “But it’s not too bad. We’re moving the patients.”

12:45 A.M. A woman with a ripe black eye is wheeled into the trauma unit. Her name, she says, is “Margaret Fields, like the cookies.” Fields, 32, groans at the doctor’s every touch. Her stomach is especially sore, as if she has been kicked. “What happened?” asks Dr. Scott Anderson, 28. “I don’t want to talk about it,” says the woman.

2:25 A.M. A young man who has been shot in the leg arrives unannounced at a back door of the hospital, accompanied by three friends. As the wounded man is hurried inside, several other friends appear on the ramp. Two of them hold animated conversations on cellular phones.

Meanwhile the nurses quickly transfer the man, Terrance White, 22, to a bed. He has a gaping hole in his right leg, with an exposed piece of bone jutting out. Worried that he has blown out an artery, the nurses listen for a pulse in his foot.

At that moment the loudspeaker, which is continually crackling, warns that a trauma victim is en route.

2:40 A.M. “It’s showtime,” says the Cook County police officer guarding the door as a female patient, a multiple gunshot victim, is rushed in. “One-two-three,” say the paramedics and nurses together, hoisting the woman onto a hospital bed. Half a dozen nurses and three doctors begin working, frantically taking blood, attaching IVs, injecting local anesthesia, trying to get information from her. “How are you doing? What is your name?” But the woman only groans. Doctors locate two wounds in her chest, another in her hand. “Let’s get her chest tube in,” says a resident.

“Back up,” yells the trauma doctor. “Chest X rays first.”

“She’s a hundred percent dead in her extremities,” says someone else.

The team starts to put white X-ray tape down to mark the gunshot wounds, which number eight, in preparation for surgery. Chief trauma surgeon Fred Brenneman, who will operate, won’t predict the outcome. “It depends a lot on what we find,” says Brenneman, who admits privately that he loves working in trauma. “I like when things happen fast.”

3:35 A.M. Police bring in a man with a deep cut over one eye. He claims he was assaulted with a baseball bat. He is hostile and won’t let doctors near him. Chicago Patrol Officer Rose Gordon says the truth is, the patient walked into his girlfriend’s party and started shooting. The revelers were not amused. “They kicked his ass,” says Gordon, “and took all his clothes off and threw him down the stairs. That’s life in the big city.”

4:40 A.M. A husky man in his 20s who was brought in half an hour earlier with his left pinkie all but severed is trashing his bed. After much questioning, he admits to smoking “happy sticks”—marijuana laced with PCP.

“The problem with PCP,” says Dr. Clymer, “is that one minute he’s happy, the next he’s a crying idiot.”

As if to illustrate, the man screams as he is placed in restraints: “You don’t have to tie me down!” Then he purrs, “This is kind of kinky.”

“Wait till you get the rectal tubes,” says nurse Victor Medina.

4:50 A.M. The parents of wounded 22-year-old Terrance White have come to visit him. His mother and father talk softly to him as the doctor explains his condition. “Who did this to you?” the father wants to know.

5:30 A.M. It appears from the X rays that Margaret Fields was punched so hard in the stomach that the blow ruptured her spleen and put a hole in her colon.

Fields moans with pain; the man on PCP rips at his restraints; a third patient vomits. “Our little shop of horrors,” observes Clymer.

7:50 A.M. There are just 10 people in the waiting room. The ER is slowing down, assuming its matinal rhythms. The 24-hour shift for residents in the trauma unit is coming to a close. Clymer removes the patient list taped to the desk in the resuscitation area. “This was a one-cup-of-coffee night,” says nurse Holly Brock.

8:10 A.M. Or maybe two. A woman has just been rushed into the trauma resuscitation area. “Somebody get some lidocaine [a local anesthetic],” Brock, 43, calls out. Two other nurses hold the woman’s legs down.

“I think I got a main [artery] here,” a doctor says.

“Pressure, 108 over 58,” says a nurse. An oxygen mask has been put over the woman’s mouth and nose.

The woman cries out. “Ma’am,” someone says, “please calm down.”

8:19 A.M. The woman is noticeably calmer as the drugs begin to kick in. James Babiuk, 29, an oral surgeon, calls out the injuries he sees: “Left body fracture,” referring to her broken jaw. “Frontal laceration, down to the bone but no step up,” he says, indicating that her forehead is deeply gouged but not fractured.

8:30 A.M. Nurse’s aide Janice Laury 46, brings in the woman’s wallet and announces her name to the trauma staff. With the woman stabilized, the residents take a moment to reconstruct what must have happened. “Car accident victim,” says Dr. Saki Ratanawong, 28, a urology resident born in Thailand. “Probably intoxicated. Ran into a pole. She has significant face and head trauma, but no seat belt marks on her.”

9:15 A.M. Both shifts gather in the conference room with Dr. John Barrett, director of the trauma unit, to discuss the 17 patients admitted the day before. The man who says he was hit with a bat may need plastic surgery. The woman with the multiple gunshot wounds is stable, following surgery. She had a hole in her liver, another in her small bowel and another in her left ovary, which they had to remove. Suddenly the fresh team dashes out of the conference room to work frantically to save the life of the woman in the car accident.

10 A.M. Now that the woman is stabilized, Holly Brock can finally take a seat. He recalls his own brush with death, which introduced him as a patient to the Cook County ER in 1969. “I was riding a motorcycle,” says Brock, “and I caught two bullets. The second one lodged in my spinal column, and I was paralyzed from the waist down.” The doctor removed the bullet in the spine, a risky procedure at the time, and after 49 days in the hospital, Brock was sent to rehabilitation, where he learned to walk again and decided to become a nurse. He has been one for 14 years, the last six on the trauma unit. Says Brock: “I would not work anywhere else.”