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Real Life, Real Death

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By Bill Mahin

There's no explanation for why this night has been like watching paint dry. According to conventional wisdom, Mount Sinai's tiny emergency room at 15th and California should be especially busy. As one of just four trauma centers left in Chicago, ambulances regularly bring the "life-threatened" here from throughout the city to this west-side hospital. Also, tonight's the start of the weekend, and today a long spell of raw weather finally broke.

Yet the most exciting call to come in over the telemetry network--the first alert of trouble on the way--was from a paramedic picking up a guy who'd "been down for three hours." That is, obviously dead. What the paramedic not so subtly hinted was that he'd like Dr. Pinkes on the radio to let him sidestep the protocol requiring him to run IVs and attempt resuscitation. He wanted to take the corpse directly to a hospital a minute or two away to be pronounced DOA. The paramedic never came right out and said that was what he wanted. He just sounded angrier and angrier.

Pinkes didn't budge. Had he acquiesced, he told me later, he could have lost his license.

According to the board indexing who's in which beds for what reasons, patients came in during the day complaining of fever, leg cramps, fever again (this was a homeless man who said he'd been HIV positive for ten years, a claim met with some skepticism from the nurses), anxiety, a chicken bone lodged in a throat, asthma (which turned out to be pneumonia as well), and battery.

After six uneventful hours visiting the emergency room I was getting ready to leave when one of the unit secretaries came over and told me they were bringing in a guy with gunshot wounds to the head and a "sucking chest wound." The last time I'd heard the term "sucking chest wound" I was in Vietnam.

Blink. So many medics flooded this sleepy emergency room that I couldn't see around them. By a fast count, 14 people are now jammed into one bay, so many that the woman with pneumonia and asthma is being wheeled out to make room.

The level of tension is very much like it is before the start of the Chicago marathon, when thousands of runners wait for the gun to fire.

It gets very quiet--just a monitor beeping somewhere in the distance.

First there's a phalanx of police, then the paramedics wheeling Steve in on a gurney. The Sinai team slides him off one back board onto another, which they set on a hospital bed. (The boards are long, narrow, and varnished, with holes at each end to hold down a patient's hands and feet.)

At this point the paramedics are essentially finished. Unlike the police, who leave once it becomes obvious that Steve won't be answering any questions for a while, if ever, the paramedics hang around doing paperwork, gulping candy bars, bullshitting with a cop here on another case, talking about tonight's basketball game.

One of them tells me Steve ran to a porch on North Waller after he got shot and collapsed there. She says Steve had snorted coke an hour before they found him. I ask how she knew. She says she asked him. She thinks Steve was shot because a drug deal went bad. He was shot four times--once in the head, twice in the chest, once in the shoulder.

The paramedics got to him at 10:25. They'd checked his vital signs, assessed his wounds, stopped the bleeding, started an IV, and were running through the ER doors by 11.

Swarming over him, Pinkes's team frantically starts stabbing needles into any veins they can find--in his arm, in his hand--and trying to run a tube through his chest wall so they can pump blood out of the cavity. Dr. Joan Surdukowski, who's in charge of the ER tonight, says that when most of the blood's gone the lung that collapsed should reinflate by itself.

It's big, this tube into his chest, perhaps a half inch in diameter. When it's finally in place and the suctioning begins, a lot of blood comes out and keeps coming out.

Steve is 30. With his shaved head he looks like a black Billy Zane. Off and on for the next 90 minutes he makes soft keening sounds. Whenever he's more conscious he complains.

"You have to be able to relate to a lot of people from a lot of different races, religions, and socioeconomic groups," Surdukowski told me earlier this evening. "From bottom-of-the-barrel society--drunks, alcoholics, criminals--to working-class people who've been beaten or in a car accident, you have to be able to develop a rapport with a patient quickly. You have to be able to get that person--somebody possibly very different from you--to trust you and consent to possibly painful or uncomfortable procedures."

Victor Pinkes had been respectful and gentle with the elderly gentleman who had a chicken bone in his throat. Now, with Steve, he isn't harsh, but the words sensitive and solicitous don't come to mind. Steve's hardly a docile patient. He keeps trying to pull his legs up, to work his body into a fetal position, which may be understandable given his situation but keeps the work from proceeding. "Steve, we're tryin' to save your life here," says Pinkes in the loud voice he uses with no one else. "How about helpin' us?"

Steve's vital signs monitor beeps steadily, unendingly, about twice a second. The ER team here probably doesn't even hear it, would notice only if its rhythm changed or if the beeps stopped altogether. To me it's maddening.

An argument breaks out when one of the X-ray plates is positioned incorrectly under the patient. The X-ray techs being nowhere to be found, one of the younger guys in scrubs had slid the plate under Steve, and he positioned it vertically rather than horizontally. Now some of the doctors are telling the techs off for disappearing and the techs are arguing right back. Pinkes makes a nice move, sliding between the combatants and taking the plate with body language that says "let's see what we've got here anyway." The confrontation ends.

On the X ray he can see little and not so little white flakes. These are pieces of shrapnel from the bullet that broke up inside Steve's chest. "We'll probably leave them where they are," Pinkes says.

They wind up taking a lot of X rays to make sure that another bullet isn't hidden somewhere in Steve's head or body. When an X ray's taken without clearing the area, one doctor says he's worried about radiation. The female tech says there's nothing to worry about so long as no one has sex tonight, at least not sex intended to get someone pregnant.

The X ray of Steve's head reveals no bullet or fragments thereof. The shot was, in police and ER parlance, a "through and through."

Steve's now wearing an oxygen mask. It makes him look like a jet pilot with the shakes. His shaking head doesn't stop his complaining though. "Steve, try not talking for about five minutes," says Pinkes.

After an hour and a half of frantic work on Steve, just before the ER sends him off for a CT scan, Pinkes asks Steve, "Do you play the lottery?" and continues, "Because you've just won." Unless Steve starts bleeding heavily--which would indicate an injury to the heart or lungs--he's going to wind up "very lucky," Pinkes says. That means no lasting damage.

Steve leaves behind a grisly wad of dark brown blood-soaked sheets. By contrast, the blood on the back board on which he was restrained is a delicate red wash, like something from Mark Rothko.

Even with all this frenzy, the emergency room didn't otherwise shut down. Indeed, Tom Widdell, the oldest-looking doctor here (the shelf life for an ER doctor is only eight or nine years), has been treating a woman with an enormous gash on her cheek, the result of a brick someone flung through the windshield of her car. As Widdell rummages for the size suture he wants to sew her up with, Pinkes comes over and helps search. He asks if the woman's going to need a plastic surgeon. Widdell says, "There is no plastic surgeon. I'm it."

The worst it's been in terms of juggling patients--and lives--that Joan Surdukowski can remember was during last summer's heat wave, when Chicago hospitals had too few ventilators and too little blood. It was, she says, "like a war zone," a time of actual triage in which "our efforts go to [the person] who is most likely to survive.

"If we'd tried to resuscitate aggressively every patient, we'd have exhausted all our blood in a matter of hours."

A day or two later I describe my night to two friends--one male, one female, both white, both educated, both urban, neither a yuppie, both treading water in the middle class. When I get to the part of the story where Steve's been shot and the emergency room fills with medical people who will desperately try to save him, both say, "They should have let him die."

Art accompanying story in printed newspaper (not available in this archive): Photograph of Victor Pinkes by Randy Tunnell.

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