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Social disease: a surgeon fights the trauma epidemic



The Fire Department ambulance sped across the city on a Friday night, headed from Albany Park to the Illinois Masonic Medical Center in Lakeview.

The cargo was a 25-year-old man who had been shot in the head. The ambulance could have put in at hospitals nearer Jesus Garcia's home, which is where he had been wounded, but Illinois Masonic is a designated trauma center. As the ambulance rushed on, a trauma team assembled in the emergency room. It was composed of Dr. Richard Fantus, Masonic's head trauma surgeon, and an anesthesiologist, a medical resident, a respiratory therapist, some nurses, and a couple of technicians.

Hospital security cleared a path through the emergency room entrance area, already busy with Friday-night heart attacks and kitchen accidents. The ambulance pulled up, and Garcia was whisked inside on a gurney.

At the city's trauma centers a gunshot wound to the head is all too common. The total trauma caseload in Chicago is rising at a rate of 10 percent a year, according to Christine Kosmos, administrator of the city trauma system for the Chicago Board of Health.

The increase has taxed the resources of local hospitals. In 1986, when the first local trauma network was organized, there were ten centers for adults. But citing high costs, four withdrew--the University of Chicago, Weiss Memorial, Loyola, and Michael Reese.

"All we're really doing is picking up the pieces," Fantus says. "We deal with the aftermath of what's occurred, but we should be looking at the causes of trauma."

Fantus's examination of Jesus Garcia was not encouraging. The bullet had entered the young man's head near the left ear. There was no detectable pulse. The nude body--trim, a gold earring glinting in the bright light--was lifeless on the examination table.

"Is the patient viable?" asked a nurse.

"We'll see," said Fantus. "Let's see if we can get a rhythm going."

A technician mounted Garcia's chest and pressed up and down with his hands. A nurse injected epinephrine and atropine. Another nurse pumped air from a blue balloon through a tube inserted into Garcia's lungs.

The electrocardiogram was flat.

"Roll him over before you call it," said Fantus, and Garcia was switched onto his stomach as work proceeded. It was hopeless. At 9:36--16 minutes after Garcia had come in--Fantus called off his forces. Garcia was declared dead, though he'd probably died before he got to Masonic.

"Bag the hands," instructed Fantus. This was to preserve any powder residue as evidence.

Most trauma victims are luckier than Jesus Garcia. They live. A trauma victim alive at the scene who makes it to a trauma center within 60 minutes of being wounded or injured--within what's termed "the golden hour" in the trade--is nearly certain to survive.

A distressing number of persons today run that race against the clock. In 1987, the first full year for Chicago's trauma network, Masonic received 200 trauma cases; last year the hospital received 1,100. Cook County Hospital treats the most trauma victims--4,500 in 1992, a nearly twofold increase since the early 1980s. "We're having an epidemic," says Dr. Gary Merlotti, head of the trauma service at Christ Hospital in Oak Lawn, which serves a large part of the south and southwest sides.

At Masonic, says Fantus, "we see more drunk drivers than we used to, though it's always been bad." The size of the gunshot population has also changed. Once only 5 percent of the trauma victims at Masonic had been shot, says Fantus; now it's a quarter of them. And rather than .22-caliber Saturday night specials, 9-millimeter semiautomatics such as Uzis are doing more and more of the damage. Victims tend to have been hit by several bullets, when a decade ago one shot sufficed.

Summer is the worst season for firearms and knife attacks. "Things rise with the hot weather," says Fantus. "People start drinking earlier, and tempers flare. We'll see seven or eight people on a hot summer night. But the holidays are bad, too; between Thanksgiving and Christmas people get depressed, and there are lots of domestic arguments. The winter tends to be slower, but you never know. Industrial accidents are constants--people are always getting crushed by forklifts and cut up by industrial saws."

Fantus, 37, is the great-nephew of the physician for whom the outpatient clinic at Cook County Hospital is named. He loves his job. "Bringing people back from the brink of death is very gratifying," he says. On shifts that range between 10 and 36 hours, he takes care of administrative chores, sleeps, and visits recovering trauma victims while waiting for his beeper to go off, alerting him to the next tragedy. If surgery is required, Fantus performs it. When someone dies, he tells the next of kin.

Fantus is awed and depressed by the things he sees and hears. One recent morning, for instance, he treated a man who had asked a coworker for a cigarette. When he was turned down he said, "What are you going to do, kill me for asking?" The coworker stabbed him in the back.

"The next guy that morning had been stabbed up under the ribs," Fantus says. "The knife had gone through his liver, but luckily for him it had slid just under the heart. It was some kind of domestic dispute. Two prostitutes were next. One had stabbed the other 14 times and the victim had lost 12 liters of blood."

Illinois Masonic sees some celebrated cases, such as the most seriously injured victims of the January pileup on the Kennedy Expressway; but the incidents that send the hospital most of its casualties don't make the papers. There was the man who put garlic on his knife before stabbing himself because, says Fantus, "he thought it would do the job better." And the man who crashed his motorcycle into a guardrail at 100 miles an hour, coming to an end so bloody that even Fantus can't forget the gore.

"Once there were these two guys sitting on the back porch at their building, drinking," Fantus relates. "They were listening to a boom box, which fell and got wedged way down on the third floor. So a nephew of one guy was lowered down on bed sheets. What happened next was the phone rang, and when one guy went to answer the phone he let go of the bed sheets. The nephew fell down 12 floors. The kid ended up with a broken pelvis and broken bones and was here for three months, but he made it. It turned out the phone call was a wrong number."

He goes on, "The best treatment for trauma is prevention. To fix someone up after they've been shot up or in a car accident is a lot harder than to get people not to drink and drive or to fasten their seat belts or to have responsible gun-control laws. Unfortunately, we'll never be out of business until society makes major changes."

Gun control is desirable, says Fantus, but tough to achieve. "There's no way you can get all handguns off the street. The NRA is just too radical about everybody having two guns, and even if you banned guns the gangs would still have access to them." Fantus issues a stiff "no comment" when asked if he owns a gun.

"But we have to eliminate assault weapons, the 9-millimeters," Fantus quickly adds. "They have no place except in a military conflict."

He is particularly angered by the extent of drunk driving. A study he directed found that more than half the drivers involved in crack-ups who came to Illinois Masonic over a 16-month period were drunk. The blood-alcohol levels of these intoxicated drivers averaged two-and-a-half times the legal limit. Yet only four of these drivers were cited for drunk driving, says Fantus, and none was convicted.

"We have to send a message out that drinking and driving is unacceptable," he says. Fantus wants to lower the legal limit of alcohol in the blood from 0.1 gram per deciliter to 0.08, or from the equivalent of six beers consumed by a 200-pound person over a two-hour period to five. Fantus is an enthusiastic member of an advisory committee on drunk driving appointed by Secretary of State George Ryan and chaired by former Chicago Bear Gary Fencik.

Dr. John Barrett, chief of the trauma unit at Cook County Hospital, argues for an all-out campaign against violent behavior. "People in the inner city don't have coping mechanisms," says Barrett, the dean of local trauma doctors. "The feeling is, if you anger me I will attack you. It's knee-jerk. What we need to do is to give people coping mechanisms against answering anger with violence. We should teach those methods in the schools, just like safe sex and proper eating habits."

"Trauma isn't for the most part accidental," agrees Dr. Merlotti of Christ Hospital. "It's caused by something--drugs, alcohol, gang factors, or a bad marriage--and we need to deal with the precipitating factors or our patients will come back to us."

But Merlotti laments his hospital's limited ability to alter a trauma victim's behavior. "There's a lot of pressure on somebody when they leave the cloistered environment of the hospital," he says. At Christ, trauma patients perceived to have a drug or alcohol problem are counseled to get treatment, but only one-fifth of them actually sign up for a program, says Merlotti.

Experience has taught a cynical Fantus not to count on the people he sees clinically to change their behavior. He has changed his own habits to place himself, his wife, and their two young sons out of harm's way.

For instance, he's curbed his own alcohol consumption: "I have an occasional drink at home, but then the only place I'm going afterwards is upstairs. If I'm out I have maybe one drink and that's it."

Television ads would have you believe the Volvo is the safest car on the road; but when Fantus went to a Volvo dealer he got different advice from the salesman. "The Volvo guy told me to buy a Mercedes," he says, "and so I did, not for the status or for all the bells and whistles but because it's safer."

Fantus's Mercedes is equipped with air bags in addition to shoulder and lap belts, and Fantus insists that his family buckle up. "There's this false sense of security that comes with an air bag, that if you just have one in the car you're safe," says Fantus. "But it should be just an adjunct to belts."

He relates, "There was this girl we saw, who'd been on her way to a prom. She didn't want to put on her seat belt because she didn't want to wrinkle her dress. Her loss. At four o'clock in the morning her date fell asleep at the wheel and she broke her neck on the dashboard."

Fantus takes other precautions. He never drives in the left-hand lane, out of fear that some careless or drunken driver will veer over and hit him. And if he's waiting to cross the street he stands back from the corner, even to the point of positioning himself behind a pole or mailbox.

"You think nothing's going to happen to you on the sidewalk, but it does," says Fantus. "A CTA bus just rolled over this one lady's legs. That's the fourth time it's happened this year."

What happened to Jesus Garcia? A cop told the trauma team that Garcia had killed himself in front of his family, an explanation Fantus didn't buy. The entry wound was on the left side of Garcia's head, and if he'd been right-handed, which most people are, it would have been quite a stretch for him to shoot himself. Then an X-ray revealed that the caliber of the bullet lodged in Garcia's head was lower than that of Garcia's gun.

The police now say Garcia was slain in a domestic spat with his brother-in-law. The state's attorney judged the killing justifiable, say the police, and has not pressed charges.

Art accompanying story in printed newspaper (not available in this archive): photo/Steven D. Arazmus.

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