DRAMA AND TRAUMA
Take a peek behind the curtain inside one of the busiest ER centers in the state as Christ Medical Center’s staff tries to cope with the pulse-pounding pace and spiking summer violence
It’s just after 1 a.m. when the doors to Christ Medical Center’s emergency department slide open yet again. Roberts Park paramedics steer a gurney carrying a 32-year-old man, his head enveloped in bandages, into trauma bay 2.
Fourteen doctors, nurses and technicians surround the bed. They remove the man’s shoes, ask where it hurts, take his blood pressure and heart rate.
The patient, in shorts and a black tank top, is alert, telling the hospital staff he’s unsure if he was stabbed in the neck with a vodka bottle or a beer bottle.
Dr. Ellen Omi, the trauma surgeon on duty, rushes over. She has stepped out of surgery to repair the perforated bowel on a gunshot victim to check on the new arrival. As the team goes through its initial ABC checklist — airway, breathing, circulation — members shout stats, Omi gets a call: A Joliet hospital wants to transfer two patients to Christ.
“Talk fast,” she says into the receiver. “I’m in the middle of two traumas.”
It’s just another weekend, and despite the shift’s two gunshot victims, four car-crash patients and one circular saw injury, it is somewhat slow considering what usually comes in on a summer Saturday night.
“You should have seen last night,” a nurse says. “GSW [gunshot wound] after GSW, all night.”
As the only Level 1 trauma center to service Region 7 in Illinois, a geographic area that is as diverse as it is broad, Christ is always busy, but even more so on the weekends in summer, when just about everything from traf- fic accidents to gun violence escalates.
Christ has the second-busiest ER department in the state, surpassed only by Stroger, said Dr. James Doherty, medical director of trauma services at the Oak Lawn hospital.
“We see more than 100,000 emergency patients each year; 3,500 of them are victims of trauma,” he said. They are treated in the first four bays of the emergency department. They come from as far south as Kankakee, as far north as 58th Street in Chicago, as far west as Yorkville and as far east as Gary, Indiana.
The breadth of the coverage area, coupled with Chicago’s escalating gun violence, particularly on the South Side, has prompted some to insist the area needs an additional Level 1 center. Protesters recently campaigned outside the University of Chicago Hospital, insisting it open an adult trauma center.
Trauma in Illinois is a voluntary designation, and many hospitals opt to not devote or divert resources to maintaining an in-house trauma surgical staff; some simply can’t afford it, and some choose to specialize in other areas of medicine.
Doherty said recent additions to staffing and the hospital’s 97 percent save rate show that the Christ team is holding its own and that it is sustainable, even as the violence surges and weapons on the streets become more sophisticated, and even as the hospital’s service area expands. Two years ago, Indiana passed a law requiring all trauma victims be transported to a trauma center if they are within a 45-minute drive. That made Christ the nearest Level 1 for much of Northwest Indiana.
The season of trauma
Friday and Saturday nights in July and August can mean pandemonium in the streets and nonstop activity in the ER, Doherty said.
The July 4 holiday weekend brought 65 to 70 trauma cases to Christ. They included fireworks injuries, shootings and motor vehicle traumas, Doherty said.
“We are unique in that we have a third [trauma surgeon] backup,” he said.
In 1986, the state enacted The Illinois Trauma Center Code, giving the Illinois Department of Public Health authority to restructure trauma centers and to regulate them. Soon after, Michael Reese and Bethany hospitals, as well as the University of Chicago, dropped out of the voluntary program because it was too costly. In 2008, St. James Hospital in Olympia Fields dedesignated too. That left Christ as the only Level 1 on the South Side.
Level 1 means there is a threat of loss of life or loss of limb, and potential for shock or traumatic amputation, Doherty said. That definition includes the blunt trauma caused by motor vehicle accidents as well as the intentional, or penetrating, trauma inflicted by gunshots and stabbings.
“Most urban areas see 20 to 30 percent intentional trauma,” Doherty said. “For us, it’s 30 percent. In rural areas, it’s almost all unintentional trauma.”
Since he started at Christ in 2002, Doherty has seen an increase in death and injuries from multiple gunshot wounds.
“Now, instead of a single gunshot wound to the abdomen, we’re seeing patients with gunshot wounds to the abdomen and the chest and the head. That suggests an increase in the number of automatic weapons being used. That also means we’re seeing more patients come in as DOAs,” he said.
“Do we need more trauma centers? That’s always a valid discussion to have,” he said. “But you have to remember that more trauma care is not going to resolve the problem of why there is so much violence today. The outrage [over violence] needs to be directed at what is causing the need for so much trauma care.”
Dr. William McDade, president of the Illinois State Medical Society, said trauma is not the only kind of health care needed. Other hospitals opt to divert resources to obstetrics or geriatric care for the uninsured or underinsured. University of Chicago, for example, has a Level 1 pediatric trauma unit, which Christ does not.
“Every hospital has to decide how it will allocate its resources,” he said.
Much of the debate over whether or not trauma care is adequate on Chicago’s South Side centers on the “golden hour” — the need to get a patient to a trauma center within the 60 minutes of injury.
“The standard is 20 minutes,” McDade said, and most people in Region 7 are within that range. In addition to Level 1 Christ, the region has several Level 2 hospitals, including Silver Cross in New Lenox and Presence St. Joseph in Joliet, where patients who are injured often are taken to be stabilized, and then transferred to Christ.
“The South Side is well-established and well-protected by trauma care,” McDade said, and having more Level 1 centers in Chicago’s south region would not necessarily change the patient outcome rate.
Nevertheless, in summer 2013, Rep. Bobby Rush, D-Ill., introduced legislation that would provide $100 million to increase service to “trauma deserts.” The bill aims to encourage other hospitals to become designated trauma centers; it is in committee.
Every kind of injury
On this night at Christ, injuries come at a steady pace, from the hand sliced by a circular saw to the man shot in the buttocks. One patient died at the scene of his injuries and another, an 11-year-old child from Country Club Hills, is taken next door to Advocate Children’s Hospital emergency department. The boy, who hit his head during a fall from a vehicle, would die before week’s end.
The nature of trauma work can lead to burnout and affects the specialties that medical students choose. It’s stressful, with high liability rates for doctors. And the hours are crazy.
Kruti Shah and Jose Marquez are medical students with University of Illinois. Both were wrapping up their first week in Christ’s emergency department.
Marquez wants to specialize in emergency medicine. “It’s unfiltered,” he said. “It’s a very democratic room. No one’s denied. Everybody has the same access, the same opportunity.”
Shah likes the ever-changing nature of the work. “You just never know what you’re going to get.”
Charge Nurse Nick Oszak said you either love working trauma or you hate it. And you find out real quick which camp you’re in.
He’s been there six years, which, of course, means he loves it. “You’ve got to be an adrenaline junkie to do this kind of work,” he said.
Doherty said: “I’ll be honest with you, we almost reached our breaking point a few years ago when we were dangerously understaffed. There was a significant burnout effect. We went to the administration. Then added two people, then two more. We went from having three to seven trauma surgeons within a two-year period.”
It’s not unusual for a trauma patient’s bills to top $1 million, Doherty said.
A 97 percent save rate means the majority of patients survive, he said. It also means many of those patients who survive a gunshot wound are left with lifelong injuries that often require therapy, rehabilitation and other ongoing medical care.
“We’re obliged to treat whoever comes through those doors; we can’t pick and choose our patients. Our patient population for the large part is young men between the ages of 18 and 28. Many are uninsured,” Doherty said. “A lot of times we’re absorbing the costs of this. But it’s part of our mission as a hospital.”
Only a curtain separates the patient with a stab wound to the neck and the patient who is handcuffed to the bed. While the staff works on the stabbing victim, who was injured during an argument in unincorporated Justice, a Chicago Police officer guards his roommate. That man was one of two injured during a police chase. The vehicle they were driving crashed into a garage and they were caught.
There is no time or interest in passing judgment, Doherty said.
Doherty said, “You have to be able to work under stressful situations.”
And you have to be able to deliver bad news in a professional yet heartfelt manner.
“Someone walks out of their house one day and doesn’t come home — that’s a tragedy,” he said. “It’s appropriate for people to be upset and angry, for them to fall down on the ground screaming, because their child has just died. That’s appropriate. That’s what I’d do if my child had just died.”
But there are positives too. He remembers one patient, a burly, heavily tattooed man who suffered a gunshot to the chest.
“We opened his chest, restarted his heart and got him up to the OR, where we fixed an arterial injury,” he said.
When Doherty went to the waiting room to tell the family it was “touch and go, but he is alive,” the injured man’s brother, who was even larger than the patient, “picked me up and hugged me.” That patient made a complete recovery and today owns a company and has several children, Doherty said. His mother became a volunteer at the hospital.
“You take a patient who comes here at death’s door and watch them walk out of the hospital,” Doherty said. “That’s the highest high you can have.”