The Place Where They Have To Take You In

Days and nights on the front line at Minnesota's busiest emergency room.

John Eppolito is the only doc back here tonight, and he's working hard--the hardest, he'll say later, he's ever worked as a physician. He's actually a family practice resident, which makes his performance remarkable: Most of the family docs who rotate through the ER don't tolerate the work very well. They always want to treat the whole person, and you can't do that here. The maxim is "treat and street"--deal with the presenting problem, write a referral to a clinic, and hope they follow through. If not, they'll be back here anyway.

Now Eppolito swings around to point at the man with the bus ticket. "Look, I'm busy. I'm real busy. Do you understand me?" Denver shrinks a little and points at a large wet spot on his pants. "I just want to dry these." "We don't have anything to dry them here. I don't mean to be impatient with you. You've been a real good guy, and I'm trying to take care of you. But I can't stop and talk to you every time I walk by." "It's just because I'm cold." "Okay. We'll get you a blanket. All right."

Minneapolis has a law against public intoxication, and the cops are required to pick up anyone who's drunk or high to the point where they can't handle themselves. For years, they brought their charges to the Hennepin County detox on Chicago Avenue. But in 1992, an investigation found a string of violations at the facility, and the state pulled its license. The shelters didn't want the detox cases; nor did the jail. That left the emergency room.

The first couple of weeks were crazy, with cops dropping off patients at triage a half dozen at a time. Nurses lined them up on the floor, for fear they might fall off chairs and hit their heads. The staff went into overdrive and within two weeks turned what had been the Urgent Care section into a special unit, separate from the main ER and with its own entrance out back. More than 10,000 patients went through it in the year before the county and the Salvation Army worked out plans for a new detox. It's up and running now, but when its 19 beds are full--or when they, and a scaled-down facility at 1800 Chicago, feel they can't handle someone--it's back to HCMC.

Besides drunks, Specials is also in charge of admitting patients who come from the jail and the workhouse, and those who "got arrested and got hurt somewhere along the way." The beds all have leather restraints that can be fastened to ankles and wrists; the holding rooms have doors that bolt shut when needed, "to decrease the stimulus."

Dawn is one of the nurses who works Specials a lot. Blonde, a mother of two, and married to a paramedic, she is quick with the kind of humor that cuts through the bullshit. She's been in the ER for five years since coming over from Riverside Hospital. "It was a big change. Real big. I grew up in a sheltered environment, suburban family. I could never go downtown. And now this. I was like, wow, people live like this?"

"415, 415," the ambulance beeper squawks, "possible sexual assault. Bloody, ETOH [intoxicated], and combative." Dawn scurries over to Holding Room 1, rousts a patient, and leads him out in his slippers and hospital gown; he'll sit in the waiting room for a while. A minute later the paramedics wheel in the gurney carrying a figure in restraints covered with blankets. "Why are you doing me like this?" a voice groans from underneath. "I'm not an animal. Please take these off me. Oh Lord. I won't say anything." "Okay," one of the medics grins. "Why don't you try that for a little while?"

Dawn kneels at the bottom of the bed, her face level with the man's. "Dave, I don't want you to fight, and I don't want you to spit. Okay?" The minute the restraints come off, his hands go flying and she catches a whack. "Okay, Dave. You're here at the Hennepin emergency room. Do you want me to help you?" "I want to talk to somebody." "Yes. We're going to have a talk." A man in green scrubs walks in, and Dave's body jerks. "You're going to whip me," he moans, and to Dawn: "Don't go. Please, please don't go." "I won't go." She introduces the doctor. " We're here to help you."

"I'm dying," Dave says. "Why are you dying?" "It's inside. There's something inside." "Did they try to put something inside you?" "I thought they were my friends. But they shot me up." "Where did they shoot you up?" He points to his arm, which is covered with needle marks and what looks like cuff scars on the wrist. "But that's old," says the doctor. Dave looks at him wide-eyed. "You're gonna shoot me up with something, and I'm gonna die. You just tied me up."

A woman in a flowery dress shows up with a name tag that says she's with the Sexual Assault Resource Service (SARS), a group of nurses specially trained to handle rape cases. Dawn briefs her on Dave's complaint and the cops' report, which wasn't very clear. "It's weird," she says. "I don't know if this rape is a now event, a past event that's coming back to him, or what." The SARS nurse goes in and shuts the door. Ten minutes later she emerges, shaking her head. Dave doesn't want a forensic exam, which involves sampling bodily fluids from every orifice. He wants Dawn. "What is it?" she glares, after the nurse tracks her down a few cubes away. "I just wanted to tell you," he says with a sly smile, "you look a little butch."

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