The Place Where They Have To Take You In

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

Eventually Dave is put to sleep with a shot of tranquilizer, the SARS nurse leaves, and Dawn pulls up his old chart. "I can't believe this," she groans after the first couple of pages. He was here with the same complaint recently. And again a few months before that. And several times before that. For the rest of the night she spends spare moments perusing the chart, searching for clues.

There are plenty of regulars--"frequent flyers"--in the emergency room. One guy comes in every month or so, hurting in his shoulders or his back, demanding a heavy-duty painkiller. One woman appeared at triage every morning for a while, carrying two shopping bags. They'd take her blood pressure and she'd be on her way. Occasionally guys will come in from the cold to hang around the waiting room. When they are told to leave, some start to cough and grab their chests. Most of the frequent flyers, though, come through Specials, and they are the ones who get the staff worked up. "Minneapolis is too kind to the poor," one of the doctors says between checking on people too drunk to control their breathing. It's enabling, he says, to take people in like this over and over again.

In some ways, the regulars are the dirty little secret of the emergency room. No one wants to admit that money is spent, night after night, on people who may need no more than someone to watch so they don't throw up and choke; yet no one can face what it would mean to turn them away. Some of the chest-pain malingerers have had heart attacks; some of the guys who stumble and weave actually have internal head injuries. The only way to find out is through a thorough medical examination. By the time that's done, they may as well sleep through the night.

Not that the staff is happy about it. To varying degrees, almost everyone complains--out of earshot--about "people who don't make good choices in life." There's a good deal of hostility in the phrase. Patients are crabby most of the time, and almost everyone on staff has been punched, kicked, or spit at. Some staffers come to harbor a profound resentment about the way "these people take everything for granted." It comes out in odd places, like the extended tug-of-wars over whether someone can have a cab voucher or needs to take the bus. People who take all this very seriously usually end up leaving.

Those who stay put have other targets for their anger. The way cops and ambulances keep dropping the drunks here, when any hospital could treat them. The way any problem can be let go until it becomes a medical emergency. The way all this seems to be a comfortable arrangement for "the outside." What evolves between them and the patients is a kind of grudging solidarity among people who know the game being played. Staff and regulars know each other by name and tacitly work the system together to extract medications, food, a better shelter placement. When word comes that someone froze to death on Franklin Avenue, people will ask each other who's missing.

"It's funny," Dawn says one night as we're blowing smoke into the freezing air outside the Specials door. "You get yelled at so much, some days you think your name is 'fuck you.' But somehow, you learn to blow that off. And you come to care for them. A lot of days, I get home just enough to tuck the kids into bed. I see more of our regulars than I do my family."

It's a weekend night, and the only gunshot wound in sight is a guy whose blackpowder rifle discharged, fracturing his thumb. In cube 6, a resident is sewing up a piece of skin protruding from a mountain of towels; next door is a guy who's been vomiting all day. Soft pieces of conversation float in from the cubes as you walk by. Occasionally the flow is punctured by a scream from the nursing-home patient in cube 8. People here learn quickly which cries of "Help me!" to ignore. Two of the docs are discussing baseball.

A piercing beep tears through the room as all the red pagers worn by select staffers around the department go off at once. "Stab room personnel to the stab room," the speaker squawks. "Stab room personnel to the stab room now." (The word is pronounced "stabe," as in stabilization.) I follow the flurry of blue and green scrubs, the gurney flying past, and squeeze into the doors that say ABSOLUTELY NO ADMISSION. "Get the restraints off," someone calls. "Anyone have a key?" The four leather bands around the man's wrists and ankles come off. With the help of some sharp blades, his clothes follow. "We need IVs," someone yells. "Quick." "This guy's under arrest," says one of the cops who came in with the gurney. No one pays attention.

"We have a cardiac standstill here," the senior resident--the "pit boss"--says. "Get me an IV. Start CPR." Nurse Mike McCloskey puts his hands on the chest and starts compressions. There are at least five people huddled around the patient. "Go ahead. We need an IV. Stop CPR for a moment. Sounds good on the left." The man's chest moves. "Someone check for a pulse. No pulse. CPR please. Five milligrams of epine-phrine please." A nurse hooks another bag to the metal stand overhead; someone pumps on the bed until the man's feet stick up in the air.

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