The Place Where They Have To Take You In

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

Suddenly, something goes thump. They've wheeled a machine over to the patient's left, with a piston that goes up and down on his chest. This must be the sound the woman from admissions was talking about yesterday, when she peeked in the door during another critical case. "He's dead," she said. "Whenever they bring out this machine, I know it's over." They call it the Red Ram.

The cop's head sticks in again through the door. "This guy, do you have anything going on him yet?" His expression is hard to figure; it's a tough face, but there's an odd glimmer in the eyes. "I placed him under arrest," he says, squaring his shoulders in the leather jacket. "Who's the doctor in charge here?" "I am," the pit boss answers, not looking up. "This guy," the cop tries again, "is probably cracked up on crack cocaine."

The Ram keeps pumping while someone goes to fetch blood. The voices quiet a bit. A couple of nurses talk about who's going on break next. "Anyone know who he is?" calls the doc to the cop. "No. He wouldn't even tell me his name." There are six lines on the monitor above the patient's head, all different colors, all flat. One of the docs is holding on to the man's wrist.

And then the red beepers go off screaming again. "411, three minutes out, male, stab wound," crackle the speakers. Everything freezes for a second, then another team materializes at the second bed. The far doors fly open and paramedics blow through, barely stopping to unload the patient. "What's your name?" the pit boss says, leaning into the guy's face while shreds of clothes fall to the sides. "Jake? Jake, where are you hurt? Hold real still now. Watch, everyone--he's gonna throw up." He does.

"We picked that guy up at a party," says the paramedic watching from the sidelines. "Big party gone bad. Couple of hundred people in a fight. He walked up to us, says 'do I really need to go to the hospital?' Yep, I says, I think so. 'Do I need stitches?' Well, you're going to need stitches where your eyebrow's pierced. He says 'my eyebrow's not pierced.' Well, I says, what's that piece of metal? So I pulled on it and it didn't move. I thought, uh-oh."

"Guess whoever did it did some prison time," says his partner. "That's what they do in prison--whenever you get stabbed, they break it off so you can't pull it out and use it against them."

By the other bed, the thumping has stopped--maybe just now, maybe minutes ago. A couple of residents head for the door, shrugging. The one doc is still holding the guy's wrist.

"We got some heartbeat," she says after a while, looking at the monitor. "There's no pulse, but this is the first time he's registered anything." "Let's start again," the other doc says, "just once." Thump, the machine cranks up again. Thu-ump. The man's chest heaves. "He's dead, isn't he?" says the nurse next to me. "Guess they haven't pronounced." "He's not dead," comes a voice with an affected British accent. "He's me-ustly dead." A hand twitches as someone pushes a button.

"Here's the X-ray," calls the pit boss from the other bed. The films show Jake's skull, plus something long and narrow that doesn't look like it belongs. "Think it's a pencil?" one of the docs asks. Laughs all around. "Neurologically intact," someone comments.

On the first bed the CPR has stopped. Lines are being disconnected. Two men in suits and long wool coats materialize at the other end of the room, looking straight out of central casting--one stout, one thin, both with little sardonic twitches at the corners of their mouths. "Homicide," the paramedic says under his breath. "Did you see that cop who brought the first stab in? He's all freaked out. It's his first dead guy."

The stabilization room is one of Hennepin County's contributions to the world of emergency medicine--an ER within the ER, dedicated to patients for whom a bumpy elevator ride or a trip down miles of corridors could make a fatal difference. Its purpose is to turn catastrophe into a kind of equilibrium; they'll put in artificial airways, hook up fluids, stitch up gushing wounds. Most patients go on to surgery or intensive care. Some--two or three, out of 20 to 30 stab cases in an average week--go to the morgue.

Not everyone likes to work the stabilization room. "I get gastritis the minute that beeper goes off," says Marsha. "And I need to go to the bathroom really bad." "That's because the beeper is hooked up to the bladder, didn't you know that?" Dawn says earnestly. "What you're saying is you're not a trauma junkie." Trauma junkies like the adrenaline rush, and the high that comes from working on instinct; there are times when the three docs and two nurses required on any stab case seem to function as a single body, in a tight choreography that leaves little to chance.

"I like the feeling that you can have an impact," Dawn adds. "Out in the cubes, you have to treat them for hours, and you never know what the outcome is going to be. In stab, it's a lot more simple. They're going to live or they're going to die. And you can make the difference."

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