"This One is a Crock"
In the Emergency Room, an older man with gangrene on his leg was being pushed in on his gurney. The leg was very far gone. The Sister and the nurse called for help.
The resident in charge was saying to his intern, "It is more important to care for the gangrene than his 56 years of schizophrenia. The chart read that this man had been sent to Medicine, but the resident there sent him to the Psychiatry Unit. The resident there sent him to the Emergency Room because of the gangrene.
After examining the old man, the resident reminisced that when he was an intern here at County, he
used to categorize the patients, calling "this one a crock, this one
an acid-head, this one a D.T.er." He used any sort of category just to put distance between himself and the patients. Now he said he looks at these patients as people who are
sick and need his help and he accepts them as that. Their problems are not new. The obese, the troubled overdoses, the skid rowers, the gangrenes all started a very long time ago.
The resident said that when he was an intern he used to categorize the patients, calling this one a crock, this one an acid-head, this one a D.T.er. He used any sort of category just to put a distance between himself and the patients. Now he looks at t hese patients as people who are sick and need his help. He accepts them as that.
"In one section of a day, " he said, "we see so much here caused by man's inhumanity to one another: the battered children, the sedated old people from nursing homes, the uncared for meningitis and T.B. cases, the derelicts, the malnouris hed. What region of the earth is not full of OUR calamities!'"
The intern said to me in the Red Blanket (patients needing urgent care or "STAT" patients) inner area, "I trust you, you can stay. I kicked out the photographers from the University who came earlier today." Then he looked at my drawi ng and commented, "You even make County look beautiful."
How we treat the helpless in our society and the defenseless children is a gauge of our humanity. As of now, we are better than we used to be; we do have a larger middle class than ever before. Somehow, though, we must feel that we do not need all of th ese patients for we let them get so very ill before they come in to the hospital. That some countries have the ability to encompass all of their people in a comprehensive health care system perhaps indicates that a free enterprise system such as ours has some limitations. However, at the County, there is a creative clash between the fresh young staff and the worn out culture that has produced this much social pathology. The beauty at the County Hospital is not in its physical appearance, rather in its staff's concern for its patients.
Composite of Physical and Neurological Examinations: An old black man with stroke was delivered to the ER from another hospital. A tube was inserted, blood pressure taken, abdomen felt, reflexes checked, temperature taken, IV inserted, EKG monitored, neurological testing..."Touch your finger to mine."
Even if at times it is awkward, it is beautiful. There is a creativity in their plainness and respect toward these simple patients, so affected by the roughness of ordinary life. The staff is struggling with the idea that something is wrong and they ask, executive in their thinking, "What can we do to make it better?" The upshot is invigorating, and the hospital has much more earthiness than the quiet low keyed hospital in the plush section of the city. The work done here has the strength of t he early Romanesque art that was produced by the effect of the Huns upon the decadent Roman civilization.
Every time the electric eye doors opened at the ambulance entry,
another patient was wheeled inside. This time an alcoholic 
came down the corridor...a burly Black man with a plastic leg. As soon as he was settled in his cubicle, he dozed right off after an intravenous injection of Valium. Then another alcoholic arrived; this one curled up on the gu
rney while waiting for the ambulance to take him back to his boarding house. The clerk had reached the patient's landlord who said he would take him back.
Meanwhile, a third alcoholic was being tied down so a physician could examine him. The clerks were getting his identification information. His wife's name, his mother's maiden name, his address and birthplace.
A burly black man with a plastic leg.
All this was entered into a computer with the readout rapidly typed out on a long sheet of paper. The doctor during this time took a history and did a physical, which indicated that no bones were broken. Then he sent the patient to the Alcoholics' Ward.
Next came a Japanese girl, probably retarded, of fourteen. She came from a guest home and had abdominal tenderness, which gave the impression of an infected liver. Upstairs to Medicine. Then came an old woman, who elicited a particularly emotional res ponse from the intern. He said that at that nursing home the patients were kept on tranquilizers, because it was easier to manage them that way. "They don't have to have occupational therapy and the room looks good for inspection, but actually the patients stay in bed sedated. They require little care or food," he said. This patient had bedsores and probably has been given an overdose.
One overloaded physician told me he was going to travel the world before he settled down. He had already completed an internship, and his fellowship in Emergency Medicine was almost finished. We wondered together if the drunks in any other country would
be any different...spiders are spiders!
Alcoholic tied down so a physician could examine him.
Just then, the emergency phone rang; the paramedics called in to announce that they would be arriving within an hour with a man who had burns over 75% of his body. A space was prepared for him on admission, STAT, in the Red Blanket area. When the ambul ance group arrived, carrying tubes of oxygen and intravenous bottles and a portable respirator, they were rushed to the inner area. There the waiting physician made sure that the man's airway was open and quickly escorted them down the hall and up the el evator to the new twelfth floor Burn Ward.
The Emergency Room resident called a conference in the small radio room. He said that there was only a five percent possibility of recovery for the patient who would most likely die of internal failures of the kidneys and lungs. Acid or some volatile f
luid had been poured on him and lit while he was asleep. The patient had
red, raw, fatty tissue on his face, back and front, and arms. He looked roasted.
The nurses turned him on his side to apply salve. They sucked out his airway when the monitor bell rang.
In another cubicle, a resident examined an elderly, shaken woman who was very ill. He said out loud, "I don't know what the hell is the matter with this one, meningitis, maybe."
As I was leaving that afternoon, an old man was having a gauze mask tied on him, because he had tuberculosis He kept pulling it off and the nurse kept coming back to say, "You have to keep it on." His body was wasted. His genitals were expos ed. Outside, a policeman gave me a lift down the ambulance ramp. I had almost gotten run over walking up the ramp that morning. I felt relieved to be with healthy people again, to get away from so much trauma. I needed a lift.
Department of Emergency Medicine
