A place of life and death A hospital emergency ward is where trouble in a hurry comes 24 hours a day, where life in crisis turns for help — sometimes too late. Writer Ian Adams has spent months studying life—and death — in big-city hospital emergency wards, and the accompanying article is a fragment taken from a book he is now completing, to be titled Emergency Ward. The dramatic pictures on these pages were taken by Maclean’s photo director Horst Ehricht in the emergency ward of Toronto’s Scarborough General Hospital.
An emergency ward is where you wind up when the bottom drops out of your life. This is what it’s like: the long white corridors, the pain, the impersonal hands
WEIDMAN HANGS UP the phone at the nursing station. He looks down the corridor and sees them pushing the stretcher through the waiting room. By the time they reach the glass doors he is already there. The ambulance attendant is struggling to lug along the portable Heart and Lung Resuscitator Unit and keep the mask on the man’s face. He gratefully surrenders the mask to Weidman, who guides the ambulance men to the third operating room, which is kept only for accidents. Luckily, it is empty. The man is in his late 40s and overweight. The extra flesh, white and flabby, shows now as the several pairs of hands cut and tear away the expensive clothing, the scissors snipping through the fine blue weave of what must have been a $250 suit. But it doesn't really matter now about the suit because it is already ruined by the massive blood stains all down the right side.
That’s where the green-and-white 1958 Meteor hit him when it came barreling through the stop sign and smashed into the side of his Lincoln. The man has been unconscious since that moment. He doesn’t know that his 16year-old son in the back seat was killed instantly, and that his wife, who was driving, is in another hospital, on the table of another emergency ward.
A nurse and a medical orderly, who has intricate oriental tattoos on his forearms, push a block under the man’s shoulder. The HLR doesn’t seem to be doing any good. You can hear the air gurgling around in all the blood and vomit in his throat. He is bleeding from the ears and nose — dark, thick blood. Weidman takes the mask off his face and the air comes pursing up in little bloody bubbles through his half-opened mouth. A sponge is wiped across his face. The skin is grey and slack. Weidman gently tries to turn the head to one side but something has happened to the neck and it won’t turn. The man’s right side is shredded with large ugly wounds that have torn the flesh. The right lung has been collapsed by the broken shards of ribs driven inward. His pulse bumps around feebly as the pump in that big flabby chest tries to keep up with the mangled circulatory system.
And now these young people around him try to keep it going. They’re all young, half the man's age. Their hands move deftly, as if the fingers had their own casual recognition of the body’s organs. The tension is betrayed only by the carefully controlled, expressionless faces; except for one nurse, whose face is pulled back in a wince of pain. This is her second week in Emergency, and nobody thinks she is going to last another.
Morantz, the assistant resident of surgery, a short, swarthy young man with black eyebrows that meet across his brow, reaches down and cuts open the man’s throat with one short, vertical slash. Like the rest of the man, the neck is heavy, and the yellow fatty tissue pops out of the cut like stuffing out of an old mattress. The gloved fingers reach inside, find the windpipe, slit it. and insert the plastic end of the tube that will start pushing oxygen down into the man’s body.
They’re still trying to get some fluid replacement into him. Wilson, a junior intern with a blond brush cut, is trying to get a tiny 18-gauge needle in the median cubital vein of the left forearm. But there’s too much fat and the pressure in the veins has collapsed from the loss of blood.
Morantz tells him to forget it. He slices into the wrist to expose the ulnar artery and slides an enormous 15-gauge needle in the artery and gets the plasma infusion working. It’s a desperation move. Then he starts stripping down the anterior malleolar vein on the man’s left ankle in an attempt to get an intravenous going there. Meanwhile, the senior intern has already clamped off the big axillary artery in that butchered right arm, and released the tourniquet someone tied across the upper arm. Now he works his way down the body, placing big sterilized sponges in its torn openings, staunching the blood, trying to find the bleeders and tie them off.
Then the fat man is suddenly dead. It is as if his ebbing life silently slipped out from under their hands. There is not much they can do. In a few minutes Morantz pronounces him dead. They all leave the O.R., even the orderly, who goes to find a workmate to help him clean up.
For a few minutes the dead man. lies there, alone and naked under the big lights in the deserted room. In death his body already seems to have shrunk in size. Some of his clothes still hang from him, the others lie in a soiled bloody heap on the green-tiled floor.
The motorcycle cop is waiting outside in the hallway. Morantz walks past him into the second O.R. where a Negro woman has a sixinch knife wound in her abdomen.
The cop knows better than to ask the doctor anything. In his heavy boots and white crash helmet he looks awkward and incongruous. The impression isn’t helped by the big flat face and the small eyes that are too close together. The nurses and white-garbed doctors step around him as if he isn’t there, not including him in their tight and closed little world.
Then the head nurse of Emergency, who is a big heavy woman in her 40s with a strong mannish face and hard voice, comes over to
the cop and tells
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him very matter of factly that the man is dead, and she gives him the wallet and papers the orderly found in his clothes.
Two of the nurses who were in the O.R. drift past on their way to take a coffee break in the nurses’ lounge — it's part of the union agreement. Without a signal of recognition, they walk past one of their friends who is making a date with a tall West Indian intern. It’s all part of the unwritten code that offers instant privacy to the nurses anil doctors who, despite the long hours they spend in this hospital, struggle for a semblance of social life. In the lounge they pour coffee and sit down to listen to two other nurses gossiping about a doctor they have both dated. One is a thin blonde with one of those high, nasal, professional English accents. "It was such a useless evening.” she says in her high whiny voice. "He was such a boring ass.”
There’s a little silence as Weidman comes in and pours himself a cup of coffee, and slumps down in one of the chairs. Then one of the nurses says. “Dr. Weidman, if you're going to drink the nurses' coffee, you have to contribute a dollar a week . . . just as we all have to.”
"Yeah, sure.” mutters Weidman as he rests his head against the wall and gazes dow n at his feet.
At the admitting desk the motorcycle cop is signing a receipt for the dead man’s wallet. Then he clomps out of the Emergency Ward.
Here, nothing is hidden
Outside it is dusk, and the cop kicks his motorcycle starter. The roar echoes up against the silent office buildings. Night is shrouding the city's shabby and indifferent soul. But here nothing is hidden. Here, in the face if pain and suffering, the rich and powerful are as easily stripped of their masks as they are i f their clothes. To this place called an emergency ward come the victims of violence, the poverty-stricken sick, the half-mad, the alcoholics — all losers: and always there are the old. who are living the last years alone and are terribly afraid to do so. And without end there is pain here. Pain and the never-tailing evidence that the flesh is so vulnerable.
Pass through the crowded waiting room where the people are so thick that only one image stays with you. It is the Portuguese woman with the heavy breasts in the black bra that show through a cheap red-nylon blouse. She is rocking slow'ly back and forth, mute, her arms clasped around her middle. Her face is closed and she is locked away in her own pain.
Down the first corridor of the emergency ward. It is lined with the stretchers of the injured and the wheelchairs of the ill. Walk past and you can hear the old men muttering and groaning in sad litanies, "I tol’ him, for chrissake. I tol’ him . . . here!” Vainly trying to clutch the sleeve of a passing orderly. Sandwiched between two emaciated old crones a 16-year-old girl weeps in-
terminably. A nurse’s aide squats dow n for a moment beside her to ask if she wants anything. The girl only weeps.
An Italian with a fragment of glass in his eye tries to explain to a nurse what has happened. He can’t understand what she is saying, so he yells impatiently down the corridor to the
waiting room. "Rico. Rico, veni qua!” And beckons to his friend to come and interpret.
At the nursing station, a dark plump nurse is drawing off 0.5 milligrams of morphine into a hypodermic, "Who do I give this to?” she asks of the cluster of interns who are fumbling through the confusion of charge sheets
around the nursing-station counter. And Wilson, who ordered it and who has been on his feet for the past 12 hours, suddenly can’t remember who it is for.
From the examination rooms you can hear the doctors asking:
"Where does it hurt? Here?”
"Does it hurt now? . . . and now? . . . and now. when I do this?” "When did you first feel the pain?”
IN ONE OF THE examination rooms
Weidman is talking to an old woman wearing a black dress rusty with age. The bones come out all over her. She can’t stop moving her long bony hands. First she is clutching Weidman’s hands, then she is smoothing her dress over her bony knees, then the sides of the wheelchair. She has fallen down in the street and now she has hallucinations.
“Why don’t you keep your eyes open?” asks Weidman.
“Oh, doctor, if 1 do I see people
and then I start falling backward.”
He goes on talking to her, and through her gibberish he finds that she lives alone in a rooming house. No, there are no relatives, no friends. Her fingers flutter to her purse and she pulls out a grimy card that shows she is a survivor of one of the public mental hospitals.
"Doctor, don't send me home, oh please don’t send me home,” she pleads hysterically. “Look, doctor, 1 took a full box of these,” and she
fumbles around in her ragbag of a purse and pulls out some capsules. To Weidman they look like Vitamin B tablets. But he is tired. Today he has to work a 12-hour shift. Yesterday it was 16. So just to be sure, he verifies his guess with the assistant resident in medicine who is standing by the nursing station, sarcastically baiting a nurse for letting a patient go home whom he had specially come down to see.
"No, it’s not Vitamin B.” he says
with a mocking smile to Weidman. “It’s Vitamin B.,.”
Weidman pushes his glasses back up on the bridge of his nose with a forefinger, and blank-faced, keeps his thoughts to himself. He turns to the head nurse and asks that a psychiatrist be called down to examine the patient. “Psych won’t look at anyone first who hasn't been seen by the senior resident on call. You know that. Dr. Weidman,” she snaps back at him. Weidman sighs and wearily goes about the bureaucratic ritual demanded by the hospital administration.
Some three hours later the psychiatrist makes it down from the psych ward on the 15th floor. By this time the old woman is babbling incoherently. The psychiatrist takes a look at her and shrugs. She doesn't look very interesting and he doesn’t want to admit her to his small ward. He begins a long series of elaborate phone calls that will take her back to the limbo of those forgotten wards of the public mental hospital.
And so it goes on. Only the very ill are admitted and passed up into the already crowded wards of the hospital. The others arc patched up and sent home with friends, relatives, or even given over to the care of surly cab drivers. Alcoholics are given a little time to sleep it off in the tank room, sedation, and then turned loose in the street before they become a real problem in delirium tremens. Some, like the fat man, die here.
The kid is brought in by her parents. They told the admitting clerk she has severe menstrual pains. By the time Weidman gets to see her she is writhing on the stretcher with painful abdominal cramps. Weidman asks the girl about her periods. Her mother keeps answering for her. He gets a
“Don’t tell Mummy,” the girl pleads
student nurse to take the mother away for a cup of coffee. When she is gone, the little girl whispers through a white and twisted face that she has missed her period for three months and thinks maybe she is pregnant. “But please don't tell Mummy,” she pleads.
“When did the bleeding start?” asks Weidman.
"A couple of hours before we came here," she answers. “I've had to change it a lot.”
On the charge sheet it reads she has been waiting since 1 I p.m. It is now 4 a.m. There is a lot of blood and Weidman can’t see very much. The nurse begins to look at him critically.
“Relax." lie grunts. He is just a month out of medical school but knows enough to keep his fingers out of there.
He goes looking for Morantz.
"Well?" demands Morantz.
“I think she is going to abort a 15week foetus.” says Weidman.
“Yeah, well I guess we better empty her out.”
Weidman does the cross-matching of the blood himself because the lab man has gone home a long time ago. He scrubs to assist Morantz, who shows him how to feel for the ruptured membrane. The ovum doesn’t come out nice and clean and Morantz has to work long and carefully with the curette. Weidman gives the girl .2 milligrams of ergonovine intramuscular. Then Morantz gives him a very dull curette blade and lets him move it around in the womb to get the feel of it.
"Take it easy.” says Morantz. “She's probably in her 18th week and the uterine wall is very thin. Don't go through it." Weidman moves the blade around the floor of the uterus, then takes it out. “Thanks,” he says.
As he is cleaning up. Weidman realizes he has worked four hours over his shift. He walks out through the waiting room, which is still just as crowded as it was at midnight. He shivers in the carly-fall morning. The street is completely empty as he walks the two grey blocks to the interns' residence. His mouth feels caked from all the cigarettes that he has smoked and his back aches from being on his feet so long.
In the dim little cubicle he shares with Davis he lies on his back for an hour, staring up at the ceiling, not even bothering to undress. Then an alarm clock sounds and Davis stumbles out of bed and turns on the light.
The hurt from the naked light bulb goes deep into Weidman’s eyes and he is seized with a wave of unreasonable hatred of Davis for turning on the light. He curses Davis and then the administration for forcing him to live in such a hole. He thinks bitterly of the $40 a month rent they take out of his $250 monthly paycheque. Then he rolls over and sinks into a heavy bloated sleep. ★