Sometimes trauma victims are alone--with no doctors or paramedics to rely on--and must decide for themselves where to seek emergency care.
The choice can be risky. For Mary Shooner, a freakish and painful injury led to a panicky search for help at two medical centers. One sent her home for the night, saying she had no serious problem. The other saved her life seven hours later.
Shooner's ordeal began last May when she got a nasty bruise on her chest after falling on the handlebars of a moped that lurched to a sudden stop. Friends say she passed out briefly but then got back on her feet and went to work in her Hollywood casting office.
"Nobody ever wants to think they're seriously hurt," the 25-year-old woman said. "I tried to brush if off. You never think something like this will threaten your life."
Symptoms Grew Worse
Then the pain began.
At first, Shooner said, breathing became difficult. It hurt when she stood up, sat down or walked. Soon, she felt like she was passing out from a strange burning sensation in her chest and realized something was wrong.
But where should she go at 7 p.m. on a Friday? Like many people, Shooner was reluctant to go to a hospital. Instead, one hour after the incident, she took friends' advice and sought help at the Citizens Medical Group in Hollywood, a walk-in clinic three blocks away.
The clinic, like many others in Southern California, offers emergency care at lower rates than most hospitals. Shooner recalled that the building's "urgent care" sign seemed reassuring.
Doctors in the small clinic examined Shooner and took tests, including a blood count, urine sample and X-rays to check for bone fractures. Although the woman said she complained about increasing pain, physicians found that her vital signs were stable and sent her home.
Problems Not Detected
"It was not felt at the time she (Shooner) was here that she had any serious problems," said Dr. Larry Barandis, the medical director. Barandis said he told Shooner to go to a hospital emergency room if she experienced any dizziness, increasing abdominal pain or fever.
Nearly seven hours later--following a night in which Shooner passed out three times, vomited and was doubled over in pain--she asked a friend to drive her to Cedars-Sinai Medical Center in Los Angeles. Unbeknownst to Shooner, she had come to a Los Angeles County trauma center.
"I knew nothing about trauma care or anything like that," she said. "All I knew is that I was experiencing unbelievable pain, and Cedars is a big hospital."
Doctors at Cedars performed a battery of tests and found that Shooner had a major pancreas injury and was bleeding heavily internally. If she had waited much longer to seek help she would have died, the physicians said.
Shooner was taken into surgery, where much of the damage caused by the moped injury was repaired. She spent the next 14 days in intensive care and had a second operation several months ago to correct continuing problems with her pancreas.
Looking back, Barandis said there was no way to know at the time that Shooner had suffered such an injury. Moreover, he said Cedars-Sinai would not have done anything differently than his clinic if she had gone there first.
Surgeons at Cedars-Sinai declined to comment on the care at Barandis' clinic. But they sharply disagreed that their treatment would have been no different.
"There's no question that a trauma center has more resources available to it than a walk-in clinic," said Dr. Stewart Gleischman, the lead surgeon who operated on Shooner.
Trauma Center Advantages
Gleischman explained that he and his colleagues conducted several key tests which quickly identified Shooner's injuries. And the hospital used sophisticated equipment to gauge the extent of her internal bleeding before surgery.
More important, he said, trauma centers like Cedars-Sinai are staffed around the clock with surgeons trained to spot internal injuries. Consumers have no guarantee that the physicians in walk-in clinics will have such skills, the doctor added.