An ER doctor without a patient is a useless man in an empty room. Nearly every patient gets delivered to me by someone in a uniform. Without a firefighter or paramedic or cop, you will die somewhere "out there"--and the center of the country's largest city may as well be wilderness.
That was New York on Tuesday, when hundreds of rescuers died, running upward around and around the narrow escape steps of the World Trade Center. They were racing for people who still had a chance, trying to bring them out. As the second tower crumbled into itself, knowing that those men and women were struggling upward against gravity and all common-sense instincts, then downward to death, my heart broke. I have seen a lot as a doctor, but I think that moment was my worst.
Big disaster or small, our sickest patients come neatly packaged. The firefighters have done the heavy lifting, literally, peeling open crushed cars or smashing through plaster and glass with brute force. Broken necks are Velcro-ed into plastic C-collars, crushed legs carefully placed in cardboard splints that look like long-stemmed-rose boxes, and wrenched backs tied straight to hard wooden back-boards. Once I was handed a tiny piece of a patient's scalp, dwarfed in a calloused firefighter's hand, looking like a little blond golf divot in a tiny plastic bag. He simply said we might need it.
Most days, these men and women are almost invisible to us. They roll the patients in and tell "the doc" the story. We listen for important clues--chest pain, or "KO"--but our minds are a few steps ahead, and so they lift the patient onto the bed and wheel quietly away. Some of them I know by name, not many. I try to thank them, most times. Sometimes I forget. I won't anymore.
ER docs pride ourselves on being "spearhead" doctors--the first to see the patient in a chaotic environment minutes after an injury, doing heroic things that make a difference. Sometimes we do, but our own lives are never in peril. Nobody is trying to kill me while I work, the floor isn't going to collapse or the room explode. If there is an accident or a fire or a disaster, someone will come looking for you, and if you get to the ER, you have a chance. But that someone won't be me or any other doctor. It will be one of these heroes, these angels, these living hands of God, by way of the academy and a civil service exam.
In disasters there are three kinds of patients. The first are killed instantly, or nearly so, by injuries that would be lethal even if they happened at the hospital doorstep. The second are walking wounded, who will survive even untreated. Our trauma system is for the remaining souls, those who have a "golden hour" of life left--if we can get to them, and bring them home. Every ambulance siren that you hear, every firetruck that you see rushing through the street, exists to save those few people. But those rescues don't come easily or without cost. They are paid for sometimes, a life for a life, with blood for blood.
We take for granted--doctors and patients--this safety net. Once in a while we give out a medal or an award, but for the most part our heroes live quietly forgotten, their hero worship confined to starry-eyed little neighborhood boys in red toy firefighter's hats from Pic 'n Save. Once in a while, if we're unlucky, we get to see a horrible reminder of the cost, played over and over on TV.
So I spent Tuesday watching that reminder, pacing the house, wishing that we still lived in Manhattan so that I could help. I spent Tuesday frustrated, watching it all happen, all nervous energy and anger and sadness--and relief that Los Angeles was quiet, with eerie, empty California skies.
As the day grew old, an ambulance and a couple of firetrucks ran up Olympic Boulevard toward UCLA, sirens somehow reassuring rather than annoying for a change. I thought about the central craziness of that job--of those who run into danger instead of away, pulled ever upward toward the fire when everybody else is coming down. Really, it makes no sense.
But compared to everything else that I saw on the television in my old hometown that day, their climb to glory was the only thing that made any sense at all.