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IN PRACTICE

'Saved from the darkness' by every hero's hand

September 22, 2008|Mark Morocco | Special to The Times
  • TO THE RESCUE: Workers assist the most seriously injured in a triage area set up at the scene of the train crash in Chatsworth that killed 25.
TO THE RESCUE: Workers assist the most seriously injured in a triage area… (Brian Vander Brug / Los Angeles…)

On Sept. 12, a freight train and a Metrolink passenger train crashed in Chatsworth, killing 25 people and injuring 135. The injured were taken to hospitals throughout the area, including UCLA Medical Center. Mark Morocco is an emergency room physician there.

--

Stay close and see what I see. Stay close and see heroes.

The steel door of the trauma elevator opens. It's as big as a single-car garage, with only three stops -- the helipad, the emergency room and the operating room. Here they come from the first helicopter -- two ordinary men who had been trying to get home, the most routine of commutes, riding a train and dreaming of anything but getting off at this unexpected stop.

David White, our trauma tech, pivots the first gurney at the corner between the two main trauma rooms and the two critical-care rooms (for the less badly injured), waiting for a split-second decision from me. The young guy strapped in the basket is screaming about his legs, trapped in a tight, hot-orange splint. He goes to one of the backup rooms. The other passenger is silent and nearly still -- his cut clothing like a pile of dirty laundry on the gurney. He can't talk to me, his face somehow serene even though his skin is torn open, twisted and raw from some inconceivable force. He lights me up like a jolt of electricity. He goes straight into Trauma 1, fast.

Twenty people -- a knot of ER docs and trauma surgeons -- make a hole for his gurney. Marshall Morgan, the chief of emergency medicine, and Gil Cryer, chief of trauma, lead the team. There's maybe 60 years of experience between them. He's in good hands.

Another chopper is on the roof, and two more criticals are coming down the elevator. Is that four more then? I ask the nurse striding alongside. She shakes her head -- doesn't know. A helicopter medic runs past us. He needs his basket back. Then he's gone, steel basket jingling. What sound does a hero make?

I shortcut through still-empty Trauma 2 as we run back to Leg Man.

Without a word or an order, two experienced nurses assemble the drugs, the needles and cutting tools. Nurse Chris Battista and I make brief eye contact, and I know that they're both ready -- the edgy guardians at the center of every hospital's universe. What color are a hero's eyes?

In Room 3, Leg Man is screaming. Scissors are flashing, cutting him free of his clothing. I talk to him, going fast, asking his name and the basics -- Do you remember the accident? "No" Where is your pain? "Head and neck and legs." No medical problems, no allergies, no surgeries.

"Good IV," says nurse Darlene Randles. So then comes the pain medicine, lots of it. The leg looks bad -- tense and hard, making a curve that no bone can ever make, the torn arteries inside filling it with blood that is trapped by the connective tissue of the leg itself, squeezing the muscle to death like a snake.

Leg Man is stable, so he'll get a CT scan of his head and neck and be sent to the operating room with the orthopedic surgeons. They'll flay open the leg so that it can swell freely and not die -- that's more important than fixing the bone, for now. The nurses hang antibiotics and give pain medicine and more pain medicine -- give it like water until Leg Man finally smiles as the nurse tosses the emptied syringe. She pats his shoulder; he reaches up and touches her hand. What does a hero feel like?

I run back into the hallway and again meet David, back from the roof with two more patients. The first one is grinding his teeth in pain, with a swollen belly like a pregnant woman, but he's able to tell me his name and that his back and stomach hurt. The second can barely mumble, both legs trussed up in cardboard splints like the boxes you buy flowers in, crushed and hanging over the edge of the backboard. I send Big Belly to the backup room and stay with Boxed Man as he's moved into the other big room -- Trauma 2.

In my head, I cut the chaos up like a pie -- three patients now: Leg Guy is OK. Big Belly is alone for now, but I can't leave him long. Boxed Man looks like he's trying to die so I can't let him.

"One, two, three and lift!" Tech Mark Jackson, the nurses and the flight medic have trouble because he's a big man, and when he hits the bed his broken legs bounce. The pain seems to wake him up and he's angry -- a horrible good sign. By his voice, I know that his airway is OK and that his lungs are not collapsed. I decide in my head that Big Belly is bleeding internally. Where are the other doctors, I wonder, working my scissors toward Boxed Man's crushed legs?

The other doctors are all with the very first guy -- not a good sign. So it's just me. I've got to keep working to pull Boxed Man's story and exam together: Head looks good, brain working, chest good, lungs up, abdomen seems OK, pelvis not broken, just the legs are a mess, and in half a minute I know that Boxed Man isn't as sick as Big Belly.

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