Emergency Doctor

by Ziegler, Edward; Goldfrank, Lewis R.

• ISBN13: 9780060595029
• ISBN10: 0060595027
• Edition: Reprint
• Format: Paperback
• Copyright: 2010-01-29
• Publisher: HarperCollins Publications

Summary

Hundreds of people slam through its doors every day: gun-shot cops, battered kids, drug addicts, and suicides, destitute drunks, homeless people, AIDS sufferers, and accident victims. It's a bizarre parade of humanity looking for help -- in the one place they know they can find it. Welcome to the frontline trenches of medicine: the emergency room of the legendary Bellevue Hospital. Here, an army of doctors and nurses faces the onslaught of young and old, rich and ragged, sick and dying. All day, all night. All year. This is their story -- an around-the-clock drama of the unexpected: a crane falling on a hapless pedestrian; a crazed executive wearing two-thirds of a three-piece suit; a pretty paralegal aide struggling with an on-the-job cocaine overdose; a trauma victim of an East River helicopter crash clinging to life. It's terrifying, tragic, triumphant ... and true.

Table of Contents

Acknowledgments	ix
Staff of Bellevue Hospital and Associated Institutions in Order of Appearance	xi
1. An Overturned Crane	1	(7)
2. "First, Do No Harm"	8	(8)
3. Learning to Juggle	16	(12)
4. A Morning's Rounds	28	(10)
5. Doing a Decent Thing	38	(10)
6. A Shock and a Dive	48	(11)
7. A Question of Poison	59	(12)
8. The Making of a Medical Student	71	(9)
9. Becoming an Emergency Doctor	80	(17)
10. The Carriage Trade	97	(11)
11. A Midday Arrival	108	(13)
12. An Alkaloid Plague	121	(10)
13. The Case of the Crazed Executives	131	(11)
14. Creepie Crawlies	142	(11)
15. A Blonde and a Severed Leg	153	(11)
16. A Lesson and a Crash	164	(12)
17. Human Warmth and a Drink of Gasoline	176	(11)
18. A Leap and an Inspection	187	(10)
19. A Doctor on Call	197	(11)
20. Notes on a Juggernaut	208	(12)
21. About Children	220	(8)
22. An Aneurysm and a Dangerous Diet	228	(11)
23. About AIDS	239	(16)
24. A Peanut and a Mercury Injection	255	(10)
25. Moulage Day	265	(14)
26. Knocking Back a Few	279	(14)
27. Pokeweed, Headaches and Tribal Medicine	293	(15)
28. No Place to Go	308	(14)
29. A Day and a Night to Remember	322	(19)
30. Toward Medical Victory	341	(12)
Afterword	353

Excerpts

Emergency Doctor

Chapter One

An Overturned Crane

It was almost noon on a bright spring day when the thirty-five-ton crane began to unload steel rods from a flat-bed truck idling at curb side. The site was that of a projected forty-two-story luxury condominium on Third Avenue between Sixty-third and Sixty-fourth streets in Manhattan.

As the extended arm of the machine began to lift a load of rods and swing them over toward the construction excavation, lunchtime pedestrians scurried uncomfortably along a sidewalk bordered by plywood barrier, behind which was the pit from which the building would rise. Two women brushed past a third. This third woman was virtually in the shadow of the machine as its loaded arm began to counterbalance the base of the crane, causing it to tip up on two of its giant wheels.

For an instant, the machine wavered, angled oddly toward the excavation. The first two women sensed something amiss and rushed to get away. The third, Brigitte Gerney, was not so fortunate. She tried to retrace her steps toward Sixty-fourth Street.

"Get out of the way! We're going over!" a voice close to her shouted. It was the twenty-nine-year-old construction worker who was at the controls of the heavy machine. Below him, the sidewalk which had been undermined by the excavation of the past few days began to cave in. Then, amid the splintering of wood and the screech of bending metal, the crane turned over, trapping Mrs. Gerney suddenly underneath and coming to rest upside down at the edge of the abyss. Only a thin course of lightly framed plywood resting atop an I-beam seemed to be keeping the crane from plunging with its victim some thirty feet into the construction pit below.

"It was like an earthquake," Mrs. Gerney later recalled. "I remember my bag flying out of my hands. I heard the noise of all the bones cracking in my legs."

For the forty-nine-year-old Manhattan mother of two, it was the beginning of a seemingly endless ordeal. Both of her legs were pinned at a point ten inches above the knees between an edge of the giant machine and the crumbled sidewalk. As the crane came to rest, her right leg seemed to be almost severed, her left severely crushed. "I felt the warm blood going out and I had the impression that my legs wer completely cut off," she would remember months later. After a moment of shocked disbelief, she cried out: "Get this off me!" Her cries set in motion one of the most intensely observed rescue attempts New York had experienced in years.

* * *

The fate of Mrs. Gerney would depend in some significant degree on a doctor who as yet had no awareness of her predicament. Some forty blocks downtown, at Bellevue Hospital, on First Avenue and Twenty-sixth Street, a phone rang in the crowded doctors' station just behind the triage* desk, at the principal entry into the Emergency Department. It is here that emergency medical specialists make their initial judgments, separating all cases into one of three categories: "emergent" (gunshot wounds, heart attacks), "urgent" (broken bone, minor cuts) and "non-urgent" (sore throats, rashes).

The attending physician on duty immediately acknowledged the message and made his triage decision, "emergent," and set in motioin the machinery to dispatch a physician in the mobile emergency rescue van (MERVan) to the scene. Whenever the Bellevue MERVan, rolls, the first person to be apprised is Dr. Lewis Goldfrank, Director of the Emergency Department (ED) at Bellevue.

Goldfrank is a tall and vigorous man in his mid-forties who had been striding swiftly toward one of the trauma slots to look in on a seven-year-old girl who had been hit by a taxi and had just been brought in. As her stretcher was wheeled by, he could tell at a glance that the girl's color was good but her breathing was labored -- sounding like the muted squealing associated with airway compromise. He swiftly assigned a team of physicians and nurses to the little girl's care, then paused momentarily to hear the specifics about the crane.

At least one person was trapped. Two others had just been freed with superficial injuries. One of the city's Emergency Medical Services ambulances was on its way to the scene and police paramedics were even then burrowing their way toward Mrs. Gerney.

Goldfrank sought out the senior attending physician on duty. That was Kathleen Delaney, a Los Angeles native who, after progressing toward a Ph.D. in biochemistry at UCLA, had applied instead to medical school, and enrolled at Columbia University's College of Physicians and Surgeons. Now, nine years later, she was board certified in internal medicine and was just completing her second year of full-time service at Bellevue's Emergency Department.

"Kathy? Can you go with the MERVan to that crane accident?

"Sure. Where?"

The attending physician at the doctors' station gave the particulars and sent word to the parking area, tucked into a courtyard behind a neighboring building, where the MERVan was parked, ready to go at a moment's notice. This kind of van, a small replica of an emergency room, extends the walls of Bellevue Hospital's Emergency Department into the streets. Two or three times a week, the MERVan is called on to augment the service that Emergency Medical Service (EMS) ambulances normally provide.

So successful has been the experience with such emergency medical services that the familiar term "DOA" -- dead on arrival -- has be come something of a rarity on the Bellevue Emergency Department charts. Dr. Delaney ran out the sliding doors of the ambulance entrance and stepped into the MERVan, which then made a wide swing around the hospital drive and went howling off up First Avenue.

Goldfrank continued with his tasks -- overseeing the work of the trauma team and pediatric staff working on the little girl ...

Emergency Doctor. Copyright © by Edward Ziegler. Reprinted by permission of HarperCollins Publishers, Inc. All rights reserved. Available now wherever books are sold.

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Excerpted from Emergency Doctor by Edward Ziegler
All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.