University of Virginia Library

Below The Antiseptic Atmosphere:
A Desperate Rush Against Time

By LAURA HAMMEL

"The Emergency Room.
You name it, we get it,"
chuckled Alex H. Sawyer,
assistant director of University
Hospital.

Intrigued by these tempting
words and armed with paper
and pen, I attempted to defy
nature and spend my Friday
night in the not-so-cheerful
Emergency Room. Though
Rugby Road, perhaps, offered
more in the way of enjoyment
that night, nowhere is there
found a more intense and
persistent drama of life.

The Emergency Room is
not unique or impressive in its
appearance. The same
antiseptic atmosphere is found
here that can be found in any
other emergency room across
the country.

Tension Unrelieved

I was slightly disappointed
with its appearance. There was
nothing to relieve the tension
or provide diversion in the
waiting room; only drab empty
walls and armless plastic chairs
serve as its decor. The waiting
room is small and cramped and
often a member of the
Emergency Room staff must
clear out all the people not in
line to see a doctor.

However the waiting room's
close quarters aren't duplicated
in the rest of the emergency
area. The Emergency Room is
designed to provide efficient
service at top speed.

The examining and
operating rooms are down the
hall from the waiting area.
Each of these rooms is fully
equipped to handle any
emergency that might arise.
Even the tape used to tape an
intravenous (IV) needle is cut
in advance and stuck on the
walls in anticipation of an
emergency.

"Each room is its own
autonomous unit," Unit
Manager Carole Dooley
declared.

Although the decor is
uninviting, it is all extremely
functional. There is even a
special room set aside for the
doctors containing two beds
and a shower.   Between
emergencies, on-duty doctors
may be found there, vainly
trying to catch forty winks.

Separate Waiting Area

The waiting area is
separated from the main halls
of the Emergency Room by a
small gate. With a certain
amount of pluck, I crossed
through that gate and entered
no man's land.

9:30 p.m.   A young
appendicitis patient, a bit
overwhelmed at what was
happening to her, anxiously
propped herself up on the
stretcher. "Make sure I am the
right patient," she warned, "I
saw that movie Hospital!"

A beefy construction
worker leaned against the
corridor wall, oozing boredom
and annoyance. Between sighs
he explained that he had
mashed his fingers at work and
was a bit "PO'd." at the
hour-long wait for results from
his X-ray. However, comfort;
was on the way when his
girlfriend "got the word at the
bowling alley" and rushed right
over.

10:20 p.m. Pale and rigid, a
high school senior was carried
in with a soccer injury.
Obviously enjoying their roles

as ambulance men, his
Hargrave Military Academy
buddies nervously paced the
floor in formation.

Staggering down the hall at
the same time, but with not
quite the same amount of
precision, was a tall lean man
who had just been involved in a
"friendly dispute." According
to the victim, the 14 stitches in
his knee were "just from
goofing around with a friend
who just happened to have a
knife." "We had been drinking
before hand,"he breathed. "No
kidding," I replied.

Confiding his future plans
and sentiments for his"friend"
at the present, he
commented,"I'll take care of
him when the time presents
itself...chuckle chuckle."

Although the knife wound
had been sufficiently cared for
by the Emergency Room staff,
the effects of the alcohol still
were present as the injured
party was so interested in the
attractive unit manager that he
could not avoid walking into
the walls.

10:30 p.m. An ambulance
siren pierced this somewhat
light and humorous tempo and
immediately the staff
responded to the signal. The
ambulance drivers rushed in a
16-year-old football player
from Fork Union Military
Academy who was writhing
in excruciating pain.

Drugged to reduce his
suffering, he was swiftly sent
on to X-ray to check for a
possible fracture of his left leg.

The Emergency Room
handles such cases with a
lightning pace. There is no
wait for the true emergency
cases. Requests from the
Emergency Room receive top
priority at night from the
various labs and Medical
Records Room. There is a
direct intercom and
closed-circuit TV to X-ray
enabling a doctor to see the
results of the X-ray
immediately after development.
The hematology and
chemical labs also have
closed circuit TV's hooked up
to the Emergency Room.

At the same time, the halls
filled with moans and cries
from an elderly and frightened
patient. Additional medicine
was administered to soothe the
hysterical woman and finally a
psychiatrist arrived to assist
her.

10:55 p.m. Unnerved by
the hysterical screams, I barely
noticed the quiet old woman
who had come in complaining
of chest pains. With little
commotion or emergency she
was admitted and sent down to
X-ray while her relatives sat
down to pass the unpleasant
wait in the lobby.

I followed the old woman
down the hall and reached the
doorway of the X-ray room
just in time to watch the
elderly patient "go into a
code" or in laymen's terms—a
heart attack followed by
cessation of breathing.

Doctors Examine Head Wound Of Young Victim

'Headless' Patient Awaiting Treatment

Skull X-Ray Taken To Detect Possible Concussion

The hallways audibly
hushed as a 'Code 12' was
called. In less than one minute
nurses, anesthesiologist and
doctors trained to work
together as a team assembled
and began a desperate attempt
to save her life.

A nurse dashed past me
clutching the Code 12 box
with the necessary instruments
and medicines used during a
Code 12 emergency. The IV
tape flew out of her hands, but
a hospital aide followed after
her retrieving that and the
other objects she dropped in
her rush. There was no time for
her to stop and pick them up
herself.

(Every room in the
Emergency Room that could
possibly have a Code 12
potential has such a box; the
X-ray room is outside the
confines of the Emergency
Room.)

Despite its quick response
and hard efforts, the coronary

care team was unsuccessful; the
old woman died.

Observing this vain race
against time were two nurses
manning the X-ray desk.
Alternately sipping Coke and
watching the drama, they
introduced me to a feeling I
was soon to discover was quite
common among emergency
room staff. Unemotional and
almost bored with the
procedures, they seemed very
removed from the struggle of
life and death going on in the
next room.

I walked back through the
halls to the waiting room. As I
looked into the lobby I was
puzzled for a moment. There
the dead woman's relatives
were confidently chatting the
minutes by, glancing
expectantly at the wall clock
and then down the hall. It
suddenly occurred to me that
they had no idea of what had
happened. How could they? To
them she was still the quiet old
lady they had last seen riding
down the corridor.

In another moment a young
doctor called the relatives
aside. Even before the hushed
conversation began, I knew
what he was going to say. After
a moment the older woman,
the patient's sister, broke down
into sobs.

In the same unemotional,
almost cold manner I had
witnessed earlier, a medical
student explained what had
occurred in the X-ray room.
The woman had stopped
breathing too long, he said, and
even if she had lived, she would
have been a vegetable for the
rest of her life.

"After repeated attempts to
revive her, the coronary care
unit didn't try too hard
because she would have been a
vegetable. It was a token
effort," he admitted flatly.
"You have to stop sometime.
She didn't even have any
pulse."

11:15 p.m. Once again the
emergency staff plunged into
action with the ugly sound of
the siren. A very young black
boy was wheeled by on a
stretcher coated with blood.
Without delay he was whisked
back to the operating room
and a new struggle for life
began. Nurses, doctors and
aides ran helter skelter in and

out of the operating room
carrying bandages, instruments
and equipment.

A friend of the boy arrived
and I asked him how such a
young boy had been stabbed.

Once assured that I was not
an undercover agent for the
police, he "set me straight.
He was trying to break up a
fight," he explained.
"Somebody was beating up his
best friend and he got in
between them. The dude
stabbed him in the chest."

The ambulance driver from
the Charlottesville-Albemarle
Rescue Squad estimated it
took less than 2 minutes to
transport the boy from the
scene of the accident to the
hospital.

Police arrived to make their
report and were able to contact
the youth's mother from his
wallet identification. The boy's
friend had not been willing to
give this information.

I saw the boy's mother
later. She looked tired... as if
she had been through this
many many times before.

12:30 a.m. A third-year
University student arrived from
a wine party in the dorms with
a broken finger. Not long after
his arrival, another student was
admitted after running into a
dorm door. (Sounded like a
good party!)

12:45 a.m. The siren's wail
announced a new arrival. I
could hear the word "O.D."
(overdose) whispered in hushed
tones from one nurse to the

next as they wheeled an
attractive young blond-haired
girl past me. I remember
thinking how still and pale she
looked.

Perhaps in a fit of
frustration at having lost one
life and watching another who
had endangered his, a resident
doctor called out to his
colleague, "You want to see
something funny? Come look
at this girl in here."

The other resident
responded, perhaps more for
my benefit than the doctor's,
"People who frequent the
emergency room are the dregs
of the earth. They only come
in to keep others awake.
Students abuse it. I get to hate
them. They want
attention...that's all."

As bitter and surprising as
these words may seem, they
were sadly understandable. To
each group of people within a
profession, certain things
become routinized. What
would ordinarily seem
shocking or strange to
"laymen" would hardly receive
a nod from this inner core of
the medical profession.

Unfortunately, or perhaps
necessarily, the concept of
death has lost its
"awesomeness" to the
Emergency Room staff – how
could it help but be that way
when they are faced with death
constantly. Instead, the
screams, the crying and even
death itself takes on a cold
unemotional character in these
people.

When asked if anything ever
"got to him" at the emergency
room, a hospital volunteer
replied, "As a matter of fact
no, and it's surprising."

A medical student summed
up the problem better than
anyone else when he said,
"There's a lot of cynicism here
that probably does not belong,
but after all, we are human like
everybody else."

2:00 a.m. A student with a
broken hand, a man with
abdominal pains and a sick
Marine filled the empty seats in
the waiting room. These are
the typical cases that come to
the attention of the emergency
room. There is not always a
dramatic shoot-out or drug
overdose, but usually many
minor complaints and routine
injuries.

"Fifty per cent of the
people who come into the
Emergency Room are not
emergency cases; yet we must
see them since there are no real
night clinics open or night-time
doctor's hours," explained Mr.
Sawyer.

"In addition, the
Emergency Room serves as a
screening and referral service
for newcomers to the area," he
observed.

Mr. Sawyer stressed that no
patients are left unseen and
that a patient does not leave
without an intern or resident
checking them first.

Except for extreme
emergencies a patient must
pass through the admittance
window before being permitted
an examination. Once a patient
is admitted to the Emergency
Room a card is kept on that
patient for the remainder of his
life.

A file is kept on every
patient seen in the Emergency
Room for two years after
examination, and records of
every patient examined in the
Emergency Room are kept on
microfilm.

"The amount of paperwork
done before a patient is
examined by a doctor is
flexible," assured Mrs. Dooley.
"We ask enough questions to
get a chart on them, such
things as if they are allergic to
penicillin."

"The clerks at the
admittance desk are hired for
attitude," remarked Mrs.
Dooley. "They must be
friendly, inspire confidence. It
is a very human Emergency
Room," she added.

2:20 a.m. Medical history
may have been made as a
dermatologist was called in for
the first night call he had ever
had to attend. (And he thought
that being a dermatologist
would assure him of a good
night's rest!)

Specialists Available

The Emergency Room has
specialists from every available
service on call 24 hours a day.
In addition, "anybody at the
emergency room may call and
be treated by their own doctor
if that doctor has privileges on
the staff," said Mr. Sawyer. He
estimated that there were 200
residents and interns and the
same number of physicians
associated with the hospital.

This large body of medical
staff still has trouble handling
the ever-increasing number of
patients in Emergency Room
because last year 30,861 patients
were admitted to the
emergency room. This number
is increasing at the rate of 200
per year according to Mr.
Sawyer.

3:30 a.m. : Prompted by a
less than cooperative nurse and
the long hours of dodging
stretchers behind us, our visit
to the Emergency Room was
curtailed.

Faultless Mechanics

I have not been back to the
Emergency Room since that
night and I hope I will never
have to. It left me with an odd
feeling; as if something was
missing from there that should
be present.

It was not in the mechanics
or operations of the
Emergency Room. As far as I
could tell they were faultless.
The unit manager was pleasant,
as   well as the night guard.
There wasn't even an hour
backlog of patients in the
waiting room that you hear so
much about.

The problem, I think, lies
underneath the antiseptic
white atmosphere – it is the
attitude of the emergency staff
itself. It frightens me a little
that the very people we depend
on to save our lives have
become so cold and nonchalant
about death.

Granted, students do abuse
the Emergency Room. But are
we "the dregs of the earth"
because we are sick? What did
those doctors know of the
forces that motivated the
young girl to overdose?

Yet perhaps I am being too
harsh in my judgment. For the
Emergency Room staff, this
apparent callousness may be
their only defense mechanism.
They are exposed to so much
death and so much sickness
that they must remain immune
if the Emergency Room is to
continue its life-saving service.