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Dr. Alexa Dorricott (center), a surgical resident, inserts a chest tube in a stabbing victim in the emergency department at Mount Sinai Hospital on the West Side.

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‘Code yellow: Trauma in the emergency room’

Working at Mount Sinai Hospital, one of Chicago’s busiest Level 1 trauma centers, the staff tends first to the patients but then better tend to themselves, or they won’t last long. 

Dr. Alexa Dorricott (center), a surgical resident, inserts a chest tube in a stabbing victim in the emergency department at Mount Sinai Hospital on the West Side.
| Ashlee Rezin Garcia / Sun-Times

“What is your name? Can you tell me your name?”

The first question that people are asked as they are rushed into the emergency room at Mount Sinai Hospital is a ploy. The nurses and doctors hovering alongside the rolling gurney aren’t really interested in that. Not now, with life potentially hanging in the balance. Besides, they probably could get the person’s name from a wallet in the bloody clothes being stripped or cut away.

What they really want is to prompt the patient to speak, or try to.

If they can, “That tells us they’re breathing fine and their lung sounds are clear because they can talk to us,” said Raquel Prendkowski, emergency department director for Sinai Health System. “We want to see if they’re audible.”

Marco Munoz, brought in on a recent warm Tuesday night, can mumble his name. But his left lung is not clear thanks to the knife plunged into his chest 15 minutes earlier in K-Town.

Medical workers perform their duties from specific positions around the bed as they treat a man with a stab wound at Mount Sinai Hospital.
Medical workers perform their duties from specific positions around the bed as they treat a man with a stab wound at Mount Sinai Hospital.
Ashlee Rezin Garcia / Sun-Times

120 patients a day

“I was supposed to take her to the zoo today. If I just would [have] taken her to the zoo today. My baby ...”

Sometimes, the vast, square, low, windowless room is almost quiet. Conversation hushed, machines pinging. Sometimes, the heartbreak is loud and unavoidable in the ER at Mount Sinai, the largest private safety-net health system in the city and one of its busiest Level 1 trauma centers, seeing an average of 120 patients a day. Particularly the kids: burnt, beaten, shot or, in this case, struck and killed by a car. The first resonating peal in someone’s lifetime of sorrow. Six years old.

“Those are the ones that stick with you,” Prendkowski says later. “We called in a counselor. My people were, like, ‘We’re OK. We need to debrief.’ I said, ‘With this one, I’m forcing you to go to the counselor. You sit back there for five minutes. If you have nothing to say, that’s fine. But I want you to just be with someone who can listen without judgment.’ ”

The staff tends first to the patients but then better tend to themselves, or they won’t last long.

“You’re either a lifer here, or you do it for a few months, and it’s too much on your soul, and you have to find something else,” Prendkowski says. “But we have quite a few lifers here. I am.”

Her own trauma was what brought Prendkowski here.

“I’ve been a nurse for 17 years now,” she says. “About three years ago — I share this because it doesn’t bother me anymore — I was beaten and stabbed for my phone. It made me want to be in the emergency department.”

So she transferred, one of a number of emergency department employees dealing not only with patients’ trauma but also their own.

“The attitude is: ‘This happened bad to me, but I’m going to make it OK for someone else,’ ” Prendkowski says. “You see that a lot with our people. We have people whose sons or grandsons have been murdered, and they still work here.”

Nobody wants blood in their eyes

“What’s your ETA?”

“About five minutes.”

Despite the flat-screen computer monitor and all of the technology, word of people on their way to Mount Sinai still comes over a radio, sounding distorted and muddy. News of the stabbing of Munoz — his name has been changed to protect his privacy — arrives shortly after 8 p.m. An RN, pen in hand, listens hard, copying the stats onto a paper form.

“He originally started at 90, we got him to 100 percent...”

“Could you repeat those vitals for me?” he says.

Dr. Amarjit Singh, watching over his shoulder, reaches to press a button on the wall. A whirring alarm and a woman’s voice sound throughout the hospital.

“Code yellow: Trauma in the emergency room.”

Surgeons begin arriving in the ER from upstairs. Trays are rolled into No. 3. Bags of fluids are set on hooks; Intravenous lines are removed from plastic and readied on rolling, steel tables. Dr. Alexa Dorricott and several other physicians tie on paper masks and don clear plastic face shields — this can get messy, and nobody wants blood in their eyes.

“Please don’t put the ultrasound there right now,” says Prendkowski, who seems to somehow be everywhere all at once.

The rest of the ER keeps right on going.

‘When there’s a full moon, things happen’

“Help me! Help me! Please help me! Help!

From across the ER come throat-ripping screams, muffled behind a closed door.

“Psych meds take a long time to work,” an RN explains.

So people found raving in the street — or this time raving while exposing herself to a police officer — need to be restrained and sedated while the meds they ignored or sold or never got in the first place do their work. Meantime, she screams, as she is restrained hand and foot to a $12,000 anti-ligature bed in one of the rooms cleared of any item that someone might use to commit suicide.

A man being seen for a stab wound curls his toes and writhes in pain at Mount Sinai Hospital.
A man being seen for a stab wound curls his toes and writhes in pain at Mount Sinai Hospital.
Ashlee Rezin Garcia / Sun-Times

“Some days are bad,” says Riki Kaelin, an RN for six years and a Chicago firefighter paramedic for 20. “Nights are when the activity picks up. I did nights for seven years here. When you’re home with friends, they say, ‘Oh, 80 degrees, its beautiful.’ I’m going to work thinking, ‘It’s going to suck’. Holidays, weekends, there’s always an uptick.”

Sometimes, though, there’s a rush, even when it’s cool outside and a Wednesday.

“It’s hit or miss,” Prendkowski says.

“We do feel that when there’s a full moon, things happen,” Kaelin says.

The same is true when public aid and Social Security checks arrive and are converted into illegal narcotics.

“We do notice our drug overdoses on the 1st,” Prendkowski says.

“The 1st and the 15th of every month,” Kaelin says.

Blood can be seen under the fingernails of a stabbing victim treated in the emergency department at Mount Sinai Hospital.
Blood can be seen under the fingernails of a stabbing victim treated in the emergency department at Mount Sinai Hospital.
Ashlee Rezin Garcia / Sun-Times

Born here, back, in pain

“I feel lighter already,” LaVernne Garfield says.

Missing a leg at the hip from vascular disease, she was feeling poorly, so she came here, though not without effort. “The elevator don’t work, so I had someone bring my wheelchair, and I scooted down six floors to the first floor.”

Scooted down in extreme pain, then she took a bus to Mount Sinai from 71st and Jeffery.

Why? Loyalty is one reason — she was born at Mount Sinai. And she likes the service she gets. Which, at the moment, involves a catheter and 3,400 cubic centimeters — nearly a gallon — of urine drained away.

“Because of her above-the-knee amputation, she can’t feel when she needs to go to the bathroom,” an RN says.

Garfield says she doesn’t let her disability keep her from getting around the city. “I don’t let the leg bother me,” she says. “I bother the leg.”

Caring for caregivers, too

“I actually showered today,” one of the medical workers says, ringing the inner desk at the Sinai ER, gazing at flat screens, typing data, ordering prescriptions, pausing to grab a sweet roll from a package someone brought in. It gets busy. Then, things get still. Then, busy again.

Mount Sinai’s ER has 24 bays. Number 12 is in the back. It’s quieter, with special blankets and sets of clothing. This bay is for rape victims. Treating them requires a demanding mix of medical, psychological and legal expertise, plus a difficult-to-maintain blend of toughness and compassion.

“I had to stop doing it because I just couldn’t see it anymore,” Prendkowski says. “It really takes a beating on the nurses as well. They go through secondary PTSD to have to constantly see what’s happening to these patients, men and women alike. With the drug use around here, it does tend to go hand in hand — the drug use and the victimization.”

She keeps an eye out for any of her people showing any sign of breaking down.

“We do care for the caregiver,” Prendkowski says. “The most telltale sign I see as a director is their attitude change and becoming either angry or completely withdrawn.”

To help keep that from happening: talk, therapists, softball games, comfort dogs. “We try to find different avenues to allow them not to be OK,” she says.

‘No way I’m pregnant’

“Look at the ultrasound — that is your baby there.”

“I am not pregnant! There is no way I’m pregnant. Just stop. Let me go home.”

Every manner of childbirth occurs at Mount Sinai, where a tinkling lullaby is played throughout the hospital every time a baby is born — five times a day, on average. In the ER, birth is less festive, from babies found abandoned in toilets to this woman, who vehemently denied that she might be pregnant right until the moment her “super-healthy” nine-pound baby girl arrived to offer evidence otherwise.

“If you like a variety of patients, this is the place to have them,” says Chere Hamilton, a nurse. “You never know who is going to come through those two doors.”

A man who is on home-monitoring comes in saying the required ankle bracelet is “messing with his pacemaker” and that he would like a note telling the authorities to remove it. A drug test shows there’s cocaine in his system.

A bus driver comes in with chest pains. A prisoner in Department of Corrections beige scrubs, who sliced off the tip of his thumb, arrives chained to a gurney, accompanied by two sheriff’s deputies — along with his thumb tip in a coffee cup. An “impressively huge” growth on a kidney is seen. There’s a woman having a sickle cell anemia crisis. And a drunk driver who wrecked her car.

Asked what has kept her at the Mount Sinai ER for 28 years, Hamilton says it’s “the camaraderie between staff.”

Hamilton has seen a lot. “We had the fire in the neighborhood, and the three kids came here DOA,” she says. “I had to call my pastor to make it through the day.

“Another time, I was the charge [nurse]. We had these kids coming from a fire — people actually threw the kids out the windows. This little girl kept grabbing me, grabbing me, grabbing me. Because of all the soot over her face and the mask, I didn’t recognize her. I didn’t realize that it was my cousin until I went outside the door and saw her father. I thought she just wanted some comfort. But I’m trying to make room for the other kids who were coming in, and it was all my family. We had to suck it up and still stay focused and still keep the room moving.

“We are the ‘Miracle on 15th Street.’ We have limited resources. And our patients are very, very challenging. They don’t come in with one problem. They come in with five or 10 problems. We do our best to try to take care of the patients the best way we can, with dignity and respect. Sometimes, that’s a big challenge.”

Raquel Prendkowski, Sinai Health System’s emergency department director, talks with Chicago police officers after a man was treated for a stab wound.
Raquel Prendkowski, Sinai Health System’s emergency department director, talks with Chicago police officers after a man was treated for a stab wound.
Ashlee Rezin Garcia / Sun-Times

Unconscious at Madison and Pulaski

“Do you know your birthday?”

A variant on the what-is-your-name question. A young man sits slumped impassively in a wheelchair, a paramedic standing behind him. He leans over.

“Sir, do you remember using any drugs today? No? Nothing?”

“Suck my ----” the young man replies.

“This guys not saying much but inappropriate things,” the paramedic says, smiling. “Usually, they can talk by now.”

Drugs are suspected. Otherwise, young men usually aren’t found unconscious at Madison and Pulaski.

“He was out, down on the ground,” the paramedic says.

Out in the waiting room, Munoz’s sister and a cousin wait. Visitors must pass through a metal detector — patients are wanded as they arrive because sometimes they’re armed. Police interview them, then leave.

His relatives say Munoz is employed, a construction worker, mid-30s, had just gotten off of work and was at the corner of 26th and Kostner when somebody tried to rob him.

The cousin shakes his head. “He was going home,” he says.

Stabilized, then off to surgery

“Sir! Sir! Sir! You gotta lie on your back. I know it’s painful. Relax — relajarse — OK?”

Doctors and nurses all around him, Munoz groans and twists. One calls for Lidocaine, another for sutures. An RN translates questions and instructions into Spanish. Relaxation isn’t on the agenda, not as Dorricott snakes a clear plastic tube through an incision in his chest, trying to reinflate a collapsed lung. His clothes are piled in the corner, atop them a blood-smeared iPhone.

In minutes, Munoz is stabilized, then rolled upstairs into surgery. A new bed is brought to await the next patient as the trauma team disperses.

“Beautiful chest tube,” someone says to Dorricott as doctors move to a woman who has been brought in, restrained, in a wheelchair.

“Where’s my stuff at?” the woman demands.

Suddenly, an alarm sounds. A voice comes over the loudspeakers:

“Code yellow: adult trauma alert in the emergency room.”

It’s a stabbing, a woman this time.

“Another one?” a nurse asks.

Emergency room doctors at Mount Sinai Hospital insert a chest tube to treat a man who suffered a collapsed lung when he was stabbed on the Southwest Side.
Emergency room doctors at Mount Sinai Hospital insert a chest tube to treat a man who suffered a collapsed lung when he was stabbed on the Southwest Side.
Ashlee Rezin Garcia / Sun-Times
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