Real life in the ER

During shift change at St. John's Mercy Medical Center in St. Louis County, doctors meet in the locker room where they change either into or out of scrubs and white jackets. There are wizened senior surgeons and sun- and sleep-deprived interns. A pediatrician just going off chats with a resident just going on.

In many ways it's not unlike the NBC television series ER, with its cast of concerned doctors, competent nurses, and gurneys full of comic/tragic patients. There are little personal dramas played out against the backdrop of larger ethical and cultural questions. There are crash carts and gallows humor.

It's a Friday night and Steve Smith, an anesthesiologist, changes from his turtleneck and jeans into ill-fitting scrubs. The 40-year-old has a runner's build and a goatee, and he wears tweed jackets with patches at the elbows. He speaks deeply and quickly and he smiles often.

"I wanted to be an orthopedic surgeon," Dr. Smith explains as he slips the paper booties over his sneakers. "I've always been a hands-on guy. My first car, got it when I was 15, was a '63 MG. I fixed it up myself. But surgeons yell at each other too much. Something about surgeons."

Dr. Smith covers his hair with a pretty blue flowery scrub hat and knots a mask around his neck. He greets an older surgeon (who doesn't yell, but he's not in a good mood, either). They talk a little politics, they talk a little managed care.

"I'm not a physician anymore," grumbles Dr. Arthur Auer, who wears a snazzy tweed driving hat and trench coat. "I'm a healthcare provider. I'm a business entity. Well, have a nice night."

[CUT TO: INTERIOR, OPERATING ROOM.]

It's bright and loud and crowded, with green-clad doctors, nurses, and OR techs. A 27-year-old woman is on the table. Her knee and face are being rebuilt after an automobile accident. The patient is hidden under sheets and equipment, with only her right knee artfully exposed. The skin around the knee is folded aside, leaving the muscle and bone open to the surgeon, Dr. Jesse Susi, and the anesthesiologist, Dr. Don Arnold.

Steely Dan plays softly on a battered stereo system in the background. It fails to drown out the pings and hisses of the OR equipment. The doctors are talking among themselves, while the nurses and techs listen on. So far they've talked about cars, they've compared wreck victims of the past, and they've discussed tattoos (this young woman has a rose-and-heart design on her hip; the surgeons admire the work). Dr. Smith enters, wearing scrubs and a surgical mask. He joins the conversation.

STEVE SMITH: We had a bad one recently, an 18-year-old girl, in her brand new Camaro. A bank robber was being chased by the cops, he pulled out in front of her. An airbag saved her life, but the force of the impact was concentrated on her femurs. Split her pelvis in two.

JESSE SUSI: Mmmmph. Know what I get a lot of? Guys putting up Christmas lights. Every single year, I get someone who has been doing Christmas decorations. Last week, guy came in, he fell off the ladder, blew out both his knees. Something I'd been doing that day, too.

DR. SMITH: (Shaking his head) Same with deer stands. I get a lot of deer stands. Guys just fall out of the trees. In fact, I think that's the most common hunting accident. Forget the guns. The real problem is gravity.

DR. SUSI: With spring coming up, we'll start seeing motorcycles. First good day, they'll start rolling in the guys who just had to take their motorcycles out for a spin.

DR. SMITH: And the rollerblades. Nice spring day, they'll be in here with wrist and elbow fractures.

DON ARNOLD: Don't forget the "Dude Brothers." They're my favorite. You know, "Some dude shot me, I was just sitting there." Weekend comes up, we'll get some of those. (Doctors laugh knowingly). [FADE TO BLACK.]

It's 9:05 p.m., and Steve Smith approaches the crash victim's father in the OR recovery room. The dad is a thin, middle-aged man wearing slacks and a golf shirt under a blazer. He seems successful; his clothes are expensive, and he wears a pager, but it's turned off. He calls to mind the Roman centurion whose servant was ill. The book of Matthew recounts how the centurion, though a man of some authority himself, humbled himself to Christ's authority out of love for his servant.

That's the temptation here, to draw too many parallels between ER physicians who save lives, and the God who gives life. Dr. Smith recognizes this and tries to redirect praise.

The punch-drunk dad is standing and fidgeting, watching his bruised daughter. She's sleeping now, next to a heart patient. The dad already has accident photos; he's showing them to doctors, to nurses, to anyone who will stand still. Steve reassures the dad, telling him the bruises will go away, and that his daughter looks worse than she feels. With some physical therapy for that knee, she'll be all right.

"I don't see how anyone could have lived through this," the dad responds, holding out photos. "Look at the way the car rolled. You doctors are magnificent."

Dr. Smith takes the pictures, shaking his head as he leafs through them. "God's hand was on her. He protected her. We're just mechanics."

In the staff lounge, a stack of pizza boxes stands as a greasy testament to Dr. Smith's staff-management principles. He bought the pizza, he explains with a grin, and the staff will suffer to be managed for at least one more shift.

Mike Keenan takes one of the last pieces; Mike is a bearded, beefy biker, who is sadly relegated to driving his old pickup, he tells Dr. Smith. His bike is down again. Maybe the fuel pump. Mike stands with one leg on a chair, laughing loudly; it's clear a little of Mike goes a long way, only there's not a little of him. He stands 6'5" and weighs in over 225. He roars out his pleasure to meet the guy writing a book-"article," Dr. Smith corrects him. "For a magazine." Mike nods, but then makes the mistake twice more during the next 15 minutes, though no one minds.

Mike tells stories as he eats. He ranges from his combat experiences to his theories about CIA drug trafficking. He tells of Panhead Fred, a biker buddy who was offended by someone while he (Fred) was fixing his (the friend's) bike. Fred took it all apart, "down to the last screw," then got up to leave.

"He says, I found what you need, man," Mike recounts. "You need an assembler!"

No one laughs harder at Mike's stories than Mike. He then cheerily talks about the grudge the former chief of nurses held, that kept him out of work for nine months. "Now I'm indispensible," he smiles.

Dr. Smith agrees. Mike is a surgical tech, an instrument-passer, and one of the best. He may not be a guy you want attending your daughter's wedding, but he's the guy you want handing the clamps when you wipe out on the interstate, Dr. Smith says.

Mike bows to the compliment.

Just after 10:30 p.m. Dr. Smith's beeper goes off, signaling him he's needed in the ER. As he enters the emergency wing, he encounters nurses and assistants who are suddenly all business.

A 12-year-old boy is horribly burned. He was sneaking a smoke in the garage, instead of outside in the below-freezing temperatures. Gasoline fumes had accumulated, and when he flicked the lighter, the garage went up.

Larry Ashby, a flight paramedic, outlines the injuries for Steve. One phrase is repeated by at least half a dozen doctors and nurses: "I hate burns."

At 10:40, the burn surgeon calls for intubation-that's where the anesthesiologist inserts a breathing tube down the patient's throat, prior to surgery. It keeps the windpipe open while the patient is under anesthesia.

At 10:41 Dr. Smith dons a thick gray robe (part of the "universal precautions" against the AIDS virus) and goes into the trauma room. The heat hits him first; the crowded room is hot, made so by body heat and the intense overhead halogen lights. Then there's the smell. Burned flesh mingles with antiseptic hospital smells.

The 12-year-old lies on a gurney, surrounded by masked people. His arms and hands twitch; charred and ruined skin hangs from his fingertips and face. He took the blast of flames in the face, hands, chest, and legs. He's burned over 50 percent of his body. "Watch my arms!" he shouts at a nurse who is trying to start an IV. And it suddenly becomes disturbingly clear the boy is conscious.

In the corner, his overwhelmed mother shakes, too. She looks lost as she watches them treat her son. She's a pretty, young woman, but her clothes are soaking wet (from the fire hoses) and her face is tear-streaked.

The boy flails as Dr. Smith goes in with the breathing tube; something goes momentarily wrong and the boy's gag reflex is triggered. Now the stench of vomit mixes with the other smells. Finally the tube goes in and the other doctors administer the drugs that will bring sleep and relief from the pain.

Outside the trauma room again, Dr. Smith stands near a couple of other doctors. "That boy's life is changed forever," one doc comments softly. "Skin grafts every Monday morning, for the next two months. That's if he lives. If that's ever me, don't bother to intubate me. Just let me go."

Dr. Smith has noticed something about the mother; he tells a nurse to try to round up some scrubs for the mom to change into, and he goes to her to examine her hands. She's been hiding them, but they're almost as badly burned as her son's. Dr. Smith comforts her until a resident comes over and treats her burns.

A few hours later, Dr. Smith goes up to the third-floor burn unit to check on the boy and his mother. The boy is mercifully unconscious, and the mom is nearly so, slumped in a chair next to her son's bed. She rouses just enough to smile at Steve, to accept a few words of comfort. He says he'll check in again before his shift ends.

"I feel God's hand here every day," he says later. "I feel bad for that family; it's bad now, and its going to get worse. Right now they need compassion and kindness to get them through the night. More than anything, they need to feel God's hand. That's what I pray for." [FADE TO BLACK. ]