‘Saved from the darkness’ by every hero’s hand

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.

Like the cavalry, a junior ER resident and a surgical resident run in from the main ER. The residents and nurses melt into a synchronized team in a few seconds. How do heroes move?

I run next door to Trauma 1. I need the ultrasound machine for Big Belly. I’m certain now that Boxed Man and Leg Man are out of danger, but Big Belly, I’m pretty sure, is bleeding into his abdomen. The ultrasound will prove in a second if he’ll need to go to the operating room. He’s been here less than five minutes, but now he’s my own ticking bomb. I hope I haven’t made a mistake.

Trauma 1 is nearly silent, and at the doorway, Cryer tells me the team is having trouble putting a breathing tube in the first patient. If we can’t help him breathe, he won’t make it to the OR. He’s dying in front of us. Around the patient’s head, Morgan and Dr. Angelique Campen, the other faculty ER doctor, and two senior ER residents, are focused on threading a thin plastic tube through the patient’s shattered mouth and jaw. Morgan squats, his face level with the bed as he holds the neck tightly -- we assume broken bones like knives are ready to slice the spinal cord -- as Campen gently levers open the mouth with a steel blade and senior ER resident James Moore eases down on the Adam’s apple to help bring the airway into view without moving the neck.

I grab the ultrasound machine as they struggle to place the tube, trying to rush out back to Big Belly, to not be drawn in, but Campen, both hands lifting the blade calls out, “Mark, pull his cheek out please,” as calmly as if she’s asking me to pass the salt. I do, stepping into the center of the storm, a finger pulling his right cheek and lip up and out of the way.

Campen is looking for the airway, but I see something else. Somehow the simple act of stepping into this circle forces a moment of clarity from the night’s chaos.

I see a city, a fire department, a university, a hospital, an ER, everything that comes down to this one moment for one man, a friend, a neighbor, maybe a father: four experienced doctors in a tight circle with one task that can save his life and allow him a chance, however uncertain, to go on to the next moment, in the hands of another set of rescuers and another, until he is well again, or the weight of his injuries drags him down despite their efforts.

I see a chain of events pulled by hands that runs back in time, out of the hospital, across the night sky, back to the crash site -- and forward too, out of the ER, through the OR and the ICU and maybe someday back to the arms of a family, saved from the darkness by every hand on each link: doctors, firefighters, nurses and everyone who ever paid a penny in taxes or gave a dollar or a pint of blood. “I see the cords,” Campen says. The tube goes in and the spell is broken.

Big Belly is still grinding his teeth as I squirt the ultrasound gel on his stomach. I point the probe at his right kidney where the blood would pool if a crushed spleen or torn vessel were leaking. Outside the room, two new patients roll by from the helipad, into the care of Morgan and Campen. We’re good for now, but I can’t locate where I am on the ultrasound screen. For a moment I’m disoriented, not sure what I’m seeing -- too much black space, the kidneys and liver not where I expect them to be, just black -- the color, on ultrasound, of blood.

“Got to call in reinforcements” -- it’s Cryer looking over my shoulder. He pulls out his phone and calls for another operating room to open. Before the night is over, five of the eight patients flown to UCLA from the accident will go to emergency surgery. None will die, in large part due to the skill of our surgeons. I watch Cryer walk away, gesturing to a resident on his way to the OR. How do you teach heroes?

On a normal night, my shift was over three hours ago. Someone tells me that there is a guy in the main ER -- I’d seen him earlier -- who was a prescription away from going home three hours ago. I run out to apologize. But he’s not angry. He shakes my hand.

Back in Trauma 1, minutes pass and this time it stays quiet. The nurses drift away to the main ER. Four hours of running and the Medical Alert Center radio, silent all night, calls us with word that there will be no more helicopters.

I drive home down Westwood Boulevard, smiling about the man who shook my hand. Then my thoughts drift to the families, the people waiting for loved ones who will never arrive -- for an opening door, a familiar footfall, the everyday turn of a key.

I stop completely and look both ways at every stop sign, and when I get home, my front door key feels like the world, safe, in the palm of my hand.

--

Mark Morocco is an assistant professor and associate residency director of emergency medicine at UCLA Medical Center. He is the former medical supervisor for “ER.”