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It's 9:30 on Friday morning, and after 27 hours on the job, Barbara Latenser needs a shower. "I smell like a goat," Latenser says looking down in disgust at her dark sweater, light blue hospital-issue uniform and clod-hopper shoes. "I want to shower," she says. "I've been standing on my feet all night. My shoes are caked with blood. I want to put on some nice clothes and do something with the day." Patients like these, victims of Philadelphia's escalating violence, are overwhelming the trauma center and its doctors. "It's urban warfare," says the 38-year-old doctor, who was trained at the University of Nevada Medical School in Las Vegas. "I'm a newcomer to Philadelphia, but the violence . . . Sometimes I'm just amazed at what a violent place it seems to be." When Center Director William Schwab hired Latenser last summer, he promised her that she would be able to spend one third of her time doing research and one third of her time learning how to run a trauma center. But increasing violence in the city has kept Latenser hopping, just taking care of patients. She doesn't have much time to eat, much less do research. "Today's my day off," she continues. "I went off at 6 a.m. I go back on duty at 6 a.m. on Saturday. It's tough. We spend all of our time taking care of patients. Sometimes I look at the faculty [surgeons] -- they're on their feet, but they look so tired, I worry about them driving home." At 6 a.m., fourth-year surgical resident Christian Schunn took over for Latenser as the physician-on-duty. But Latenser is staying around while the faculty critique the previous night's action, and quiz the trauma residents. "This is a stab wound clinic," says senior trauma surgeon Mike Rotondo as he points to a chalkboard drawing of a 37-year-old man who was admitted to the trauma center last night. Eight 'X's mark the spots where the man was stabbed. · "We're full right now," a nurse in the trauma intensive care unit says at about 1:30 on Friday afternoon. "But we're not going to close down. If someone else comes in we'll fit them in somehow." The day is going peacefully for Dr. Schunn. No new trauma patients have come in since he came on duty, and he's spending his time taking care of the patients in the intensive care unit and the recovering patients in the trauma ward. "We have almost as many patients in the intensive care unit as on the ward and some of them are very sick," Schunn says. "A few of them are trying very hard to die." · Schunn's peaceful day is shattered at 9:17 p.m. "Trauma alert," a metallic voice announces from Schunn's beeper. Schunn hurries to the trauma bay in the emergency room and dons a surgical gown, cap and mask along with a plastic face protector. Nurses, residents and other hospital personnel scurry to prepare for the incoming patient. The bay is outfitted with everything needed to assess the patient's condition, including a portable X-ray machine and facilities for on-the-spot surgery. When the patient arrives in the bay at 9:20 p.m., a 10-person surgery team is waiting for him. Paramedics John Gelibter and Pat Fletcher wheel a 36-year-old man in and help lift him onto the table. "Somebody jumped him and stabbed him once in the chest with a long knife," Gelibter tells Schunn. Outside the trauma bay a secretary puts the man's blood-soaked clothes in a bag, while inside the team works to revive the patient. At 9:31, Schunn takes his mask off and walks away from the patient while X-rays are taken. "He's comfortable," Schunn says. At 9:36, while the trauma team is still working on the stab victim, beepers sound again, "Trauma alert! Four minutes ETA!" "Let's get this guy out of here," Schunn says. "Here's his blood," he adds, handing a packet of type-O blood for transfusion to a nurse. "He's number 409." "What's coming?" a nurse waiting in the trauma bay asks Schunn. "Head trauma -- that's all I know," he answers. At 9:39, paramedics wheel in a 30-year-old homeless man who had been hit over the head with a baseball bat. Blood coats his shirt and blue jeans. His clothes reek of vomit and alcohol. "Hey! Move your legs for me!" Schunn shouts at the patient, checking to see if he is paralyzed. "We found him lying on a step at 52nd and Pensbrook Street," Paramedic Angel Navaro tells Schunn. "We stabilized him in the back of the truck." The patient moans. "No. No. I'm alright. Really, I just fell down." Philadelphia Police Officer Bob Hampton walks up to the trauma bay and tries to get some information on the patient from the nurses. "I just came over to see if there was any crime involved," Hampton says. But the doctors are busy working on the patient and haven't even found out his name yet. At 9:50 p.m., Schunn emerges from the trauma bay. "He's got a pretty bad head laceration, but I think he'll be alright." He returns his attention to the stabbing patient in the next room. Third-year surgical resident Jim McCaughan tells Schunn that he thinks the patient should get a chest tube to drain the blood which is filling his chest. Schunn isn't sure the case is that serious. Because Schunn has several other patients on the ward with tubes in their chests, he doesn't want to needlessly expose this patient to infection. He decides to consult Dr. Rotondo and calls him at home. "O.K., do it," Schunn tells McCaughan as he hangs up the phone a few moments later. McCaughan tells the stabbing victim to look away as he and Resident John Blank insert he tube through his wound. Blood spills out of the patient's chest and splashes onto the floor. · Up in the PennSTAR helicopter flight lounge, things have been quiet all day -- they haven't even been put on alert once. But soon after the bars close at 2 a.m. Saturday morning, the call finally comes. There's been a five-car crash on the New Jersey Turnpike. The flight crew takes off within minutes. It won't return to the hospital for another three hours, until it has finished transporting two patients to a trauma center near Newark. · At 3 a.m., Schunn gets his last trauma alert of the night -- a 90-year-old man had fallen down the stairs and injured his head. At 6 a.m., Schunn goes off duty. It hasn't been so bad for a Friday night.

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