A night in the ER: The state of emergencies

For Hospital of the University of Pennsylvania physicians, life never quiets down in the ER. Between assisting a car-crash victim, a woman whose ex-boyfriend clubbed her on the head with a baseball bat and an HIV-positive woman with respiratory problems, Elizabeth Datner found time to admire photos of a colleague's baby and call her husband to check up on her own 17-month-old daughter. It's just another night in the Emergency Room of the Hospital of the University of Pennsylvania. Datner -- an Emergency Medicine professor at the School of Medicine -- was one of three attending physicians working a recent shift observed by a reporter and photographer from The Daily Pennsylvanian. "The hardest part is learning how to juggle so many things at once," Datner said. "It requires a lot of coordination." Each month, about 720 seriously injured patients pass through the 26,000-square-foot Emergency Room, which is located on 34th Street just south of HUP's main entrance. About one-sixth of these patients are in such severe condition that physicians must treat them in the department's trauma bay, which is capable of handling up to six patients at a time. Datner reports to the trauma bay to supervise the anesthesia residents whenever dispatchers alert doctors to prepare for a patient arriving via ambulance or the PennStar helicopter. Although the area may seem chaotic to an outsider, Datner said that the trauma staff responds to serious injuries in an organized, well-orchestrated manner. In one of the night's most serious injuries, the helicopter brought in a woman who had been in a major car accident. X-rays posted on a backlit wall revealed that she had a broken neck and severe brain damage. "I don't think this one is going to make it," Datner said. The woman remained in critical condition as of late last night. While the Emergency Department staff devotes immediate attention to major cases such as the accident victim, doctors, nurses and technicians spend most of their time attending to patients in the other 21 acute-care beds. Datner, who came to HUP almost three years ago after completing a joint residency program in Washington between George Washington and Georgetown universities, said she chose to practice emergency medicine because it allows her to do "a little bit of everything," from psychiatry to gynecology to surgery and pediatrics. After arriving at the Emergency Department, patients see a nurse who measures their vital signs and determines the severity of their condition. Residents -- medical-school graduates training to be full physicians -- perform initial evaluations of patients and present individual cases to the attending physicians, who do their own assessments. The physicians and residents then confer to determine which tests to run, discussing possible treatment options and making the decision of whether to admit or discharge patients. One patient, the HIV-positive woman who was having trouble breathing, told Datner she had been in and out of Temple University Hospital for months. The patient said she thought she would be able to breathe more comfortably if doctors inserted a wider tube into her windpipe. Datner immediately called in a head-and-neck specialist to examine her. While Datner prepared a report, another attending physician, Sarah Stahmer, dealt with a drunk woman whose face was covered with blood. The woman cursed at staff members while they tried to assess the extent of her injuries. Across the hall, Datner moved on to the woman whose ex-boyfriend -- the father of one of her five children -- had beaten her and hit her on the head with a baseball bat. About 23 percent of women who come through the Emergency Department are victims of domestic abuse, said Datner, who researches the subject. Datner suggested that the patient get a restraining order to protect herself and her children from the ex-boyfriend. Before the woman left, Datner gave her the telephone numbers of several local shelters and abuse hotlines. "Even if you can only talk to someone for a few minutes, you can still make a difference," she said. Datner recalled a man who came to the Emergency Department after getting in a fight which left his face covered with blood. A year later, he returned with his girlfriend and told Datner he had cleaned up his act. "It's nice to know I'm not banging my head against a brick wall," she said. "If you take the time to educate the patients, you can make them think about what could happen next time and really have an impact on their lives."

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