A night in a Detroit trauma ward

My old friend from journalism school Charlie LeDuff, who writes for the Detroit News, spent the night hanging around one of the city hospital's trauma wards. His host was chief surgeon Dr. Pat Patton, 46. Among patients with stab and gunshot wounds, Charlie gains some insight into the consequences of a crap economy, health insurance, and a routine evening for a surgeon who has regularly worked 100 hours per week in the ward... for the last twenty years. From the Detroit News:

Consider his case load on a typical evening: A child was hit by a car and rushed to the trauma unit. After a battery of tests, the child was found to be well enough to go home. Instead of picking him up, the boy’s mother told the nurse to send him home on a city bus.

A man was shot through the ankle with a high-caliber rifle, the foot holding tenuously by a flap of skin. The victim owed the dope man money and the bullet was a “friendly reminder” that the bill had come due. A man who had been stabbed in the chest with a knife was being discharged to his girlfriend that evening. As it happened, the man admitted it was the girlfriend who had stabbed him in the chest with a knife...

The trauma surgeon – perhaps the most knowledgeable about the workings of the entire human body – is considered something of a butcher among the cutting class: a brute who is the jack of all trades, the master of none. A general surgeon like Patton may not understand the intricacies of neurosurgery, but he is able to cobble together the shattered pieces of a gunshot victim in a late-night marathon of surgery.

Patton’s most important tool appears to be his right index finger. That digit acts as his probe, his periscope, his divining rod, his cork. He can remember on more than one occasion saving the life of a gunshot victim who arrived at the hospital in the back of a sedan. He simply plugged the hole with his finger.

“Feeling is believing,” Patton tells a glassy-eyed intern as he fishes around in a knife wound in the back of a man’s knee, trying to augur whether its damage to the vein or the artery.

Watching Patton work shatters the illusion of TV medicine. For one, he would win no beauty contests: large, broad-shouldered and ill-shaven, the doctor looks more like a football tackle than a soap-opera heartthrob. For another, when he operates it is not the stuff of daintiness accompanied by the subdued pings of the EKG machine. He is often elbows deep inside the victim’s cavity, tugging and rooting around as if he’s lost a set of keys. And then there is his bedside manner, which is not so much sympathetic clucking, but rather a combination of pugilism and cold-water truth that has an odd but soothing effect on the patient.

“You’re going to die if you keep pulling that tube out,” he tells the wino who insists on yanking out his catheter. The wino gives him a gummy smile and sweetly asks for a thimble-full of morphine.

"LeDuff: Trauma ward shows a harsh reality"



  1. I work in a hospital, my husband works in a hospital.

    The rest of you better figure out fast that unless we all take care of people, we are all going to die sooner than later.

  2. Definitely sounds like the Gary, IN hospitals where I did some of my EMT training and shadowing at.

    Like this article, we also an incident where a child was hit by a car with only minor injuries, and their family wanted us to send him home in our ambulance.

    We also had a guy in full defib come in and die in the ER; me and another student had to do chest compressions for over an hour while they tried to bring in the family to either allow us to stop resuscitation efforts or plug him in. Turns out the family was too busy having a drunken brawl in their front yard and didn’t have enough sense left to follow the ambulance to the hospital.

    1. “We also had a guy in full defib come in and die in the ER;”

      If he was in DEfib, shouldn’t he have been ok?

      1. Misspoke =P I’m sick and my brain is a little fried. “Full cardiac arrest”, aka fib, is what I was going for.

  3. This should not come as news to anyone who’s worked at a hospital or even watched the TLC classic “Trauma: Life in the ER.” LOVED that show. The one from Louisville, KY, where a man came in after his brother (-in-law?) BIT OFF HIS EAR in a dispute, IIRC, over a lawnmower. The wife’s there drawling, “That ain’t human. Dawgs do that. Wahld animals do that.”

    /good times, good times

  4. I, too, have been in the Emergency Department doing EMT training and this is similar to what I experienced in Des Moines, IA. The staff “favorite” story to get new student’s (nursing, EMT, medical) reaction was The Bologna Stabbing. Super Bowl Sunday, two guys were drinking and watching the game with a lunch-meat spread at their buddy’s place. They ended up fighting over a piece of bologna and one guy got stabbed with a butter knife. The victim was carried in by his host and the offender. The guy made it.

    The only TV emergency department show any medic I’ve talked to thought was close to the real thing was E.R. I thought Trauma (cancelled by NBC) was the best I’ve seen, but my family has given up watching with me since I seem to correct or criticize the treatment given by those who decided to write the script.

    1. The show I listed was an early reality show, not a network drama. I also liked the episode filmed at Allegheny General in Pittsburgh (the hospital where I was born, yaaaay crazy muppet arms!) because of the old yinzer bartender they patched up who insisted on going back to his bar. Which is still open, BTW.

  5. I spent a good chunk of my childhood in ERs in Chicago due to Asthma, often late at night. Watching the horror show roll in was just astounding. Walking wounded with gunshots to the chest, kids younger than me with multiple stab wounds, the ODs, the drunks who had had strokes or heart attacks and were found in a pile by the cops, this stream of people in extremis. I got to know the nurses, including those specializing in trauma. Such an amazing caliber of human. Working insane hours, stitching together strangers, holding the dying, consoling the living. People who commit to these professions are truly heroic.

    1. “Working insane hours, stitching together strangers, holding the dying, consoling the living. People who commit to these professions are truly heroic.”

      MG, thanks for the compliment. I am a paramedic and RN, and the general public has no idea of what personnel in a big-city level IV trauma center go through on a regular basis. How about a head injury case, who when she is declared fit to be D/C’ed (discharged), can’t find a place to go. We call her nearest living relative, and turns out the patient in question is a crack adddict; her relatives won’t take her. “She’s your problem; you guys put her in rehab…” Call social work. My brother, a physician of 30 years, once had a group of gang-bangers get brought into the same ER/ED, and from rival gangs! Once they saw the other side there, they forgot all about their wounds and started to rumble again… ’til the cops were called. Or, in my case, a latina whose entire family was killed in an MVA (car crash), and the entire case was on the TV news – but she hadn’t yet been told, and was in recovery from surgery. I had to act like all was A-OK, even though I knew the surgeon was gonna break the news to her. That’s the kind of life we lead. If you have a good doc, nurse, or paramedic, treat ’em well. They earn every penny of what they make, and compassion can’t be bought.

  6. I’m an ER nurse and have worked in a couple of different trauma centers, although none that could compare to what this guy sees in Detroit.

    I really like the way he talks about his job. Also I thought his line (paraphrased here) about “Dealing with death is easy, dealing with the survivors is the hard part,” is really the truth for those in the ER. My own toughest moments have come when *I* had to tell friends and family that someone had died. The only reason that fell to me was because the doctor was dealing with a family member that had passed out from the news. The wails and cries of anguish (and I mean wails) were something that, to this day, still give me the occasional bad dream.

    His lack of euphemisms is also refreshing. No more “passed away” or “expired.” Milk expires, footballs are passed away, people die.

  7. I used to work my way through college in the radiology department of a teaching hospital, and changed out the ER x-ray room images on a regular basis. It’s amazing the things one sees.

    Of course, there’s always the kids who have swallowed things, and sometimes it’s like a game to figure out what the item was, and where it’s lodged. Other times, it’s a little strange or gruesome, like the varied gunshot wounds to the buttocks, thighs, etc. or nail gun accidents, or shattered bones.

    Even stranger still is the “special” file of x-ray copies with the patient’s names blocked out that the radiologists keep around for curiosity’s sake, many of them images of rectally inserted objects…

  8. The note about the doc’s appearance amused me… I met a friend’s husband for the first time last year and immediately guessed he must be a construction worker or some other blue-collar vocation. My husband clued me in later – he’s the head of neurosurgery at a prominent Dallas hospital. Still makes me laugh.

  9. I found it interesting that when comparing real-life to TV, the first thing the reporter mentioned was the doctor’s physical appearance. Is that really the most important difference?

  10. ‘The guys’ dying. . .he’s not supposed to die’

    That trauma surgery is some impressive, heroic shit. It takes a certain kind: I like this guy, he’s the real deal. As a working EMT in San Francisco for the last 10 years I’ve seen some things, but the best I can do is help people NOT to die for a little while; these ER people put. them. back. together.

    Most impressive.

    As a friendly local plug: If you ever get blasted, blowed up or bifurcated on the West Coast, the folks at SFGH do a fine job indeed.

    1. As a friendly local plug: If you ever get blasted, blowed up or bifurcated on the West Coast, the folks at SFGH do a fine job indeed.

      Yes. Do not go to the ER at UCSF unless you have a hangnail and a day or two to kill.

    2. If you ever get blasted, blowed up or bifurcated on the West Coast, the folks at SFGH do a fine job indeed.


  11. It’s really sad to think of all the people who don’t have anyone willing or able to care for them when they are seriously injured. And with the insurance companies being the way they are these people are often sent out on the street, to suffer, maybe to die, or even home alone, because of being poor and having no one they can depend on.

    An injured child sent home on a bus? Probably his mother didn’t have a car and was so exhausted from her own life that “send him home on a bus” was the best she could do.

    Maybe some “real” Christians need to hang out in the ER to help people like that. If such a thing exists.

  12. I found it interesting that when comparing real-life to TV, the first thing the reporter mentioned was the doctor’s physical appearance. Is that really the most important difference?

    Because on TV (and in movies) big guys are either thugs or simpletons, or both.

    1. Tank: You know why they call me Tank, Arch?
      Archie: I imagine it’s ’cause your a great big black bastard.
      Tank: Think Tank, Arch, nothing gets past the old think tank.

      — Guy Ritchie’s RocknRolla

  13. #14/Antinous

    so true.. but then I was really brave and went to Summit Oakland once because I had a nasty lung thing that felt like pneumonia settling in + chronic hypertension…

    I woke up 9 weeks later having been in a coma all that time. Amusingly, they didn’t tow my car out of the Emergency lot until I was awake and had actually seen that it was still there while being transported to another building for an MRI.

    They never did figure out what was wrong with me.

    Bill was $276,000, plus they repaid the cost of retrieving my car. I didn’t pay anything. I think we came out even.

  14. David —

    Would this be the same Charlie LeDuff that came through the minority intern program with Jayson Blair and has been caught making up quotes in New York and in Detroit, and who plagiarized an entire article from another guy’s book (for which he at least had the decency to apologize?)

    Did you learn that in J-School, too, or is that Charlie’s own character peeking through? Or do I have the wrong Charlie LeDuff and there’s two of them writing for the Det News?

    Anyway, I’d click through to the article, but how do I know he didn’t make this one up, or rip it off, as has been his habit in the past?

    You know, in some trades a guy with this level of integrity would have to go find a new trade. Not in politics, law, the academy, or… journalism, though. There’s always a job there for an embezzling bank teller. Lucky Charlie!

  15. “I want juicy watermelon” pretty much summarizes it.

    Consider humane euthanasia.

    But yeah, personality wise, an ER doc is an adrenaline addict.

  16. But America doesn’t need universal healthcare, right?

    And I still have the right to bear arms, right?

    Phew! For a minute there I thought you were taking away my liberties…

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