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"