The Washington Post Magazine

Story by Steve Vogel
Photographs by
Michael Williamson

The Washington Post
Sunday, January 4, 1998

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The D.C. Council voted to sever government ties to the hospital.

People may

think they

know what

goes on in

an emergency


D.C. General,


not only

confirms what

we suspect.

It stretches

what we


D.C. General: Where Miracles Happen

Livingston removes handcuffs from a patient.
Greg Livingston removes handcuffs from a patient.

"At the moment, we're in full swing," Greg Livingston is saying, standing in scrubs and gloves and face mask and shoe covers as he waits to see what exactly will be coming his way next.

It is the middle of the night at D.C. General, a hospital that that by one ranking is among the better hospitals in the country, and by popular perception is among the scariest. Already, the trauma team, of which Livingston is a part, is busy with a shooting, a beating and a car crash, and now, coming through the ambulance bay doors, motionless on a stretcher, bleeding from the face, neck and back, is what Livingston has been anticipating since he was hurrying by the nurses' station a few minutes before and picked up the phone, which had been ringing and ringing unanswered because none of the nurses had time to grab it. It was the fire department, saying the next one coming in would be a stabbing.

"Put your arms on your chest," one paramedic is saying to the victim as he pushes the stretcher toward the trauma team. "He's too high to do anything," says the other para-medic. "He's not going to cooperate."

The trauma team surrounds the man, preparing to hook him to an IV and take X-rays. His chest isn't moving. "How about breathing?" the doctor on duty says into his ear.

The light in the room is bright, uncompromising fluorescent.

"Hellooo. How about breathing?" the doctor repeats.

The air has a sweet, sickly smell.

"How about breathing?"

The chest moves.

"Okay," the doctor says. "We're going to take some blood," and with that Livingston, whose title of trauma technician means he does just about everything, which is why the dead of night is when he feels most alive, pushes a needle into the man's leg. "Relax," he says to the man. "Relax," he repeats, while, behind him, a nurse is asking the patient questions: "What's your Social Security number? . . . Have you been here before? . . . What's your date of birth?" There are mumbled replies, incomprehensible.

The X-ray is put up on the light board, showing that the injuries, though serious, aren't life-threatening after all. "It looks good," is the doctor's pronouncement. He and the rest of the team finish stabilizing the patient and move on to more pressing duties -- and though on TV such encounters can seem the stuff of drama, the reality of this one is less of drama than of routine.

Even when, as if on cue, a police detective shows up to tell the man that there's been an arrest in the case -- his girlfriend.

Which causes the man, suddenly alert and speaking clearly, to say, "She didn't do this, sir."

Which causes the detective to just about sneer, "She's going to jail."

On TV, maybe this is dramatic; in real life, it leaves Livingston disgusted.

"True love," one of the paramedics says.

"Something stupid, " Livingston says. "No matter what the excuse is, it's always something stupid. Bottom line."

'This is like going to a war,' Greg Livingston says. 'That's the best thing I can compare it to.'

Stupid -- and never-ending. That's another thing Greg Livingston knows, and one thing more: There is no other place in Washington like the trauma center at D.C. General.

People may think they know what goes on in an inner-city emergency room -- a succession of crime victims, accident victims, attempted suicides, drug overdoses, stroke victims, heart attacks, broken bones. What goes on in D.C. General, though, not only confirms what we suspect, it stretches what we can imagine.

There is a strong room in the emergency area that has been divided into three tiny jail cells for use by the police because, on most nights, so many of the trauma center patients are under arrest.

There is another room, used as an office by homicide detectives, because so many patients turn out to be murder victims.

There is a black book, labeled DOA, on the counter at the nurse's station for recording the names of the dead-on-arrival.

Charles Rukus, a medical student, performs a heart massage.
Charles Rukus, a medical student, performs a heart massage.

There are, among the living, assailants and victims who are often treated side by side, which sometimes leads to confrontations solved by police officers drawing their guns to calm things down -- a sight so commonplace that hardly anyone takes notice by flinching or ducking for cover.

Add to this the out-of-control drug addicts who are cursing and soiled and have to be restrained; and the out-of-control patients brought in for mental observation, like the elderly woman on a stretcher one night who keeps calling out, "You better pray to God, because Satan will make you die in your sleep"; and the prisoners who are chained together in groups of three or four; and the police officers milling about who are from the District and Prince George's County and the U.S. Park Police and Amtrak and the Smithsonian force and any other department in the city, no matter how obscure; and the 125 walk-in patients per day who routinely wait five hours, eight hours, even longer to be treated in between the code yellows; and the result is the busiest trauma center in the Washington region and one of the 10 busiest in the United States. In a typical year, the hospital treats about 2,000 major trauma cases -- the bulk of serious trauma in the area by far -- including, in 1996, 523 gunshot wounds and 370 stabbings. Additionally, 16,000 less serious emergencies are treated, which is another way of saying that every day, and every night, in come people for treatment of their ulcers and diabetes and stomachaches and dizzy spells because they know of nowhere else to go; in come people looking for free medicine, free food, free shelter from cold weather; in come people shot in the mouth, clubbed in the ear, sliced in the throat, stabbed in the heart.

It used to be that most of the trauma was confined to weekends. Then came gangs, then came drugs, then came automatic weapons, and "now you never know," says Livingston. "It can be any night. You can have a quiet weekend and a hell of a week. Or just a hell of a week."

"D.C. General -- Where Miracles Happen Every Day," says the sign that greets those arriving at Washington's hospital of last resort.

"We never turn anybody back," says Praxton Simmons, a nurse. "Never ever."

"I have been hit. Spat upon. You have to have the patience of Job," says Paul Oriaifo, a trauma surgeon.

"What I'm doing here, if I was still a corpsman, would be working in what we called a BAS -- a battle aid station," says Greg Livingston, comparing the trauma center to his experience in the Navy. "This is like going to a war. That's the best thing I can compare it to -- it's like going to a small-scale war."

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