The Doctor Will See You Now

by Cory Franklin

  In 1995 Cook County Hospital occupied the building constructed in 1914 at the corner of Harrison and Wood. (The facade of the partially demolished building still stands.) Other than the operating room, emergency room, intensive care units, and, of course, the administrators’ offices, the old building had no air-conditioning. During the heat wave, the general wards were stifling, and conditions for patients were unbearable. There were no private rooms on the wards, and opening what windows could be opened yielded no relief because the recirculated air was so hot.

  For several days, patients were continuously exposed to oppressive room temperatures that were often as high or higher than the temperatures outside. It was so bad that it was impossible to tell which patients were running fevers. When the nurses took temperatures, virtually everyone had a temperature of at least 100 degrees.

  The two patients who died of heatstroke were elderly, bedridden, and could not dissipate excess body heat and cool themselves by bathing in cold water in the bathrooms as others did. Two other patients developed heatstroke but were transferred to the intensive care unit and survived. Soon afterward portable air conditioners were installed on the wards.

  This was something from an earlier era; while dangerous body temperatures can result from medication reactions, no physician or nurse I knew had ever seen a patient already in the hospital develop heatstroke and die. Since today’s hospitals, including the rebuilt Cook County Hospital, are air-conditioned, it is unlikely this will ever happen in the absence of a power failure (although a decade later some inpatients at Charity Hospital in New Orleans might have developed heatstroke after Hurricane Katrina knocked out the power).

  The role of air-conditioning in preventing heat-related deaths cannot be overestimated. Since 1995, Chicago has had several sweltering summers, but the mortality has not been close to what was seen that July. This is due to greater awareness of the danger of high temperatures and public health measures, including outreach to vulnerable citizens, combined with an effort to provide those at risk with access to cooling centers and air-conditioned buildings. Studies have indicated that mortality during American heat waves has dropped by 80 percent since 1960, with virtually every study concluding the decline in deaths is explained by the adoption of air-conditioning.

  In 2015 more than three thousand people died as a result of severe heat waves in Pakistan and on the Indian subcontinent. Virtually all the victims lacked access to reliable electricity and, obviously, air-conditioning. As one study that examined the drop in American heat wave deaths concluded, “Residential air conditioning appears to be the most promising technology to help poor countries mitigate the temperature-related mortality impacts of climate change.”

  Meanwhile, writer Shubhankar Chhokra pointed out in the blog Hot Air that next door to the pope’s residence in the air-conditioned Domus Sanctae Marthae is the Vatican Secret Archives, where ancient documents are protected in a temperature-controlled environment. Right next to that is the Sistine Chapel, where the Vatican recently installed a sophisticated air-conditioning system to prevent heat, dust, and carbon dioxide from damaging the priceless frescoes of Michelangelo.

  Take note, Pope Francis: such is the revolutionary power of modern air-conditioning. The book of Luke advises, “When you give a banquet, invite the poor, the crippled, the lame, the blind.” Today it might have added, “And so they will be safe, take care the banquet hall is air-conditioned in the summertime.”

  15

  FLIGHT 191 ON A SPRING DAY

  * * *

  American 191 Heavy, you want to come back in? What runway?

  —LAST GROUND TRANSMISSION FROM

  O’HARE CONTROL TOWER TO FLIGHT 191

  THE MEMORIAL DAY weekend of 1979 began beautifully, erasing memories of the record snowstorms that had battered Chicago only months before. The mild Lake Michigan breezes, aroma of blossoms, and trees filled with robins stood in contrast to the snows that turned out to be a footnote to world history. (The heavy snows that winter ended the dominance of the Daley Democratic machine and ultimately paved the way for Chicago’s first African American mayor, Harold Washington, who in turn became the role model for Barack Obama.)

  At O’Hare International Airport, American Airlines Flight 191 was cleared for takeoff, beginning its afternoon flight to Los Angeles. Suddenly, as the massive jet departed the runway, its left engine fell off, disabling critical flight systems. The plane rolled and quickly plummeted to Earth, igniting its full jet-fuel tanks, creating a huge explosion and fireball visible for miles in the azure sky.

  On the ground, the grisly inferno resembled a battlefield after a particularly gruesome encounter. Except for 9/11, the crash of Flight 191 remains the worst air disaster in American history—all 271 people on the plane and two people on the ground were killed instantly. Almost all were burned beyond recognition. That afternoon at Cook County Hospital it was shift change when the head nurse was informed the plane had just crashed. A code red—major external disaster—was called. At the time, we were unaware there were no survivors.

  As the senior resident in the intensive care unit, along with the trauma and burn teams, I had to coordinate the plan for admitting and caring for crash victims. A quick count of available beds indicated we could take fifty critical patients and another fifty less critical patients. We were told to prepare for ambulances and to mobilize staff immediately.

  Fortunately, most of the nurses and respiratory therapists scheduled to leave at shift change voluntarily stayed. That type of selfless response is one of the most gratifying things about working in medicine and typical of how medical personnel respond in emergencies. Everyone went to his or her respective area to ensure there were enough intravenous fluid bags, ventilators, bandages, and other equipment. I rounded up all the available interns. Then there was nothing to do but wait for the ambulances.

  Today hospitals have television sets everywhere—patient rooms, waiting areas, cafeterias. Between Twitter and CNN’s immediate presence at disasters, everyone is in real-time touch with events. But back then, the only television at County was in the office of an administrator who had left early for the weekend.

  While waiting for word of the crash survivors, I felt akin to what I imagine soldiers feel before going into battle—minus the personal danger, of course. A frisson of self-doubt, combined with a touch of frightened exhilaration. What would happen if thirty patients came in immediately? My mind raced. Did we have enough staff? What were they doing at Rush-Presbyterian and Northwestern Memorial Hospital? Could County handle this?

  In less than an hour, the issue became moot. The head nurse announced somberly, “Code red over. No survivors.” For a minute, people stared at each other blankly. Even veteran nurses, used to experiencing death, were shocked.

  It became a typical Friday night. Overdoses, gunshot victims, drunks.

  For me the postscript came two days later when I had to fly to California. By coincidence I was flying American Airlines in the same type of plane as Flight 191. The flight number was close in sequence, perhaps 195 or 197. At the terminal, seeing people reading Sunday newspapers filled with terrible pictures of the 191 crash was quite unsettling. (It was reminiscent of the famous picture of the New York commuter train with every passenger reading the headlines of the JFK assassination.) When we boarded, the pilot announced the flight path would be directly over the still-smoldering crash site. Investigators and emergency vehicles would be easily visible from the plane. To compensate us for having to fly over this horrific scene, the airline offered each passenger a free voucher for a one-way trip anywhere in the United States.

  No one looked out the window during takeoff.

  16

  NEWTOWN PTSD

  * * *

  And the memory dangled over his heart like the sword of Damocles.

  —JOSEPH WAMBAUGH, THE ONION FIELD

  THE AFTERMATH of the 2012 Sandy Hook Elementary School mass shooting irrevocably altered the lives of the victims’ f
amilies. Now the first responders are also suffering profound repercussions. One Newtown police officer has been diagnosed with post-traumatic stress disorder (PTSD); other cases are anticipated. As a union lawyer for the police told the New York Times, “Our concern from the beginning has been the effects of PTSD. We estimate it is probably going to be 12 to 15 Newtown officers who are going to be dealing with that, for the remainder of their careers, we imagine, from what we’ve been told by professionals who deal with PTSD.”

  PTSD, once associated primarily with soldiers, is now a well-recognized syndrome in police officers as well. Years ago, before much was known about PTSD (not a recognized diagnosis until 1980), noted crime author Joseph Wambaugh vividly described a police officer suffering PTSD symptoms in The Onion Field, his superb 1973 book, which was later made into a movie starring James Woods and Ted Danson.

  During an uneventful patrol on a moonlit Southern California night in 1963, two Los Angeles policemen, Ian Campbell and Karl Hettinger, noticed a suspicious vehicle with two men in it. After pulling the car over, Campbell, the senior officer, approached and asked the driver to exit the car.

  Events then took a horrific turn. Campbell was unaware the driver, Gregory Powell, a career criminal, had a concealed gun under the driver’s seat. As Powell exited the car, he maneuvered the gun with his foot, emerged holding the weapon, and quickly subdued the unsuspecting Campbell. Powell, his gun in Campbell’s back, then ordered Hettinger to surrender his service revolver. At first Hettinger refused, but with his partner’s life at stake, he reluctantly gave up his gun.

  Powell and his accomplice then kidnapped the two disarmed officers and drove them to a secluded rural road in an onion field about one hundred miles away. They shot and killed Campbell, but just as they were about to kill Hettinger, a cloud obscured the moonlight, and Hettinger escaped in the darkness and confusion.

  The two criminals were soon captured and convicted, and received long prison sentences. Campbell, married and a father of two young daughters, had a police burial with full honors, including a team of bagpipers playing “Amazing Grace,” a Los Angeles Police Department tradition since his death.

  Wambaugh, a fellow L.A. police officer, decided to write The Onion Field because of what happened to the surviving officer, Karl Hettinger. After the incident, the LAPD was only vaguely aware of the overwhelming guilt Hettinger was experiencing. Police brass sent him to police roll calls across Los Angeles and ordered him to describe the events of that evening, how he surrendered his weapon, and the devastating consequences. Being forced to recount the details over and over simply reinforced his anguish and the feeling that he was somehow responsible for Campbell’s death.

  Depressed and finding it difficult to function, Hettinger was transferred to a less stressful job as a driver for the police chief, but he soon began shoplifting openly in front of people. He stole trivial items he did not need, and his behavior became so brazen he was forced to resign from the police force. He became a gardener in Los Angeles, and before dying in 1994, he relocated to Bakersfield, close to the onion field murder site, an intriguing postscript.

  Hettinger’s tragic circumstance inspired policeman-turned-author Wambaugh, who was quoted as saying,

  There wasn’t anything said in those days about post-traumatic stress syndrome, let alone as it affects police officers. Nobody talked about that, but I was thinking about it, there has got to be a story here. This honest cop is running around stealing everything he can get his hands on. Sounds to me like guilt crying out for punishment. I thought if I ever become a writer, I’d sure like to look into this. . . . Sending that guy to roll calls and making him describe how he “screwed up” that night by surrendering his weapon. That kind of thing was probably more destructive to his psyche than the killing in the onion field. And what nearly destroyed him was the way that he was treated by the police department, but with no ill will and no malice. They didn’t know what they were doing to the guy, it was just ignorance.

  In 2013 on the fiftieth anniversary of the onion field murder, a sign was dedicated near the intersection of the traffic stop in memory of Ian Campbell. The LAPD has revised their procedures, advising officers never to surrender their weapons. Some closure was reached after Gregory Powell died in prison in 2012. (His accomplice died years ago.)

  Shakespeare cautioned us to remember that what’s past is prologue. Today we understand PTSD far better, but the pall it casts never completely disappears. Now that lingering pall is thousands of miles away from Los Angeles in distant Newtown.

  17

  NOTORIOUS PATIENTS:

  THE BOSTON MARATHON BOMBER

  * * *

  The evil that men do lives after them; the good is oft interrèd with their bones.

  —WILLIAM SHAKESPEARE, JULIUS CAESAR

  WHEN DZHOKHAR TSARNAEV, the Boston Marathon bomber, was brought bleeding and wounded into the emergency room at Boston’s Beth Israel Deaconess Medical Center, the staff faced a distressing predicament. How would the nurses and physicians take care of an especially notorious patient, one whose values are inimical to society?

  As one trauma nurse who cared for Tsarnaev during his first night in the hospital explained it to the Boston Globe, “I am compassionate, that’s what we do. But should I be? The rest of the world hates him right now. The emotions are like one big salad, all tossed around.”

  Everyone who treated Tsarnaev will struggle with those emotions for a long time. Every health professional in the emergency room and intensive care unit learns to treat felons, murderers, and rapists. Working in those particular hospital areas generally does not permit staff the luxury of refusing to treat a patient, no matter how odious that person may be. When something like the Boston Marathon bombing happens, the usual approach is to view the offender as simply another patient, just part of the hospital routine.

  While that may be an adequate defense mechanism when caregivers treat most criminals, treating particularly heinous suspects, in this case an alleged terrorist, can be more complicated. For these kinds of patients, many in the public ask caregivers, “How can you take care of that person? Why do you do it?” The short but incomplete answer is it is part of the code nurses and physicians live by. But in reality, caring for patients like Tsarnaev compels even the most hardened nurse or physician to undergo some uncomfortable introspection. As that Boston trauma nurse added, “You see a hurt 19-year-old and you can’t help but feel sorry for him,” yet she said she “would not be upset if he got the death penalty. There is no way to reconcile the two different feelings.”

  I have heard military physicians who cared for enemy prisoners of war express similar sentiments. That internal conflict can be difficult to reconcile when you work in the hospital, especially when you are tasked with saving the life or relieving the suffering of someone who has maliciously taken innocent lives or caused others to suffer. Moreover, the constraints of confidentiality often prohibit caregivers from discussing details outside the hospital about the care they give to a high-profile patient. Not being able to share your feelings about treating the subject of national or international headlines can be stressful.

  One final thing about caring for patients like Tsarnaev: there is something about them that will always be etched in your memory. Doctors and nurses generally forget most of the patients they treat in the course of their professional careers. But not in cases like this. No doctor or nurse at Beth Israel is likely to forget Tsarnaev. Each may have a different memory of some specific detail about treating him, but those details will remain with the workers for the rest of their lives. A physician I knew once cared for a notorious convicted murderer who tortured his victims before killing them. Years later, my colleague was able to describe in vivid detail the fear this murderer had of needles; the irony of a sadistic killer who could not bear the smallest needle for a tetanus shot or to have his blood drawn.

  For me it was the faces. Many years ago, I briefly treated three people convicted of particul
arly gruesome crimes—one was an infamous serial killer, another was a mass murderer, and the third a mother who killed her child. All three, now dead for many years, made national headlines. Even today, decades later, I remember how each would stare at me menacingly when I came near them. It was chilling.

  Things like that stay with you. There is something about certain patients you can never forget, and the Boston caregivers may unfortunately learn that about Dzhokhar Tsarnaev.

  18

  BORN TO RAISE HELL

  * * *

  The Lord saw that the wickedness of man was great in the earth, and that every intention of the thoughts of his heart was only evil continually.

  —GENESIS 6:5

  I HAD MY FIRST REAL EXPERIENCE with evil in the world fifty years ago when I was twelve. In the summer of 1966, some friends and I went to the local news agency, where we were offered one dollar a day to wrap copies of the afternoon Chicago Daily News, ride in an old Pontiac with a chain-smoking delivery guy, and throw papers on the lawns of a new suburban subdivision. Good pay, unless you pitched a paper on the roof of a house. You got one mulligan—the second time you worked for free.