Trauma Mama

Leandra Vilardi works at the city's busiest emergency room. She only wishes it were busier.

The assistant head nurse stared through the trees outside Ben Taub, waiting for the lights and the sirens to bring something to do. People die, she said. You have to accept that. You only hope the dying will arrive on your shift.

This was not the case at the moment. Sipping coffee and puffing a cigarette, she blamed the calm on the cooler weather. She blamed it on that fraction of a moon. And then, as she does when there is nothing else to do, Leandra Vilardi put down her cup and began dancing the Trauma Dance.

Iiiit's toooo quiiiiiiiiiet, she chanted, spinning slowly, quietly, around and around. It was somewhere between a rain dance and a war dance, and she danced it until she thought the trauma gods were listening. Just as she finished, the announcement came: "Surgery shock, code three, GSW to the abdomen, one minute out."

Leandra smiled. "See? It's happening!" she said, and she hurried off to prepare the reception.

The patient arrived with great fanfare, a black man without identity or story, with

only his red life spilling onto the floor. Six people lifted him onto the table in the shock room and about six more cut away his clothes and pride until he lay naked and bleeding under the light. There was more to this man than a gunshot wound to the abdomen; there were 16 gunshot wounds over the whole of his body. What made it worse, he was still conscious.

"Sir," said the doctor, "I need to do a rectal exam."
"Sir, I need to put a catheter in your penis."
"Sir, we are going to have to make an incision down the middle of your abdomen and fix anything that is wrong. Sir, you will probably need blood, which means the risk of hepatitis and AIDS -- do you know what hepatitis and AIDS are, sir?"

Beneath the oxygen mask, the man nodded and grunted. Then he felt a hand on his forehead and saw the face of the assistant head nurse, smiling down.

"Ya okay, honey? My name's Leandra. We're going to do a lot of things to you, but we're going to save you."

The nurses in Ben Taub's emergency room could work in any war zone in the world, says the chief of staff, Dr. Ken Mattox, but there is something special about Leandra. She has "this uncanny sixth sense," he says, "a good nose for trauma, even before it occurs."

This summer, when the county allotted no money for raises at Ben Taub for the fifth year in a row, ten nurses in the emergency room quit. Leandra had trained many of them, and she trained their replacements, too. The younger nurses say things like "She's it" and "She's God." And an old-timer said, "Don't put my name in there. It would be like I want to suck up, and I don't. I just love Leandra. I'm so fed up with this place I'd leave if not for her."

Years ago, Leandra herself left Ben Taub for a better-paying job in a post-traumatic stress disorder clinic. Then she realized she missed patients who were actually bleeding, and she came back. After that, Leandra was tagged the Trauma Mama, and Trauma Mama has been in the emergency room for ten years so far, working only nights and weekends in order to receive the bulk of the wounded.

Her hobbies include shooting guns, riding Harley-Davidson motorcycles, crying during sad movies and harvesting organs. Two years ago, the first time she removed skin, bones, veins and vitals from a corpse, Leandra couldn't believe what she had just done. She rushed to the bathroom, fell on her knees -- and thanked God for the opportunity.

Perhaps the only thing that thrills her more is an emergency thoracotomy. "Oh, man," she says, slapping her knee, "if you want to see someone excited on a date, let's go crack a chest together. I'm yours the rest of the evening!"

It is the most aggressive lifesaving measure there is. At Ben Taub, emergency thoracotomies are done only about 20 times a year, when the patient actually expires in the shock room. Off goes the shirt, and out comes the Gigli saw. The doctor slices through the sternum, until, like the hood of a car, the left side of the chest is lifted, and the mystery of life isn't a mystery any more but a broken machine. Beneath the lungs, the heart lies flaccid, pale and dead. The doctor reaches in to pick it up and, with the movement of gentle applause, he massages it. If he's lucky, and the patient is very lucky, the heart regains color and purpose.

"It's awesome, man!" says Leandra, but it's rarely successful. Usually, the patient dies, and Leandra is left alone to prepare the body for the family. "How many people," she wonders, "have touched a human heart?" and often, she reaches in to do that. Kidneys and livers are okay, but without the heart, as she puts it, "you're not going to be perfusing to your other organs." The heart is the clock in the emergency room. The heart is life. Leandra has fallen passionately in love with the heart, and if you understand this, perhaps it doesn't seem so curious what her colleagues say -- that in one of the world's most respected emergency centers, Trauma Mama is the best nurse because of her interest in life.

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