Trauma Mama

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

Ben Taub's ER nurses generally agree they are independent types, that they prefer an unregulated atmosphere and that it is true there is "dysfunction" in their histories. In a way, the emergency room is the ultimate recovery group, and even for the Trauma Mama, there was a period of adjustment.

She still remembers the patient who arrived without a scalp ("That was like, Hello!") and the evening that she removed the sponges and clamps from a dead man's chest, only to look down and see that he wore black wingtips, her father's shoes.

But more patients followed -- tens, hundreds, thousands more. They had all been ripped, bleeding, out of context, and like dead men, people with oxygen masks tell no tales. They became their wounds, and the bullet holes and stabbings became commonplace and forgettable and merged into the process of saving lives. Leandra came to love the process. She never wanted people to get hurt, but only the chance to save those who were. The emergency room she found more "emotionally safe" than other areas of nursing. Unlike, say, watching a cancer patient die, the emergency room is less a matter of developing relationships than of having passionate affairs: "One night -- boom -- it's intense, and it's gone."

Nonetheless, Leandra has become the person on the staff whom returning patients request, the one who will wheel a psychotic outside to ease a nicotine fit, who will drink coffee with the grieving, feed the homeless and hold the hands of the drunks whose odor repels everyone else.

She's the official handholder for the staff as well. Between the more experienced nurses and the more educated young doctors doing their rotations, there's a constant tension, with Leandra in the middle. Usually, she defends her nurses, and usually, the doctors accept it. But when a young doctor who was berating a nurse heard Leandra tell him to "chill," he began exhibiting symptoms of apoplexy.

"You cannot speak to me that way," said the doctor. "I am the doctor! You are dismissed!"

"You don't understand," Leandra replied. "I am the supervisor of this department. I don't go anywhere. And you still need to chill."

There are few who misunderstand who the real boss is in the shock room. When the proceedings degenerate into what one nurse gently described as a "cluster fuck," it is Leandra who calls the room to order. Always, she is there for the doctors with her ego-friendly advice -- offering instruments before they are requested, asking her leading questions. Faced with some wound or ailment they have never seen or imagined, the doctors will suddenly hear over their shoulder Leandra's whisper: "Should we put in a chest tube?"

Yes, that is exactly what we should do: The doctors say Leandra makes them look good, and they are nearly always grateful. When they are not, Leandra repeats her nice questions three times and then says, "Look!" -- this is what we have to do. Stick the tubes in, do the tests, take care of the patient. Several doctors revolted when Leandra brought a man with a boil into the shock room, but then they confirmed Leandra's suspicion -- the man was having a heart attack.

The emergency thoracotomy that she loves so much is performed primarily on the dead, and can there be any greater thrill than bringing someone back from the dead? What the surgeons do is an act of God, Leandra believes. They are men of action, and though she has her occasional battles with them, there is no one, short of God, whom she admires more than a surgeon.

"I mean, think about it," she says. "You have to be a pretty bold soul to open up and invade this vessel, this chalice."

Leandra quizzes the doctors about how they fix something like a transected aorta. She reads the doctors' textbook on Advanced Trauma Life Support ("I'm connected," she confides). When she encountered her first organ donor, she tried to make her cuts not too deep and not too shallow but "just right." And when she held the dead heart in her hands, she said "it was just the ultimate." Leandra closed the cavity with stitches a surgeon friend had taught her.

If she were younger, yes, she would love to become a surgeon, she admits. As it is, her stories are not about surgery but about the struggle for order, so that surgeons may work. Leandra's wrist has been twisted, her face has been spat on, she has been kicked in the stomach and bitten in the breast by a barking man. She has wrestled down a huge woman who was pummeling one of her nurses. She has wrestled down a huge naked man who believed the doctors were trying to kill him. Men have sworn they would rape Leandra; women have vowed to murder her.

But none of it really compares to the emotional trauma. Doctors and nurses have euphemisms for death -- crumping, coding -- that detach them from what it really is. Leandra isn't sure she could do this work if she didn't believe in an afterlife, which means she doesn't really believe in death at all. There is crumping everywhere. You can't grieve every crump, but when the wailing is loud, she said, "sometimes things here scratch your surface."

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