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.
The first time she ever experienced death -- real death and not just the rumor of it in Spain or Israel or among distant uncles and aunts -- Leandra was nine years old.
She was told her mother had cancer, and Leandra built an altar out of shoeboxes and candles. In their Bridgeport, Connecticut, home, Leandra charged her Italian relatives to pray there, and then she pedaled to the church with the money, lighted more candles and prayed more prayers. Leandra bought her mother grapefruit and chocolate. She played the piano for her. She did what she could to provide comfort, and when her mother stepped out of the shower after the mastectomy, the girl came forth to kiss the scar.
She was enraged at God when her mother died -- "like if I knew where he lived," she says, "I would have ripped him off." God had ignored her, her mother had left her, and when her father the salesman sent her off to a Catholic boarding school, Leandra felt completely abandoned.
There proceeded a long, slow spiral, during which she sniffed glue ("I absolutely loved it!"), flunked out of two boarding schools ("He wanted me to be a damn debutante"), became a "full-blown hippie," went to Woodstock, formed such bands as Wisteria and Moonchild and hit the road for California to become a famous musician.
At this point, Leandra's story becomes a classic down-and-out recovery tale. The Laurel Canyon exit had a nice "vibe," and so she pulled her Dodge Maxi Van off the freeway and became a part of Los Angeles. During the day, she worked as a laborer, a janitor, a truck driver. At night, she played her music, drank and did cocaine with her friends. Then she began drinking and doing cocaine without them. Then she just drank and drank. Her hands began to shake until she could no longer play music, until she lost her job and had been evicted from her apartment. At "the righteous bottom," she woke up on some friend of a friend's couch one morning, searching for a way out.
If she sliced her wrists, she thought, she might botch the job. As for a gun, there was always the chance of surviving a gunshot. As for pills, they were expensive, and the people in the emergency room might pump her stomach and waste them.
So Leandra found a hose and retreated to the only thing she had left. Her trusty Dodge Maxi Van had brought her this far, and maybe it could take her just a little farther, to some remote, beautiful place in the mountains where she could simply cry herself to sleep. Leandra closed the door, put the key in the ignition and....
Nothing. The damn thing wouldn't start. Hallelujah! The battery was more dead than she ever wanted to be, and Leandra took it as a sign that she wasn't supposed to die at all. That night, she went to Alcoholics Anonymous and confessed her sins. She went twice the next day and the day after that and on the many, many days that followed. In the recovery group, she found the family at last who understood her. She recovered her faith in God (though not in the Catholic God), and she revived one of the few goals she had ever had.
Scraping by as a housepainter, Leandra enrolled in the nursing prerequisites at a junior college. Like her music, nursing was a way of giving, she believed. She aced her courses, and after a year, she went to visit the University of Southern California. The tuition figure they told her had far too many zeros, and Leandra returned home in the kind of despair that would formerly have resulted in a good drunk.
Then the telephone rang. It was the University of Southern California calling to offer a full scholarship. All she had to do, they said, was show up at the orientation tea on Monday. Leandra threw down the phone and rushed out the door. At the blood bank, she opened a vein and sold her platelets for $60. At the department store, she picked out something nice to wear to tea.
During the next few years, she always feared she would be discovered as a fraud. It never happened. For the first time, she embraced The System and became a part of it, and when she did her emergency room rotation and encountered a man charred over 90 percent of his body, it was her preceptor who began vomiting, and it was Leandra who held her.
In the emergency room were chaos and desperate need and not least of all, adrenaline. "It was like, love," said Leandra, and everyone told her, "You want to do trauma? Ben Taub's the place."
The hospital is one of two serving a million of Harris County's poor. Its emergency room is among the busiest in the country. During Leandra's time, there have been five shootings, one of which left a bullet hole in the admitting desk.
"Those who are turned on by being there," said Dr. Ken L. Mattox, "by being at the cutting edge, they then find themselves professionally stimulated by this environment."
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."
It happens most commonly with the death of children. In a dim room with peach walls and a painting of trees and sky, Leandra leaves the body and brings the parents. There was a Cajun man who was blown apart when he found his son here. He roared and staggered back out. He ripped off his shirt and crunched down on his teeth. He began spitting his teeth "like Chiclets" at Leandra's feet.
So there is a toll to this work, and Leandra tries to protect herself. She has learned that those who have been shot with a nine-millimeter bullet usually arrive alive, and when she bought her guns, she made sure to get something more deadly. Leandra keeps her two 40-caliber revolvers loaded with a "badass bullet" called a Golden Saber, which opens upon impact and claws a large hole through the target. "You can't let fear paralyze you," she says, and with her gun, she is not afraid of crime.
She finds truth in cliches, particularly the one about living today because you may die tomorrow. "I had a great trike, man," she says, smiling. Her Harley had extended forks, mini-ape bars and a "badass stereo system." Riding it gave Leandra a sense of freedom, until it was totaled a few years ago in a wreck that almost killed her.
She is building a new Harley, but for now, when she can, she derives the same feeling from drifting deep in the water. When her scuba equipment failed in Cozumel, she nearly died again, but she had swum with groupers and moray eels and barracudas as big as her desk. "I got to experience something," says Leandra.
She lived fast for a long time, and then about two months ago, when she was simply sitting in the car at the post office, Leandra's own heart began thumping wild and fast for no reason. There was nothing she could do to control it. She felt a shortness of breath. She rushed to the emergency room.
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Her friends, the doctors, gave her medicine for arrhythmia and referred her for more tests. Leandra ignored them. She doesn't take her medicine because "pharmacology's a racket," and she hasn't scheduled her tests because she is afraid. Leandra would prefer that her heart keep its secrets. The end that is hardest to face is her own.
The patient with 16 bullet holes was patched and saved, and after that, the night improved. Another man arrived who had been shot in the throat, and then came a hit-and-run victim whose scalp had been "degloved" and whose leg was attached only by flesh.
There were television cameramen peering into every ambulance, and this was always a good sign. Leandra said she was happy.
"Come on, lady," said the security guard, "I want a quiet night!"
"Ah, people in hell want ice water," said Leandra, and walked on.