By Craig Schneider
The Atlanta Journal-Constitution
Copyright 2007 The Atlanta Journal-Constitution
ATLANTA — Barreling down the hall of Grady hospital’s emergency room, paramedics wheel a gurney carrying a 15-year-old boy stabbed in the chest.
The boy has a big white dressing over his wound. His mother walks beside him. He’s awake and alert; she’s stunned-silent. There’s no sign of blood.
In the trauma room, Dr. Gary Vercruysse scans the boy’s chest with an ultrasound machine. Blood is filling the sac that surrounds his heart. If too much blood builds up, the pressure will prevent the heart from beating and the boy will die.
“It’s a matter of minutes rather than hours,” the doctor says.
He takes the boy, Terrell Lewis of Decatur, to the operating room, leaving the mother behind. Sherry Lewis’ eyes are puffy from tears. She wipes her brow and clutches her son’s black sneakers and pants to her chest.
Grady Memorial Hospital has the only Level 1 trauma unit serving metro Atlanta. That means the hospital offers the most comprehensive care for the most critically injured people: victims of car crashes, shootings and burns — or a teenage boy stabbed in the heart. It means neurosurgeons and other essential doctors are always here. Not on call, but on site. All that costs a lot, and it is contributing to Grady’s growing financial crisis.
Grady is one of only four Level 1 trauma centers in the state, and the next-closest one is in Macon. Grady’s trauma unit treats about 3,700 seriously injured patients a year. As the bumper sticker says: “If I’m injured in a crash, take me to Grady.”
On this busy Friday night in the emergency room, many patients don’t know Grady is so bad off financially that some experts say it may close in a matter of months, or at least start shutting down some services. Its staggering debt — more than $50 million — and monthly operating losses of $3 million delay replacement of medical equipment, which takes a toll on patient care.
Doctors and staff work with outdated equipment. Many worry that they won’t have jobs soon, that Grady won’t be able to continue its mission of treating the uninsured and poor and that tens of thousands of poor people will flood the emergency rooms of other hospitals.
“We talk about it all the time. I think people are very frustrated,” said Vercruysse, an Emory assistant professor and attending surgeon at Grady. “We’re trying to do a really good job taking care of people. And we feel we produce a vital service that should continue.”
Perhaps more than ever in the hospital’s 115-year history, it needs the support of the powerful community forces — elected officials, clergy, civic activists and business people — who are working to save Grady, one of the largest and oldest public hospitals in the country.
“We don’t want a stopgap solution,” Vercruysse said.
Ready and waiting
On this night, though, Vercruysse is focused on saving lives. The staff expects a busy night. It’s payday and the moon is full on one of the last Indian summer Fridays when the weather’s still warm and the sun stays up into the evening.
Terrell will live. Vercruysse drained the blood from around his heart and sewed up the dime-size hole.
“I feel good about it,” the doctor says.
But that feeling never lasts. “What’s next?”
Boom! A big wooden door to the trauma room bursts open, revealing a man lying still on a gurney, a paramedic on top of him vigorously pumping his chest.
The trauma unit — a flock of doctors, nurses and staff — is waiting for him. With just minutes to prepare, they are in their operating scrubs and have an array of life-saving instruments lined up.
This is what Level 1 trauma is about. Nobody has to be paged or called in from home. A neurosurgeon is here at all hours, ready to treat brain and spine injuries.
The Atlanta man, tall with a little chin beard, has a bullet wound to the chest. Staff cut off his clothes. He has no pulse and is not breathing. Decisions are made quickly.
Dr. Takki Momin, a fourth-year surgery resident at Emory, slices a horizontal incision across the man’s chest, cuts the muscles between a set of ribs and cracks apart the chest bone with a chisel. As one doctor squeezes a bag to pump air into the man’s lungs, another reaches in and starts rhythmically squeezing his heart, trying to restart it.
“Spike two more units of blood,” calls out nurse Peter Roth.
The man’s blood is pouring off the table, pooling on the white floor. A mass of bloody footprints marks the scramble to save him. But it’s too late. The bullet drove through the man’s heart, creating what doctors call an “unreconstructable injury.”
They call the death at 11:03 p.m. His name is Gerald English. He’s 44.
After, Momin draws several medical students close to show them the wounds on the heart. Real-life procedures often become teaching moments, as Grady is the teaching hospital for the Emory and Morehouse medical schools. Grady officials estimate that one in four of the doctors in Georgia received training here.
‘We make do’
Doctors know little of the circumstances that bring people to the Grady emergency room. They don’t know that Terrell Lewis was stabbed on the way home from school, during a fight, his mother said. They don’t know that Gerald English, according to police, was shot during a robbery in front of his southwest Atlanta home, after he hesitated to comply with a demand for money.
In turn, many patients know little of the challenges these doctors face in a hospital that is going broke and can’t afford new equipment.
Doctors talk about the old broken X-ray machine mounted on the ceiling of the trauma room. In its stead, they use a portable X-ray machine that looks like a garbage can with two big wheels, with an electrical cord that retracts like a vacuum cleaner’s.
Other hospitals use digital machines to take X-rays that instantly appear on a computer screen. Grady takes pictures the old-fashioned way, developing film and reading an image against a white light board. That can take an extra five to 10 minutes when time is critical, staff say.
Doctors had to complain to get replacements for what they considered cheap rubber gloves and gowns.
“Some of the instruments [are] low quality and don’t work as they should,” said Momin, the surgeon. He pointed to needle holders used to sew up blood vessels. “But we make do.”
Nor do the doctors know how a patient’s care will be paid for. Only about 7 percent of Grady patients are privately insured. Many have no insurance, and many are covered by the state’s Medicaid program for the poor. Medicaid reimburses the hospital for only 85 percent of its costs of providing care for these patients. In 2005, that left the hospital to cover $144 million, the most recent figure available. The money would have gone a long way to offset the hospital’s losses.
Because of the hospital’s financial shortfall, Grady has been unable to make any significant capital improvements in years, which, according to a consultant’s report this spring, “is now impacting the quality of care.” Immediate needs include EKG and ultrasound devices and CT and MRI scanners, the report said.
‘If it weren’t for Grady’
Dizzy, dehydrated, nauseated, Toby Merritt came to the Grady hospital pharmacy to renew his prescription for insulin, the drug that treats his diabetes. When he arrived, a pharmacist told him he had no renewals left and had to check with his doctor.
For Merritt, a 28-year-old student who lives in Lithonia and has no insurance, that meant a trip through Grady’s emergency room.
Many uninsured people use Grady the way most people use their primary physicians. That clogs up the emergency waiting room and — because emergency room care is so expensive — drives up Grady’s bills and debt.
Doctors in the emergency room discover Merritt’s blood sugar level is 490, approaching a level that could send a person into a coma. Merritt has been in three such comas, the most recent of which lasted eight days in 2001.
Soon, his blood sugar treated and back to an acceptable level, Merritt recovers on a gurney parked in the emergency room hall, a crowded passageway lined with people banged up, scraped up and otherwise in bad shape.
Merritt comes to Grady regularly, and he fears for his fate should the hospital close.
“Oh no — keep Grady. Keep Grady,” he said. “If it weren’t for Grady, I wouldn’t be here.”
Behind the hustle and bustle of this emergency room is a flurry of activity to keep Grady alive. The Fulton County Commission recently sent the hospital an additional $15 million. The Metro Atlanta Chamber of Commerce issued a save-Grady study.
The board that governs the hospital is considering handing over daily control to a nonprofit, community-based group, because that may be what it takes to get financial backing. The state Legislature is expected to consider allocating more money.
None of that matters to Bree Ledford as she drives this night from Douglas County to Grady, because her son was in an accident on his motorcycle. Along the way, delayed in traffic for 45 minutes, she dwells on a single thought: Don’t let it be a head or spinal injury.
Her father died from complications of a head injury after he fell from a roof in 1999 while cleaning gutters.
Her son, Drew Hood, 23, was taken to Grady from Douglasville. For the most part, anyone rendered unconscious in a crash in metro Atlanta is taken to Grady, if only to check for brain damage. When Hood arrived, the trauma unit used a little circular saw to cut off his helmet. Motor vehicle-related injuries make up the majority of emergency room work.
Some believe Grady serves only people in and about Atlanta, but many people are rushed here from accidents around North Georgia.
About one in four trauma patients at Grady comes from counties other than Fulton and DeKalb, the only two that financially support the hospital.
By the time Ledford arrives, her son is groggy and she waits with him for the results of a CAT scan.
“That’s my baby. He’s a good kid,” she says, holding two plastic bags with his clothes and shoes. “He just got out of the Army a year ago.”
Her son will go home the next morning, after treatment for a concussion.
Here in the Grady emergency room, not even happy endings last long before a new drama comes through the door.
Boom! The doors open for a woman flown by emergency helicopter from a car crash in Carroll County. The top of her head is wrapped in bloody gauze.
The trauma unit shifts her onto a table, but they can’t straighten her leg. A bone is protruding. They crowd around her, checking the ABCs — airway, breathing, circulation.
“Her airway’s intact.”
“She has a skull laceration.”
“Are you allergic to any medication?’'