Inside Harborview: An elite emergency team fights to mend broken bodies and minds

THE MALADIES and hard knocks juxtapose wildly on widescreen monitors in the hallways of Harborview Medical Center’s Emergency Department, a menagerie of affliction and suffering that takes your breath away.

Stomach pain and headaches. Psychosis and seizures. Heart attacks, strokes, car crashes, fights and fainting spells — ordinary existence thrown into disarray.

An addict needs rehab. Down the hall, somebody wants to commit suicide. Not far away, the screams of a child who’s fallen out of a window tear your heart out. When the kid’s mom leans in between nurses and doctors and sings sweetly in her little boy’s ear, you want to sing with her.

There are broken bones but just as many broken hearts here, bodies and minds alike in need of mending — victims of neglect, self-sabotage, bad deeds and damned chance.

The Harborview ED is a world unto itself, where the poor and uninsured are guaranteed to be seen and where renowned emergency burn, neurology, pediatrics and other doctors treat patients with special emergencies from as far away as Alaska.

But it’s also a microcosm of the city and region in which it operates. Staff members see society laid bare and in living color, not just our mishaps but our pathology, our hubris, our troubled relationships and our failure to solve social ills, such as homelessness and the neglect of the mentally disabled, before they lead to tragedies.

Unlike other settings in the public sphere where it’s easy to avoid lives that you don’t want to see, at Harborview there’s no looking away from the human condition.

In another bed, a Somali man who says he was attacked and broke his foot at a food line, but walked on it for 10 days anyway after staff at another hospital told him he was fine, curses and groans as doctors squeeze the shattered and dislocated bones to get a better feel for the misalignment.

The man’s eyes are red with wincing discomfort. Then, as the doctors release their grip, a look of sweet relief and even gratitude.

Emergency medicine comes down to this: Life, death and the dreaded and hopeful spaces in between.

Sixty-six thousand people came through Harborview’s ED last year to receive care in the department’s two wards, one for medical emergencies such as strokes, chest pain and pneumonia, and another that handles traumas such as acute abdominal pain, falls, traffic accidents and violent attacks.

With so much activity, this can be a disorienting place, tugging your sympathy from one patient’s misery to another.

Behind one green curtain, a hissing noise like air being let out of a tire — the sound of searing agony. It’s hard to take, if only because most of us don’t want to imagine what it’s like to need to be here at all, to be so dependent on healing hands, to be so naked and prone and outwardly pained in the presence of strangers.

But there Gerardo Ponce De Leon Ayala sits, unclothed except for shorts and gritting his teeth as nurse Dan Ursino gingerly applies a local-anesthetic cream to patches of his back where skin used to be.

The darndest thing has just happened to Ayala.

After parking his car on a steep Capitol Hill street, the car started rolling. He tried to climb back inside and hit the brake pedal but tripped. The runaway car dragged him down the street.

“This is called short-term misery for long-term benefit,” Ursino says to reassure Ayala that the stinging will subside soon.

“You’ll be all right,” Dr. Patrick Maher, who’s on residency at Harborview, adds for moral support.

Ursino coaches Ayala through the pain. “Let it burn,” he whispers after applying some more cream. “Just breathe. Breathe. Breathe. Breathe.”

Ayala oohs and ahs and grimaces like a man on fire, then fans himself with a free hand.

As extraordinary as Ayala’s case may be, though, for Ursino, Maher and company, it’s just another day at the office.

THE 47-BED Emergency Department is the soul of the hospital, where teams of doctors, surgeons, nurses, assistants, anesthesiologists, lab technicians and social workers toil on the front lines of health care.

It is the control center for Airlift Northwest’s quick-response helicopter fleet, as well as the renowned Medic One ambulance service, whose medics receive advanced training to keep patients alive en route to the hospital. It also coordinates the regional medical response during major incidents such as the recent Oso mudslide, keeping track of available beds at different hospitals.

Harborview, while owned by King County, is managed by UW Medicine, so it’s also a major teaching and research institution, where young doctors like Maher can practice medicine in a real-life setting.

The ED also is the only local hospital with a psychiatrist on staff 24/7, which means it’s often the go-to location for psychologically challenged emergency patients.

But as the Northwest’s only designated Level 1 trauma center for adults and children, Harborview is best known as the destination for the severely injured, especially those who are clinging to life. The department saw 5,400 trauma cases last year alone, about 15 a day.

During one “trauma code,” as it’s called, a swarm of about 20 doctors, nurses and technicians with high-speed scanning equipment descends on a patient who has been in a terrible traffic collision. This flood of staff members, dressed in their signature blue scrubs, is referred to as “the blue wave.”

They perform a transfixing series of procedures on the patient, from inserting intravenous tubes to capturing X-rays — so elegant that some describe this stage of treatment as a “trauma ballet.” It gets results. The survival rate for trauma patients at Harborview is over 96 percent, according to the hospital.

To be sure, the scenes that unfold in the emergency rooms can be gruesome. Nothing can prepare the uninitiated for the repeated sight of fractured limbs, swollen faces, bleeding wounds and slumping torpor.

Emergency departments are without romance by design. At Harborview, triage nurses look at the list of patients arriving through the waiting room out front or by ambulance gurney through sliding-glass doors, and coolly decide who gets seen first and last based on the severity of each person’s condition. Waits for evaluations, exam results and operating rooms can last for hours. It can get alarmingly noisy. At busy times, rooms may not come open right away, meaning some patients have to be stationed in hallways.

And yet touching moments mix with the grimness, chaos and frustration. A nurse blows up a blue latex medical glove and gives it to an increasingly fidgety boy during an emergency-room exam. Another nurse streams old-time rock ’n’ roll on a music device to calm a yelling, physically aggressive man who is strapped to his bed and whose head is covered in a see-through mask to keep him from spitting on staff.

A heroin addict sobs in shame for having given in to the drug again. Her medics and the doctor attending to her listen patiently as they work at bedside — shoulders to cry on for a patient who seems all alone.

One afternoon between patient visits, Dr. Niten Singh, a vascular surgeon who specializes in lung preservation, says he spent the previous day performing surgery during a 6 a.m. to 2 a.m. shift that had everything — a gunshot victim, a car accident, an aortic injury.

But under such an intense workload, you can’t let personal feelings bog you down, says his colleague that day, Dr. Gabriel Wallace.

“You have to think about, ‘What do we do medically to fix problems?’ ” Wallace says. “You think about the other stuff later.”

A sudden rush of patients, then calm.

The department is itself like a living thing, its own atmospheric pulse randomly rising and falling.

“We’re all adrenaline junkies,” longtime nurse Katie Purdom jokes one day after a flurry of activity.

“I just think we’re different as humans,” she explains, turning serious. “We can turn on a dime.”

Purdom says she has developed “mother ears,” which helps her perform her own kind of triage to determine whether a patient moaning or coughing in one of the rooms needs help right away or whether they can wait while she attends to more urgent cases.

She agrees that at Harborview, employees have to become specialists in managing not just medical care but emotions — their own in particular.

“You go home, have a big glass of wine and come back tomorrow,” she says. “I don’t mean to sound callous — that’s just the way it is. What if someone else comes in right now? I’ve gotta have my shit together.”

But then Purdom softens.

“Probably the hardest thing is kids, trauma kids that don’t get well,” she says. “It’s hard on everybody. It’s especially hard when you get families back here and you see their reactions. But you know what? You laugh with them, you hug them. And yeah, if you cry, you cry.”

HARBORVIEW OPENED in 1931 as King County Hospital. Prominent Seattle architect Harlan Thomas outdid himself in his design for the building, a 15-story, pyramid-capped, Art Deco structure that rises like a medical Tower of Babel above downtown.

Though surrounded by subsequent additions today, the 246,800-square-foot original building’s grandeur perfectly reflects its outsize role as the hospital of choice, default and best resort for an eclectic patient base.

Medics wheel in another patient, a car-crash survivor who is moaning and bleeding from a deep head wound.

The woman is beside herself. “Oh, Jesus!” “Oh, Jesus!” is all she can say.

A blue wave of about a dozen doctors, nurses and technicians washes over the woman, but her trembling voice searches the heavens.

“Help me, Jesus. Help me, Jesus,” she calls out.

An answer comes.

“Hi,” Dr. Maher says. “I’m here to help you.”

Maher positions himself above the patient at the head of the bed to get a good look at the wound, then gives an assessment of her situation.

She seems inconsolable, scared. Her chest heaves dramatically.

Oh Jesus. Oh Jesus. Oh, Jesus. Help me, Jesus.

It takes a moment for everything to sink in.

Then, at last, “Thank you, Jesus. Thank you, Jesus,” she says.

A few feet away behind another green curtain, injured hiker Viviane deBros rests after some tests and delights in the news that her dad will be flying in from the East Coast to visit her. The day before, the 29-year-old tumbled 600 feet while descending a snow-capped mountain in the Cascades, suffering a broken arm and a mean black eye. A rescue helicopter was finally able to retrieve her the next morning.

It is a wild tale but just then, a Level 1 trauma alert goes out.

Medics in the field will arrive shortly with one gravely wounded gunshot victim, possibly more.

The ED, busy in a routine sort of way up until then, goes into full disaster mode.

Current patients are moved to clear work space. Mobile testing devices are rolled into position, and bags of blood are readied for possible transfusions. Half a dozen operating rooms downstairs are prepped for surgery as white-coated surgeons assemble by the nursing station. Some staff don orange vests, typically worn during major disasters, to make themselves more easily identifiable.

The place is spring-loaded with tension, so loud with medical chatter and patients’ voices it’s hard to follow any one thread of conversation.

In the fog of this warlike scenario, though, some still aren’t sure where the incident happened.

Local and national news outlets start broadcasting details to the outside world: A gunman has opened fire on the campus of Seattle Pacific University, critically injuring at least one and up to several others.

The estimate of possible wounded from authorities at the scene will keep rising as the minutes pass — maybe four, maybe five, maybe six or seven victims in all.

Right now, the exact storyline isn’t important. The crew here needs to be ready for however many victims come through the door.

The ambulance finally arrives.

The doors leading to the driveway slide open and unleash a flood of adrenaline. Medics pushing on either side of the gunshot victim’s gurney literally run toward the resuscitation room.

One team member rides along on the bed, delivering CPR with rapid, furious pumps to the chest, the brute force of one life channeled into another.

The CPR continues as a blue wave of two dozen people maneuver at a frenetic pace.

Maher presides, examining the patient’s wound, calling out orders and checking monitors for positive changes that justify moving forward — a heart rhythm, a breath.

There’s nothing.

Trauma doctors and nurses at Harborview, recognized as among the best in the country, are generally good about concealing joy, anger, disdain and regret behind a veneer of stone-faced professionalism.

But when Maher announces that he can’t do anything further to save his patient, sadness, fleeting but vivid, fills the room. If you blinked, you missed it.

Because additional shooting victims are on their way, staff members don’t get to learn much more than the name of their patient, SPU student Paul Lee.

In the end, Lee, a 19-year-old from Beaverton, Ore., is the only one of three gunshot victims from the shooting to lose his life.

His friends and family will go on to describe him as a devoted Christian who loved to dance like Michael Jackson and do favors for people out of the goodness of his heart. He wanted to go into psychology and work with people who had mental disorders, make a difference.

In the aftermath of the shooting, at the hands of 26-year-old Aaron Ybarra of Mountlake Terrace, who struggled with his own psychological problems, the family set up the Paul Lee Foundation to raise money for programs that focus on mental health.

But for a different twist of fate, Lee might have gotten a job with Harborview’s emergency psychiatry or social-work teams one day.

Ahmed Ahmed, an ED security guard, has watched the Harborview crew work in the face of tragedy and folly again and again, from late weekend nights after last call, when booze-fueled fights and drunk-driving accidents tend to happen, to summer, known around here as “trauma season,” when outdoor-activity-related injuries skyrocket.

“You meet all walks of life here — from janitors to people who are way up there,” he says of patients. “You see people’s lives change in a nanosecond.”

“When I first started here, it put me on edge,” Ahmed says. “You start to think, ‘It could be my family.’ You become grateful for what you have after what you see here.”

No matter who you are, he says, “If you look up and you see one of these people working on you, you’re in good hands.”