You are 17. You know the streets of the wild west side of Chicago. Streets. Guns. Dope. Gangs. It is Saturday night. Your sneakers are on the wrong turf at the wrong time. Or somebody is on your turf. Whatever. Details later. You take five bullets from an automatic. Bam! Bam! Bam! Bam! Bam!
The paramedics swarm. They haul you off this mean street, they load you, drive you and treat you. You are a level one trauma case. They speed you past other hospitals to the naggingly familiar blue awning of Cook County ER.
County. Six ambulance bays. Whirling lights. Dying sirens. Cold air. You are 17 and here. Lying on your gurney you are most people's idea of tragedy. Heartbreak. Some mother's son.
Wounds. Count them. Side of head. Left shoulder. Scrotum. Thigh. Abdomen. Life slipping through the colander that is your body.
In the big warm emergency room you are lifted from the ambulance amid scenes of apparent chaos just like in that TV series.
Paramedics shout your statistics. Blood pressure. Pulse. Gun shot wounds. "One. Two. Three. LIFT!"
A woman with a clipperboard takes your history. Many hands cut your clothes off. The noise abates. People fetch blood, an IV, instruments. You stare upwards. Cold scared. Above a mask you see the eyes of Dr John Barrett. His eyes are those of a man working on a crossword puzzle.
This is a technical challenge, Your body is trying to die. John Barrett's job is stopping that. He's not interested in your story. Were you shot? How many times? See the weapon? What happened afterwards? That's all he wants to know.
Don't shiver. You are not a tragedy to him now. You are a puzzle. He solves you. You made it here alive. You have a 98 per cent chance of leaving here alive. Every two months Cook County will send John Barrett a salary cheque. For many times less than he is worth. You know that now. Welcome to the real ER.
When Michael Crichton was creating a TV series based on the life of an emergency room in a large public hospital, Cook County on the west side of Chicago was the obvious choice as a model. This is that place. No make-up. No lights. No camera. Just action.
Cook County has a roiling river of humanity flowing through its bottom floor. The visitor's instinct is to flee quickly. When they replace this huge, grim institution in two years' time they will halve the number of beds to 464 and build 32 clinics in the community. Just to filter that river.
It was something else, though, which brought Crichton here. County had the first trauma unit in America. The trauma unit takes care of car crash victims and violence victims. Violence brings better storylines. It is adrenalin healing. Cook County Hospital treats more than 1,000 gunshot wounds a year. Nobody is better at the business of bullets. ER had to be set in the marginally altered Cook County General.
John Barrett likes the TV series. Likes the facsimile excitement, the recreation of the rush. He doesn't know about all the romantic storylines, but then he's 54. He doesn't ask. He enjoys the TV medicine.
"A guy comes in. He's stabbed over his heart. He has tense distended neck pains. They can't feel a pulse. I'm watching and I'll say: `My God he has perio-cardio tempinad' and they'll go `oh my God he has a perio-cardio tempinad' and `I'll say quick lads do a perio-cardio synthesis' and they'll look at each other and say `quick do a perio-cardio synthesis'. They get it right. I like that."
They have it wrong with the yelling. Paramedics are pumped and they shout but when the yellow-gowned, double-gloved medics gather, well, if you see 1,000 gunshot wounds a year after 999 of them you are in something of a routine.
They buzz quietly like worker bees. They know the protocols for each wound.
It's like this. Soft voices.
"Do you want an echo done?"
"Yeah. We should. It's in the cardiac box."
And so lives are saved.
John Barrett, dean of this strange place, was born, bred and raised in Turner's Cross, in Co Cork. He went to med school at UCC thinking he'd be a GP working out in west Cork somewhere. A quiet life, a figure in a small community, pass the practice on to a son or daughter perhaps.
A long winding road brought him here. Via South Infirmary, North Infirmary, St Finbarr's hospital, Norfolk, Virginia, and Charity Hospital in New Orleans.
In 1980, after five years working on his fellowship at County he decided that his future was inside this old building which Dickens might have imagined. County had an opening for a trauma surgeon.
John Barrett got the slot. Then, in 1982 Bob Lowe, director of the trauma unit, died young. John Barrett was offered the job. In a way he was home.
Bullets. John Barrett could talk about them for hours. Here's the thing with bullets. You are 17. You don't know this. You still think you can fly.
Bullets have kinetic energy. They fly so quickly and get so hot that they become sterile. They gather some of your clothing and flesh as they enter you, but what the heck.
If the bullet passes straight out through you it still has velocity, energy. That's usually good news for you. You haven't absorbed it all.
BULLETS. On the streets they now have Teflon-coated bullets. Designed to pierce body armour. There's worse too. Black Talons. Bullets scored at the top so the tip of the bullet peels back like claws and rips itself to a stop inside you. You absorb the rip and you take the dispersal of energy when the bullet stops.
The old-fashioned close range shotgun wound is still a horror. Low velocity stuff just 1,000-1,500 feet per second. A nine millimetre whips into you at 2,000 feet per second and a military round at, oh, 3,000 feet per second. Your old shotgun thuds in and the energy, the debris is dissipated inside you.
John Barrett had a guy once. He was shot in the buttocks and through the rectum. They were pulling out pieces of his billfold, his wallet, his drivers ID. Hours it took. Bad, bad stuff.
Lately they are watching for exploding bullets. The tip is hollowed out. Mercury or nitrous something or other put in. The bullet slows. The substance reaches the interior of the bullet. It explodes. Inside you. If you are operating and the damn thing hasn't exploded you will hit it and set it off. They are supposed to be painted red or yellow these beauties. John Barrett hasn't seen one peeking out from a patient's tissue yet, but he has seen bullets fragmented into a million pieces. And wondered.
You are 17 and, baby, you are part of a trend. In 1982, Cook County saw 500 gunshot wounds. The good old days. In the 1980s the typical case was a single bullet wound affair. A low-calibre Saturday night special job punches a nice clean hole impact concentrated in one area. Back then only 5 per cent of those admitted had been struck by more than one bullet. By the time Trauma expanded to become a department within Cook County in 1995 they were seeing 1,000 gunshot victims a year. Twenty-five per cent of them are struck by more than one bullet.
In all the training that he did in Ireland Dr John Barrett saw one gunshot wound. A farmer in west Cork was climbing over a ditch and shot himself in the foot with his rifle. The injury caused a great medical commotion. What to do, what to do.
Here the entire hospital is committed to trauma. Which is nice and necessary. Nobody else wants this business. The big city's detritus. As well as guns and knives, Trauma sees the burns, it sees AIDS, TB, addictions, all the diseases of addiction and neglect. Trauma sees the late presentation of all these.
TB? The badge of the poor is back. Through AIDS, through overcrowding in shelters, through bad housing. The hardy scourge flourishes. Hospital staff are checked once every six months for TB.
"Sometimes," says John Barrett, "I think we are moving backwards in time. In so far as America even has a health system it doesn't work for the people coming through here. From the violence we treat to the people who just present themselves with illnesses, most of what we treat in County is a function of poverty."
TB and guns. The cops take 20,000 or so guns off the streets of Chicago every year. Band-aid stuff. John Barrett wants prevention and education the way lung specialists want the head of big tobacco. He's prepared for the long haul on educating people.
"You have a gun at home you are 30 times more likely to shoot a member of your family with the gun than you are to shoot a dangerous stranger. People think they'll have the gun handy and they'll shoot an intruder. They keep a loaded, easily accessible gun and their kid finds the gun and shoots a friend.
"Automatics. People say they keep them unloaded. But you take the clip out and it leaves one bullet loaded in the chamber. I've seen so many tears over that. People end up angry or drunk or their kid finds the gun. Add in suicides and a gun at home is one hundred times more likely to be used to shoot a friend, a relative. You need this for protection? C'mon."
Apart from the thousand riddled bodies who come through County and the bullets which get extracted in five other Chicago trauma centres, 700 people in this city are killed with handguns each year. Black and poor mainly. It takes white kids in Columbine High to bleed before anybody scratches their head and wonders.
"Even then, it was people saying something had to be done, something had to be done. What was done? Listen, violence is like malaria. Malaria is a disease spread by mosquitoes. If you want to get rid of malaria you kill off the mosquitoes. In medical terms mosquito is a vector. In medicine, a gun is also a vector. The disease is violence, but the gun is the vector. If you control the vector you diminish the disease."
He knows. Back when they were building the regional hospitals in Ireland he hoped to open a trauma department in one, bring home all this experience and knowledge. There wasn't enough trauma to sustain his business. No mosquitoes.
County. This place with its own police force. This is malaria central. Shots are fired. Rival gang members hit the pavement. They arrive in here, through the backdoor, two bleeding kids with their angry loaded posses behind them. Somebody's got to disarm them.
Amid the chaos, cases linger. The fellowship of emergency services is such that everyone hates to hear of a 10-one. Cop down. They'll turn out the lights in the projects and flee. The paramedics walk on minefields just getting there.
ER. Yeah, you have bad cases. Two policemen died on the unit this year. And a woman nine months pregnant with triplets. They lost her and all three babies. The staff suffered for weeks.
"You sit down and go through what we did and find if there is anything we could have done better. This is no place for tough guys though. You are encouraged to talk about these things. No chewing nails and spitting out rust. We lost lives here. We express emotions through a great deal of interpersonal support. We have a crisis intervention process which goes through each member of staff. Don't pretend to be tough around here.
"I've had a lot of successes and good saves but the ones that are always there are the bad ones. A state trooper struck by a car on the Eisenhower Expressway. Both legs and an arm gone. One after the other. I thought we could save each limb. He was left with one arm and the nerves in it were torn. A young man. Married. A young wife and young family. He should have been dead within 24 hours but he took months to die, months where we thought we had done enough. Absolutely terrible. That sticks. We did everything there was, but there are some cases that are that bad."
When they were planning the TV series they came and asked people here for stories. Boy. You sit down with a bunch of ER docs and trauma surgeons and they bend your ears off. Fisherman's yarns. Tearjerkers. Good saves.
County stories. The strangest things for John Barrett are impalement injuries. He likes those ones.
The first one he saw was a construction worker who fell off scaffolding and there was a half-inch diameter bar which stuck up from the ground and it entered through his jaw and came out the top of his head. The paramedics cut the bar with a welding torch and he was not alone alive, he was awake with the tragicomic bar through his head when he arrived in ER.
County stories. Guy walks in with a knife in his heart. As the heart beats the knife twitches. Once they had a guy with a picket fence right through his abdomen. White picket fence. In one side. Out the other. Or the guy with the knife stuck out his back. The moment when they pondered how to lie him down to examine and anaesthetise him.
They don't remove the bullet by the way. It isn't delivered from you like a new born baby. It doesn't come out on tweezers for the ER team to gaze at, solemnly shaking their heads before clinking it into a metal trash can.
Patients ask: Where is the bullet? Did you take out the bullet? Unless it is in a joint or near the skin and is unsightly or likely to cause infection, they won't evict your intruder.
You're 17 and when you leave here you will join the thousands of people walking the west side with bullets in them. The trauma team once got staff T-shirts printed up with the words Did You Get The Bullet Out? Crazy black humour gets you through the nights.
This place was built on a baseball field. Left field was the psychiatric institute. Crazy. That's where the phrase "out of left field" came from. John Barrett will miss this history, this smell of humanity when they move to the shiny new hospital the city is building. Cook County Hospital as it stands seems to suit Chicago, square shouldered old city that it is. Cook County takes left field.
You are 17. One of 22 admissions tonight. They come churning through. All sorts. Another guy with multiple gunshot wounds. A man with bullet to the liver. A gunshot wound of the neck. Another to the back. Several stabbings. Foggy night. Lots of motor accidents too.
YOU are 17. You are shot. You have passed through John Barrett's hands. You are stitched and you are saved. You are moving through the units of Cook County. Life is no TV show, but this is a happy ending. Maybe the only one you will know.
A few beds down is another 17-year-old. He came in on Wednesday. Third time in three years he has been shot. He hangs in the smokey umbra of some gang. A porous wannabee.
John Barrett wants to change your life. How can he? He'd like to say, leave Chicago and go live on a farm in Wisconsin. You are 17, dirt poor, black and beyond schooling. You live for instant gratification and your wound will be a badge next week. Telling you how to change you're lifestyle is the problem.
"Guys like these," says John Barrett sadly "you treat 'em and street 'em."
It is December. Christmas soon. You'll live to see it. There is a bright winter sun bleaching the starchy bed sheets. On the scrab grass in front of Cook County there is a bust of Louis Pasteur. You can see Louis up on his pedestal. John Barrett walks past Louis Pasteur, past his inscription.
"One doesn't ask of one who suffers what is your country or what is your religion. One merely says, you suffer this is enough for me . . ."
John Barrett turns his collar up against to the wind, jigs his coat over his shoulders, hunches into the day. You are 17. Shot. There is a one in four chance that you will be seeing John Barrett again. Under the same circumstances. You are 17. You have no remote control. You can't change channels.