While the TV-drama "ER" is perched atop the popularity ratings, its exquisite plots are highly condensed and oftentimes distorted versions of real life emergency rooms, as the show's producers aren't subject to accuracy ratings.
The University's own emergency room, nestled below the hospital's main entrance on East Medical Center drive, didn't bear any resemblance to "ER" last Friday night.
"They try real hard to make the show realistic," said Dr. Joseph Ladika, an internal medicine resident. "It has gotten better - they do some hospital stuff - but it's slightly on the dramatic side."
But the University's emergency room, which didn't harbor any multiple gunshot victims or survivors of mangled car wrecks on Friday, had its own kind of dramatic urgency with a perpetual flow of minor injuries.
It was a little after 6 p.m. and Dr. Mark Lowell, medical director and attendant physician in the emergency room for the past five years, peered up at the white markerboard and checked the status of each patient.
"A one indicates critical condition, two means it's serious and a three means the patient is stable," Lowell said.
Only twos and threes fill the chart.
The center was calm but crowded since almost every room is full. Lowell notices that one of the patients had been in the emergency room for nearly six hours.
"The minimum time for patients is a half hour," he said. "If they stay longer than six hours, then I'm worried."
Lowell asked one of the resident doctors to check on the patient before he ducked into the x-ray viewing room, outside of which is a middle-aged man sat sideways in a bed, hunched over and having trouble breathing.
Lowell turned from the fluorescent panel and said the man's lungs are similar to a balloon trying to inflate in a box filled with fluid.
"We have to remove the fluid without popping the balloon," he said.
While Lowell treats many patients directly, his role is often supervisor to the resident doctors - five of whom were working Friday - which leaves him moving briskly about the emergency room.
Lowell watched as Ladika stuck a syringe into a numbed portion of the man's back and drew the plunger back, extracting the dark yellow fluid as the man squinted.
More of the fluid was to be removed later. Taking it all out at once would be too sudden of a pressure change for the lungs and would do more harm than good, Lowell said.
Meanwhile, in another room down the hall, a young man was lying on his back with scrapes and bruises on his arms and a cut on the side of his neck, after running into someone on his bicycle.
Dr. Mike Lipscond, emergency medicine resident, prepared to stitch up the wound.
While there wouldn't be any traumatic surgeries that night, Dr. Lipscond said that after having a little experience in the emergency room, it's not difficult to develop a blase attitude toward the more gory injuries.
"You get used to it pretty quick," Lipscond said. "It makes you scared at first, but then it doesn't even faze you anymore."
"I think anybody can get used to anything," he said.
But he added that it's difficult for his children to get used to not seeing him for several days at a time - on Friday he hadn't seen them in more than two days.
Dr. Rebecca Stroh, emergency medicine intern, said she has grown accustomed to the social atmosphere of the emergency room.
"I think you get used to the level of criticalness of people," Stroh said. "You do something for someone and you feel good - sometimes the patient is even happy."
Lowell examined an elderly woman complaining of dizziness. The woman's husband grumbled in the corner chair about previous doctors' misdiagnoses and seemed to expect a panacea from Lowell. The woman appeared to be healthy and Lowell politely asked the husband why he brought his wife to the emergency room this particular evening.
The husband said he had no place else to go.
Lowell said many people come to the emergency room not because of a specific problem, but because they can't get help anywhere else.
"We are in a unique position to act as patient advocate for many different reasons," he said. "A lot of the time we can't cure their disease or solve their problem, but we can point them in the right direction."
Trying to help the disoriented woman while mollifying her irate husband appeared to be a diplomatic exercise that can't be taught in medical school.
Dr. Tom Higgins, emergency medical resident, believes some medical schools prepare students for emergency medicine better than others, but said no school can hope to fully train a student for the variety of crises that occur in the emergency room.
"It depends on where you go to school, but in any school, no, you're not totally prepared," Higgins said. "Medical school gives you the undergraduate education. This is the graduate education."
Stroh said residency is where students finally become doctors.
"Medical school isn't where you learn how to be a doctor," Stroh said. "You get acclimatized and learn vocabulary, but you don't learn how to take care of people."
Lowell said most of the injuries in the emergency room consist of students hurting themselves playing basketball, volleyball or roller blading.
But for more severe injuries that occur farther away, the hospital takes advantage of its survival flight service.
JENNIFER BRADLEY-SWIFT/Daily
Paramedics lift a vehicle accident patient from the gurney into the hands of Dr. Whetstone.
Lowell then went into the dispatch room.
Just outside the emergency room and down a corridor is a small room faintly lit by the glow of an electronic panel, a gray TV monitor displaying two helicopters on the roof and the luster of plaques adorning the wall. The plaques are awards for consecutive successful flights.
The University hospitals' helicopter service, which began in 1983, has flown more than 15,000 missions without an accident. The helicopters average just more than three flights per day.
"I like the fact that we are able to take things to other people," said Mary Ingalls, who dispatches the flights. "We're able to do things nobody else does."
But Ingalls is quick to point out the importance of the crew's safety, which she said is paramount, taking precedence over the patient's, because other means of reaching the accident scene can usually be found. Sometimes flights are grounded because of dense fog rising from the Huron River.
Emergency medicine involves an extensive range of people, including physicians, residents, nurses, medical students, paramedics and clerks.
Dr. Michael Roebuck, an emergency medicine resident and member of the survival flight crew, said the whole process begins in the field.
"The concept of emergency medicine starts with the paramedics in the field, in the home, at the emergency scene."
Upon leaving the dispatch room, Lowell stepped into a waiting room to explain to a distraught wife that it would be a while before her husband, who was brought to the emergency room intoxicated, will be allowed to leave.
After explaining to the woman that her husband can't leave until he's sobered up, Lowell headsed back to the emergency room to check on a young man who dislocated his shoulder playing basketball. Lowell relocated the man's shoulder earlier in the night after "consciously sedating" him with drugs to relax his muscles, relieve his pain and allow him to breathe on his own.
The young man, still groggy from the drugs, asked Lowell if he already relocated his shoulder.
Lowell, who had put the shoulder back in place by swiftly shoving his arm upward, said the young man's ignorance of the procedure was evidence of the excellent combination of drugs.
In the room next to the young man a paramedic and a student trainee were about to lift a patient onto a stretcher.
The student, Kelly Wagner, said treating patients at accident scenes is not frightening but extremely exciting.
"I've always wanted to do it," Wagner said. "It doesn't scare me, but my adrenaline gets going real high, especially with spinal and head injuries."
It was 11:15 p.m. and Lowell's shift is nearly finished. Lowell made a few last rounds, ensuring that the patients were stable until the next attendant physician arrived.
"One of the biggest potential liabilities for emergency care physicians are patients who get turned over between shifts," he said. "We don't want anyone to fall through the cracks."
JENNIFER BRADLEY-SWIFT/Daily
University Hospital doctors discuss current patients' conditions and field calls concerning incoming patients.
After checking each of the patients, Lowell removed his coat and unwound in his office. He apologized for the lack of trauma while maintaining that the night was busy. Everyone was treated swiftly, which, he said, is his primary duty.
"When sick patients end up waiting for their care, then I've failed at my job," he said. "When the system fails me, I feel that I've failed, but that doesn't happen very often."
Lowell, who seemed to maneuver his way among the various predicaments with an intuitive grace, said essential traits for emergency care physicians are sharp senses and confidence in judgments.
"You have to be able to quickly read each patient in each situation and count on your first impression, to be able to identify an attitude and ask yourself, 'Why is this patient here?'"
Lowell said he watched "ER" on videotape once for 10 minutes, but decided to quit watching because the people in the room kept stopping the tape to ask him what the medical terms meant.
While the University's emergency room isn't as dramatic as the TV show, there is drama to be found in treating the various mundane injuries and in the persistence that each staff member gives in performing their jobs.
"It's not Hollywood, but it's fun," said Lowell.
JENNIFER BRADLEY-SWIFT/Daily
Rita Armand observes her husband William as they wait for a doctor to check William's possible leaking anuerysm.