A journalist's eye view of the trauma physician's dilemma.

Abstract

This one yours? asks the nursing supervisor. Does he have a bullet in him? Yes, indeed. Then he's ours, says Garvey, bored. Across the corridor, two doctors and a six-pack of nurses are expending their collective talent on the prone body of a West Baltimore drug trafficker. The electrocardiogram is irregular, and blood is pouring down the gurney and onto a white tile floor. He's not doing real well, the supervisor adds, turning back toward the nursing station in University of Maryland Hospital's emergency room. They're cracking the chest. And to that, Richard Garvey can't hold his tongue. After all, as a veteran detective in the Baltimore Police Department's homicide unit, Garvey has seen this sort of thing before. Night after night, his clients arrive as bleeders at his city's best trauma units—Johns Hopkins, Sinai, University of Maryland Hospital—where the vanguard of emergency medicine attempts to prolong the lives of