Crozet Annals of Medicine: Tempus Fugit

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The old UVA Hospital Emergency Room. Photo: Dr. Robert Reiser

I said goodbye to an old friend this month. On October 15 at 5 a.m. the last patient was admitted to the old ER in the main hospital at U.Va. Our new ER opened in a newer building and began caring for patients.

The new ER is about three times as large as the old one and it is beautiful, with floor to ceiling windows in the halls and natural light in many of the rooms. It is sublime to stand at the foot of a bed with the monitors softly glowing and beeping and admire the turning colors of the fall tree-scape just beyond the glass. It is a healing landscape. 

My badge still works to get me into the old ER and I wandered in after the move, curious to see it without the perpetual crowds of suffering patients I had come to expect. It resembled the empty, hastily abandoned buildings of Chernobyl. Beds were half-made, strewn about haphazardly. Monitors were silent, their wire leads hanging in mid-air, the patients they were attached to never to return. It was quiet, which was the most notable change, an absolute silence that was eerie after three decades of chaos and often bedlam.

I wandered around peering into the empty rooms. Here was bed 4 where I once coded a 17-year-old kid for an hour and a half. After 90 minutes of CPR I convinced a thoracic surgeon to put him on cardiac bypass. He woke up the next day in the ICU and asked for a cheeseburger. An ECG machine stood vigil by the bedside, still plugged in but no longer needed.

Here was bed 61, the trauma bay where I had lost dozens of lives. But saved more. The trash was filled with bloody bandages waiting to be disposed of. 

Here was bed 41 where my senior resident Mellissa once waited for the helicopter to deliver a sick trauma patient. He was wheeled in with a bandaged head and an oxygen mask covering his face. He sat up, took off the oxygen mask and asked Mellissa to marry him. She agreed on the spot. It was her boyfriend Roy. That was a long, long time ago and things were more free-wheeling then. We no longer use the helicopters for meet-cute-resident proposals. 

Here was bed 47, the negative pressure respiratory isolation room, where so many suspected TB patients (and worse) had been cared for. During the Ebola scare days, we geared up for several suspected cases here but never had a confirmed case of the deadly disease.

All of these rooms had been pressed into service for the mass casualty event on August 12, 2017, when neo-Nazis tried to tear the fabric of our town asunder. Dozens of casualties filled the ER all afternoon. We repaired most of the damage that afternoon. 

Every bed in the 67-bed unit held memories, stories, and thoughts of departed residents who had spent three of the most important years of their lives here. And I had spent 23 years here.

In some ways it was like returning to your old high school during a summer break. It is much smaller than you remembered and much less complex now that it has ceased functioning. 

Over the past two weeks I have monitored the slow dismantling of the old ER. If you have ever seen a ship-breaking operation, it is much like that. Crews swarm over the corpse of the ship, scavenging items of value before knocking down the structure. First the computers were rounded up. Hundreds of them. Where do they go? Then the old medical equipment. We can’t use it, but it looks like someone is going to. Now just the stretchers are left, but they are being lined up as well. 

Old notices remain posted on the half-demolished walls, reminders to wash your hands or the newest important policy change. 

Soon all remnants of the old ER will be gone and only the memories will remain. Our new ER is spacious and clean and well-lighted. For now, the new space is sterile of memories, but over time it will acquire its own patina of memories. I hope most of them are good ones. 

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