She heard the screams first.
Dr. Morgan Eutermoser was working another shift in a seemingly endless gantlet of them during the pandemic at the Denver Health emergency department, where she is an attending physician. Her N95 mask dug reassuringly into her face.
It was late summer — usually the high season for trauma cases in the hospital’s emergency department, the busiest in the city. But the usual patterns had warped in the pandemic. Blunt-force trauma, the kind caused by car crashes, had fallen dramatically in the spring. But penetrating trauma, the kind most typically associated with violence, had increased at the same time and never let up.
Almost every day was now a bad day.
And, then, the screams.
Eutermoser was standing in a patient’s room near the ambulance bay doors when she heard them. She ran into the hall to see a woman holding a bleeding child.
“She’s been shot!” the woman shouted.
Security guards scrambled to screen the pair. The emergency department’s biophone — used by paramedics to call in cases as they race toward the hospital — blared its loud ring. As Eutermoser tended to the child, her cellphone beeped. More victims were on their way, all wounded in a drive-by shooting at a park.
A trauma surgeon arrived. Another attending physician took up a post at the ambulance bay doors to triage patients as they came in. They made a plan: Tourniquets on everyone.
And then, within a few frantic minutes, patients stabilized. Within hours, the emergency department calmed. Soon, her shift ended, and she handed off duty to another doctor.
Eutermoser packed up her things and drove home — another day of work completed. Another long night ahead.
“I don’t process it then,” she said. “I don’t process it when I’m in the ED. I’m just working. And then I go home and it becomes a whole other … I don’t know, you just feel alone.”
A surge of violent trauma cases
This past year has been brutal across the medical profession.
Surges of coronavirus patients frayed resources and emotional reserves in hospitals. The need to wear masks and other protective gear nonstop left visible bruises. Doctors and nurses talk openly about burnout.
But the year has also brought another strain to the Denver Health emergency department. The city is in the midst of a wave of violence, one that tracks with a nationwide trend of increasing homicide numbers. The emergency medicine doctors at Denver Health believe this is likely tied to the stress of the pandemic.
While the overall number of trauma cases coming into the ED in 2020 was little changed from 2019, the cases that did arrive were so much more traumatizing — even for the staff of a hospital that once carried the dark-humor nickname “the knife and gun club” for the number of violent injuries it treated.
The rate of penetrating trauma cases — think gunshot wounds and stabbings — increased 8% in 2020 compared with 2019, said Dr. Ryan Lawless, a surgeon who is the hospital’s trauma medical director. Cases linked to domestic abuse rose 77% in 2020. Cases tied to “non-accidental trauma” — a category that most frequently involves child abuse — rose 267%.
The hospital uses a system called Injury Severity Score to grade how badly wounded its patients are. Anything above a 15 is a high-severity injury, one more likely to cause death or long-lasting impacts. In 2020, the number of high-severity injuries treated at Denver Health rose 12.5% over the hospital’s five-year average.
Sometimes these came from high-profile incidents. Lawless was on duty the day a car drove into a crowd of demonstrators during a protest in downtown Denver. By the end of his shift that day, the emergency department’s rooms were filled with both protesters and police officers.
But, more typically, the cases that arrived were ones the public never heard about and ones that hospital staff will never forget. Lawless described doctors sometimes treating multiple patients with gunshot wounds per shift — “too fast, too soon, too much,” he said.
“It just seems during the pandemic like everytime you came in it was something else,” he said. “It was another tough night.”
To cope, hospital staff have formed informal support groups. Doctors call one another on their drives home to decompress. Lawless, who typically goes on a run when his shift ends, will invite colleagues to come along. He tells staff that it’s OK during the day to take a few minutes to sit in the ambulance bay and cry.
But that’s not always enough to shed the heartache. This past year will leave permanent marks.
“It’s not easy to tell a family member that their 14-year-old shot themselves in the head,” Lawless said. “And we can’t tell them why. And we can’t tell them he’s going to be OK.”
“I can’t stop this from happening”
Rarely does Eutermoser ask why.
That’s not for her to know, she said. She doesn’t need to hear the backstory of how a patient ended up in her care — not unless it’s required for the patient’s wellbeing. It’s just not her role.
But she does wonder.
What is happening in the world that has brought such sadness into the emergency department? What can be done to stop it?
Both she and Lawless said the trauma they are seeing almost certainly must be linked to the pandemic.
“It’s from quarantine, which is the correct thing we should be doing,” Eutermoser said. “It’s from COVID. It’s from the changes going on in everybody’s lives. It’s from the loss of jobs. … Everything is changing in the world. No one thinks they have control, and in that situation people do things they might ordinarily not.”
But that understanding does little to make the surge of cases easier to bear. Instead, it’s like tidal waves crashing over the hospital, knocking the staff to the ground. No sooner do they stand again then in comes another wave. There is no way to make it stop, no resolution, no closure. Just waves.
“You go home and you sit with yourself and you say, ‘I can’t believe this is happening,’” She said. “And I can’t stop this. I can treat it, but I can’t stop this from happening. And that’s the part that keeps you up.”
Hope for a better normal
By early this year, Eutermoser said a sense of routine had begun to settle over the emergency department.
She wasn’t sure if the numbers had actually started to go back down. In fact, she said, it felt like the hospital never saw its usual winter lull in violent trauma cases. But somehow it now felt … typical?
“This is becoming normal in our heads that it’s not just a summer thing anymore,” she said earlier this month. “It’s an all-the-time thing.”
The stresses of the pandemic had become numbing in so many ways.
She no longer minded wearing a tight-fitting mask all shift long. She was grateful for it. She and the rest of the staff had better figured out how to make them comfortable, how to take them off and put them back on safely, without contaminating them, so they could eat and drink. And this was the first year in a long time that she didn’t come down with a bout of gastroenteritis after coming into contact with so many sick patients.
She had also come to a kind of truce in her emotions toward people who aren’t taking the pandemic seriously — people who include members of her own extended family. Early on, she had been inclined to push back when she heard a family member say the coronavirus was no big deal, just medical hype and media hysteria.
She thought: There are people dying in my hospital. How can you not believe me?
When she would tell relatives about all the trauma cases and the possible ties to pandemic stress, she felt almost accused by their response. They blamed the rules designed to protect public health — rules intended to keep her emergency department from being overwhelmed; rules she supports.
But, gradually, she began to believe that she couldn’t make people understand her experiences, not if they haven’t seen what she has.
“At this point,” she said, “I just say I live in a different world.”
And she has even begun to allow for hope.
Coronavirus vaccinations are rolling out across the state. With that, the public health rules are starting to loosen. The economy is slowly rebounding. Schools are reopening to in-person instruction.
There will be much to reckon with in the months to come, she knows. But maybe, also, there will be better days ahead.
“If we can start getting people back to a more normal state, I’m hoping we’ll see the trauma numbers go down,” she said. “That’s my hope that we’ll see, that people will feel better.”
She seemed almost surprised by her own words, an expression of optimism after such a dark year. So she added: “I’m a half-full kind of person.”