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Last Updated

24 Mar 2003

Source: Washington Post, March 24, 2003

ERs Prepare For Another Battle Front

For Hospital Workers, The Threat Is Personal

By Susan Levine, Washington Post Staff Writer

If a terrorist unleashes nerve gas, a dirty bomb or deadly disease, the front line suddenly will be thousands of miles closer than the swirling sands of Iraq. The troops will wear hospital scrubs rather than desert camouflage.

The battlefield could be just several hundred yards off Old Georgetown Road in Bethesda, beyond a parking lot of bumper-stickered SUVs and straight through the six sliding doors that Suburban Hospital marks Emergency & Trauma. Color-coded adhesive strips already are waiting if needed to handle the chaos of mass casualties: red for immediate treatment, yellow for delayed, green for minor. Gray for the dead.

Michael Polite is among those certain to be in the thick of such triage. Polite is a tall, beefy nurse with the Bible in his Palm Pilot, and these days he finds special comfort in Psalm 91: "No evil shall befall you, Nor shall any plague come near your dwelling."

Maggi White would be on duty, too, especially if terrorists deploy viral or bacterial agents. White specializes in infection control, and ever since the Pentagon was hit, her relatives in rural Pennsylvania have worried about her. "It's important for me to be here," she has told them.

And there would be dozens of others, some up against excruciating decisions. Physician Barton Leonard's wife is seven months pregnant with the couple's first child. At least, he tries to joke, she'll know where to find him. They could be separated for days, possibly much longer, depending on the count of wounded.

"This has changed the rules of the game," Leonard acknowledged Thursday as the ground war began half a world away -- greatly escalating, or so government officials warned, the probability of further terrorism at home. "We'll be practicing battlefield medicine in the ER."

Just like soldiers in the desert, Leonard and his colleagues could be risking their lives by doing their job. The possibility of danger is something their ranks have long known and tacitly accepted: the stranger who shows up with meningitis, for instance, or the gunfire that follows a wounded gang member right into the hospital. Disaster has been understood also, with the larger emergency rooms always prepared for the potential overload of a train crash or building collapse.

But never has their exposure seemed so daunting. Never have the scenarios seemed so overwhelming. Victims infected with smallpox or tainted with anthrax could pose a very personal -- and, perhaps, fatal -- threat to those who seek to treat them.

For the past 18 months, it's all made Suburban's doctors and nurses think hard about what they do and why. Which is, respond in times of crisis. Stay at their posts to save lives. And yet, in a catastrophe exceeding Sept. 11. 2001, would the moment come when they might be forced to pick between work and home? One nurse has a new baby, no nearby family and a husband overseas on the USS Comfort. What is the tipping point of her calculus?

"I'm not afraid of being on the front line," said emergency department medical director Robert Rothstein. "I am afraid of being put in the position of having to make a choice."

The same likely holds true at hospitals across the Washington area, though some won't let their people talk publicly about fears. In the aftermath of the region's back-to-back assaults by airplane and anthrax, the institutions have drilled as purposefully as the U.S. forces advancing on Baghdad. They've organized incident command teams, upgraded communication systems, calculated admission "surge capacities" and collaborated to a rare degree to bolster drug and equipment inventories for the worst-case crises. Their cheat sheets remind them of the signs and symptoms of weapons of mass destruction, including disease horrors they never expected to consider, much less treat.

"We're totally trained and ready," said Ramona Tomallo Bowman, who oversees patient care in the ER at Virginia Hospital Center-Arlington. But given the scale of what could happen, "are we emotionally prepared and ready? Probably not."

For now, none of this is visible to patients or their families. Despite the nation's Code Orange, the hospitals continued last week to deal mainly with routine sickness and tragedy. Thursday afternoon, Suburban's ER was even a little more calm than usual. Most of its 27 beds and trauma bays were empty, the curtains pulled back. Conversations drifted between EKG results and pending cultures. The phones rang only intermittently.

Disaster seemed far removed.

Behind the scenes, however, waits the portable decontamination shower that could handle hundreds of people every hour -- imagine a carwash for humans, with spray washers and blow driers and paper clothes, one size fits all, at the end. A special supply room, where dozens of cots are folded and boxed and head-to-toe hazard-protection suits are available for instantaneous donning, is just down the hall. And one door away is the former registration office that would serve as command center. It could become operational with a couple of flicks of the switches, particularly the computer switches that would connect Suburban to a protected statewide communication system.

Here, disaster looms ominously closer.

Nurse Kia Fennel, 37, who fronts resolve and a quick smile, has vowed not to run from it. "I chose this profession. I knew what I was getting into," she said. "Now's not the time to jump ship."

Fennel has much reason to contemplate her commitment. At home are her husband and their children, ages 11, 14 and 16. The family has discussed contingency plans, and what scares her kids most is being separated if something happens, with Mom caught at work. If they grasp the danger she could face there, they haven't said. Nor has she. "They have enough on their plates. You have to keep certain things abstract."

Yet in the late-at-night quiet, the "hush-hush talk" between husband and wife, the subject of course has come up, she said. The two of them have mulled various situations -- if he and the children had to flee the area without her, how they would keep in touch, where they'd reconnect. But when he moves onto prevailing-wind theories, Fennel can't focus. The thought of what she'd say on a stay-safe-I-love-you phone call pushes her to tears.

She remembers that cloudless September morning in 2001, when she heard the first reports on the radio and immediately headed toward the hospital. Across the street from Suburban sits the National Institutes of Health, and as she got close, she saw that armed soldiers already had surrounded the campus. Then NIH, like the rest of the federal government, evacuated. And it hit her: "They were all leaving. And we were all not leaving."

For Fennel's boss, a gregarious personality named Perry Conticchio, the pressure points are different. He's responsible for the emergency's department's 70 nurses, technicians and clerical workers. He said he feels that responsibility acutely, wonders whether he can protect them.

"It was easy before," he said quietly, hands meshed in front of him, almost as if in prayer.

The risk he might take bothers him less. At 49, Conticchio has seen nearly every kind of death in his career and chanced it himself. He once remained behind with a medically fragile patient as an entire hospital evacuated for a bomb threat. The caller had said the bomb would explode at 10 o'clock, and as that hour approached and passed, the deserted silence was sobering. What else could he have done, though? Those New York firefighters kept climbing the stairs of the World Trade Center. "I don't see a big difference."

As for his wife and grown children, "they pretty much accept that if something happens, I won't be with them." A tiny pause. "And it is very, very hard."

Even the most experienced ER veteran struggles these days. Department director Rothstein, a soft-spoken doctor of 53 and the father of three teenagers, said he wonders where his own threshold lies. Then he pushes the question away, admitting, "I don't want to find out."

He concentrates on what he can determine right now -- the stress level of his staff, its overall readiness. He believes everyone's doing pretty well, all things considered.

"We are as prepared as I believe we can be at this point," he said. "The only thing that can prepare us better is something I don't want to go through."

Staff writer Leef Smith contributed to this report.