I am sleeping and dreaming, and in my dream the phone rings, and then the doorbell a moment later. I think the banging on the door woke me, and the last push of the doorbell echoes through the house. The security truck pulls away from my trailer just as I manage to peer out the front window. I call the ER to find out why security would want to wake me up at 10 p.m. on a Saturday night.
When the secretary answers the phone, the noise in the background answers my question for me.
“We’re having a code.”
“Do you need me there?”
She puts the phone away from her mouth. “Martha wants to come in, do we need another nurse?” I cringe at her choice of words; I left the ER staff nearly two months ago, and I most certainly do not want to come in. I want to go back to bed and enjoy a quiet, three-day-weekend in my latest self-imposed solitude.
There is shouting in the background, and she comes back on the line. “We need help in triage; come in.”
It is cold, nearly freezing outside, and raining. Navajo police trucks, lights flashing, have blocked the entrance to the clinic on both sides. Our contract ambulance company is there; Navajo Nation EMS is there; the ambulances crowd the ER side entrance. A paramedic friend is closing the doors to the rig.
“Biz, what the hell is going on?”
She looks exhausted. “Van roll-over, full of Mexicans. Three are critical in the ER; the rest are in the lobby.”
“Jeeezus fucking christ.” I push the button to open the sliding doors, and once again walk back into my ER.
There is a man strapped to a backboard, in full c-spine precautions on the first bed. Then there is an empty bed, and in the middle bed there is a man covered in blood, and two RNs, dressed in the ‘crash uniform’ of disposable gowns, gloves, booties, and splatter guards, are manually bagging him; he has already been paralyzed and intubated and they are now breathing for him with a little hand pump. Another empty bed; then a third man with an EKG setup stuck to his chest, looking around in shock.
The ER is full of staff. Both night secretaries. The night doc, the backup doc on call. Nurses called out of bed. The pharmacist on call. Extra aides. Security. All of the EMS personnel. The crash cart is open and supplies are strewn across the floor.
I walk over to the last bed, where my old preceptor and a secretary are trying to get a man’s birthday. As I walk up, she says, “Ask him what his birthday is.”
I can’t think of the right word to say; I curse myself for not paying attention in high school spanish. Finally I come up with, “Cumpleanos?” And it’s enough to get the point across.
She sends me out to help another nurse in triage.
There are twelve more illegal immigrants sitting in our lobby, most of them splattered with blood; some with visible injuries, but most of them, astonishingly enough, hardly injured beyond bruises and fright. The oldest is a 46-year-old woman, the youngest is a six-year-old girl. Most of them are about 18 years old; absolutely none of them speak enough English to translate. It is only through the bewildering forces of fate and luck that the primary doctor working this evening speaks very good Spanish, and is therefore able to accurately assess this sudden deluge of patients.
But in triage, we have to make do with my poor Spanish and a lot of sign language.
The other nurse and I check everyone to ensure that nobody is critically ill; then I send her home — it is now midnight and she’s scheduled to work again at 6:30 a.m. Then I start organizing the group in the lobby. One by one I call them in.
“Me llamo Marta. Hablo solamente un poquito de espanol.” They nod.
I hand them a piece of paper. “Escribe tu nombre. Y tu cumpleanos.” I set up their paperwork. Put a patient bracelet on them with their name. Check their vitals.
“Donde te dueles?” Where do you hurt? It is mostly the same — mi cabeza, mi abrazo, estoy nervioso. My head hurts, my arm hurts, I am scared…
Everyone in the lobby now has bracelets and papers. I head back to the ER. It is 1 a.m. The critically ill man has been flown to Phoenix — his left arm was nearly severed in the crash, and was avascular upon arrival. His trauma RN thinks it will be amputated. The man on the backboard is being loaded into an ambulance, also to be flown to Phoenix. He is coming in and out of consciousness; he does not know where he is.
The third man is being prepped to be driven to Tuba City. He has broken his leg, but is otherwise well.
I start working with the secretary to assign patient numbers to each of the twelve immigrants in the lobby, and one by one we call them back to be examined. The doctor assesses them; I can understand Spanish better than I speak it, and he is marvellous. He is kind and compassionate and takes them seriously. He orders them intramuscular pain medicines, he orders comprehensive x-rays.
We will never see the money for these fifteen people; Kayenta will eat this cost. We give them all of our resources regardless.
It is 2 a.m. and now we have the story.
There were eighteen people in a pickup truck with a camper top on the bed — the three coyotes sat in the front, and the fifteen illegal Mexican immigrants crushed themselves into the camper. They had walked from Mexico to the United States; they had walked for three days and three nights across the desert; they had ended this walk the previous evening. Now, as the truck with its flimsy camper headed north – to “New York,” said the immigrants – as they took the curve on Highway 163 near the volcanic stone formation we call El Capitan, the speeding driver lost control on the cold, slick road, and the truck flipped and rolled. The camper top literally shredded.
The three coyotes fled on foot, leaving their passengers bleeding in the rainy dark night of the Navajo Nation.
They are thirsty and starving. The ER staff begin to give away their lunches, their bottled drinks, to ease the additional suffering that hunger brings to these people.
In a lull after the last transport, I drive up to the junction to the Conoco station we call “Mustang” and buy $50 worth of Gatorade, sandwiches, chips, and bananas. I hand out bananas and Gatorade in cups to the immigrants; I hold the sandwiches and chips and juice for the staff who have now been dealing with this trauma for five hours.
At 4 a.m. all but three immigrants have now gone to the local Catholic church for the evening; a place to sleep and rest and wait to see what happens to them in the morning. I don’t know what that will be. One of the aides jokes that the population of Kayenta had just grown by eighteen people.
She was so funny, and the laughter helped us push past a nearly insurmountable language barrier. She habitually reverted back to Navajo; she addressed these people in the language of her own people. Naturally, they understood her Navajo no more than they understood our English. But we taught her two words: “bueno,” for good, and so she walked from bed to bed saying, “Bueno?” to make sure everyone was all right. And we taught her “abuela,” for grandmother, so she would point to herself and say “Bueno abuela!” and everyone would laugh.
At 4:15 a.m. I leave the ER. I come home, turn off my alarm clock, curl up with my cats and try to sleep. I have been asked repeatedly that evening, by the doctor, by the aides, by the EMS personnel, why I don’t work in the ER anymore; I have to sidestep their questions with phrases like, “There were a lot of reasons,” and then change the topic.
It is a good question; it’s complicated; I still can’t bring myself to write about it yet.
But I reflect on that evening, on six hours dealing with the kind of trauma that could overwhelm our little clinic, that could happen, here, in Arizona, on a regular basis now before the fence goes up across our border. And I know that I will always, always come back to the ER in the middle of a rainy night to help.
But I also know that I will never transfer back full-time. And I am content with that thought, and I fall asleep. And dream.