07/26/2004 02:01 -0500 GMT

An Emergency Chapter

I remember a UCI medical school admissions office administrator telling me back more than a dozen years ago, "It will take a miracle for you to get into medical school."

But I believe in miracles, I thought, but didn't say.

She was right though. A dozen years ago, I wasn't ready. I was a lost kid, without a prayer of having my goals and priorities organized enough to study web design, let alone something that affects others' lives.

So I started some work in a trauma center in southern California. I was fortunate, really. The luck of the Irish smiled down on me like the sun and good rains on a green plot of land. Of 70 applicants, two of us were accepted to serve as EMT-1, "senior trauma technicians" at the University of California Irvine Medical Center (UCIMC).

At UCIMC, I tasted many of the problems that face medical care in a first world, uninsured, dramatic, language-challenged, poignant, night-shift, 12 hour shifts at a time manner of learning. I came in early and stayed late. I worked 16 when necessary. I resuscitated gunshot wound victims, stabbings, cardiac and traumatic full arrests. I monitored births, and placed my gloved hands, first touches, on two new human beings. I saw AIDS patients, both conscious and already gone, abused and respected in that ER. I saw remarkable addiction behavior. I tended wounds, splinted fractures, catheterized, phlebotomized, assured, communicated, stocked, prepared, observed, reported, and became a man.

I witnessed death firsthand. I recall a gunshot wound victim with a large caliber hole in his left chest, but he was sitting upright and talking. He was positioned horizontal, and then he crashed. We cut his chest open, performed open heart massage, and despite all efforts, could not revive him. What was going on in the periphery was perhaps the most memorable.

We were approximately 15 working on this individual. But included in our number were police from four cities, with guns drawn and their feet ensuring that the doors shutting the two entryways into the trauma bay were closed. Our patient was shot by a gang; it was the bloods and the crips, was all I knew. As we squeezed his heart to try to restore blood flow, unfortunate hoodlums from two factions were arriving at the hospital to either ensure the job was finished or to offer support to their fallen comrade. Some saw that their friend was OK when he arrived. So when word of his death trickled out, anger flared.

That week, I went with my father to a uniform store that sold bullet-proof vests, where Dad bought me a lifesaver. Medicine can be a contact sport, and one must take precautions.

Let me take you through a few more snapshots of my experiences at UCIMC, then I'll shift frames and lead you a step closer to where I am today.

I remember an AIDS patient dying in a trauma bay in the early 1990s. When he expired, a resident said, "Let's take care of some real patients." That felt wrong to me.

I remember a young guy who was in a horrible motorcycle accident. He lost his left leg above the knee. The leg wasn't so much lost, because the medics brought it in a plastic bag. I had no gloves, but pressed 4x4s against some of the bleeding.

"I really need to get some gloves on," I said.

"Yes, you do," a surgical resident agreed.

Several moments later, I carried the heavy plastic bag to the OR, and next to the patient's gurney, I said, "Where do you want his leg?" I remember thinking oops, and looking at the patient's face, remembering that he was still fully conscious, and seeing his eyes grow big with fear, the whites showing all 'round the irises. Walking away down the corridor I knew for the first time the impulse one has to punch a hole in a wall. The patient died within 12 hours of a cerebral hemorrhage.

I remember a repeat performer who came in occasionally with ascites. He had excess fluid in his abdomen due to liver failure. He was a big dude, with 70s hair and a mustache, but one could see that he was thinner than he used to be. He said he used to be a weight lifter. I asked him what I could do to help, and based on his response, I purchased a couple of pens and a note pad with envelopes from the gift shop, delivering them to his room two days later. He was grateful, and I never saw him again.

I remember a baby's skull, crushed in a senseless automobile accident wherein 8 of 12 people died. A gentleman in the waiting room lost his pregnant wife, his child, and his brother and sister - these were the only family he knew in the United States. I witnessed him going angrily, understandably mad in our waiting room. The crash was the front page story in the Orange County Register.

I remember going out the flight deck and pulling a patient out of the helicopter, feeling a strong pressure on my back. I looked back, irritated, at a pilot with his helmet and sunglasses on, preventing me from moving into the area where the tail rotors continued to spin. I nodded an acknowledgement to him.

I remember applying to schools of public health, but I don't remember checking the department to which I was applying. Health Care Organizations and Policy. I do remember that I had a front row seat to all that ails society, and thinking that the only way to change things was through policy. So that was the tack I took.

I worked for three years at UCIMC, and there I learned responsibility. I had the great fortune of finding my biological parents near the end of my stint at UCIMC, and that fact, combined with matriculating in a graduate school, propelled me into a new chapter of my life.