This man died because he was homeless

On the front lines, an emergency room doctor sees people who would live instead of die -- if they had a place to live

Michael Goodwin

Special to the Sun

Wednesday, January 09, 2008

CREDIT: Ian Smith, Vancouver Sun Files An alley is no substitute for a home, and an increasing number of people in Vancouver don't have a home.

It was 3 a.m on a winter Saturday night and the emergency department was bustling at Vancouver's downtown hospital.

As a resident on call I was attending to a stabbing victim in the trauma bay, someone in the Downtown Eastside who had been stabbed in the back near a pub after closing time. His was not an uncommon story.

Suddenly shouts emanated from the nursing station: "Clear out! Clear the trauma bay! We've got another stabbing! They lost his pulse. ETA five minutes!"

Our first stabbed patient was whisked out of the trauma bay to the only place available for him -- the hallway. We then busied ourselves preparing for the new arrival.

Intravenous bags and lines were opened and primed. Resuscitation equipment was connected and readied. We started to don gowns, gloves and masks in preparation for what would likely be a bloody encounter.

Usually in these situations there is a lull before the patient arrives.  Everyone gets ready, and then waits silently for the emergency bay doors to open. Sometimes that waiting seems like forever. This time things happened quickly. Before we could organize ourselves, the bay doors were suddenly bursting open and the paramedics were wheeling our victim towards us on a stretcher.

One paramedic was "bagging" the patient -- providing breaths via a bag and mask attached to an oxygen canister. A second paramedic was steadily compressing the victim's chest to try to maintain circulation of blood. A third was pushing and steering the stretcher while simultaneously barking out a summary of the story. Like one of the street performers at Granville Island, he shouted his oration to all of us: "Homeless man stabbed in the anterior mid-chest.

Vital signs were lost at the scene. CPR was begun immediately." In other words, this man had died out on the street right in front of them only moments ago and now we were all fighting to get him back.

I couldn't help but look down at the man and his unsightly appearance with pity. His ragged plaid shirts, worn in layers to keep out the winter cold, were now completely soaked in blood. His long unkempt hair, his tattered pants, worn-out shoes and his calloused, dirt-filled hands all confirmed the orator's broadcast that he was homeless. 

I looked back up and the room had become a swarm of people: Doctors, nurses, paramedics, respiratory therapists, residents, medical students and police. Some were truly part of the trauma team and others came by to help and learn.

The senior emergency doctor took charge. "You, get an airway," she said to one of the other residents. She didn't need to talk to the nurses; they had already swooped on the man and were busy putting in IV lines, removing clothing and assessing his injuries. She looked at me: "You, put in a femoral line and a chest tube."

Despite all our work we quickly realized we were losing. The senior physician made the quick decision that if we had any hope of getting this man back alive we would need to open his chest right now and try to stop the bleeding. She took a scalpel and cut his left chest wide open right there. A large gush of blood emptied out. She put the rib spreaders in and evacuated more blood. We reached into the man's chest, and she took his heart in both hands and squeezed. This provided a weak pulse. She continued to compress the man's heart, but it was already empty of blood.

We looked for the source of bleeding and found a hole in the man's thoracic aorta, the main blood vessel draining the heart. A large injury here is uniformly fatal. No more heroics could bring him back.

We stopped our resuscitation efforts. "Time of death: 3:45," someone announced.

The commotion stopped. One by one the tubes were disconnected. One by one people filed out of the room. With the pronouncement of death, what had been a noisy and chaotic affair suddenly became very quiet and solemn.

I stood there alone looking down at him again. Such a young age to die, I thought. Will he be missed? Will his death go unnoticed? Will there be justice?

Some would say his life as a homeless man was not worth living. But this man was somebody's son, somebody's brother, and now he's gone forever.

Later I later talked to the police officer involved that night and tried to make sense of why this happened. "Oh we remember Stevie," said the officer who knew the Downtown Eastside well and, as it turns out, remembered our victim from his days on the street.

"Sure, he was in our system for some minor this and that, nothing major at all. He basically pushed his buggy around and collected bottles." He went on to tell me the killer seemed to randomly stab both our victims that night within a few minutes of each other. It sounded like Stevie was just in the wrong place at the wrong time.

I don't pretend to know all the details leading up to his death that night. But I do know he would be alive right now if he had a place to sleep instead of pushing his buggy through the alleys at three in the morning.

Sure, he died because he was stabbed. But let a coroner's inquest state:

This man died because he was homeless.

In my sleep-deprived state the next morning I thought back and realized he certainly wasn't the only homeless person I'd come across at St Paul's lately. I also realized he wasn't the only homeless person I'd watched die.

I thought of the young homeless woman in the intensive care unit dying of overwhelming pneumonia. Another homeless young prostitute stabbed by her john. The homeless man in his 50s mowed down by a car while crossing the street.

I can speak for many other frontline health-care workers when I say this is a growing problem. This shouldn't come as a surprise to anyone. We know there are a lot more homeless in Vancouver than even a few years ago, well over 2,000 as of 2005.

A large number of these individuals cycle through our hospitals at alarmingly high rates because they suffer disease, infection and trauma at rates much higher than the general population.

We also know that the homeless die at rates much higher than the housed population, mostly from trauma and infection. According to recent research from Toronto, the risk is even higher for young women.

We talk about smoking doubling your risk of dying of lung cancer. But if you're a young woman, not having a roof over your head increases your risk of death ten-fold.

It is only somewhat encouraging to hear of recent government initiatives pledging more resources for the homeless. The current reality is that our present administrations have only witnessed the problem get worse.

As the homeless dig in to face what is being heralded as the coldest winter in years, we as front-line health care workers add our voices to those calling on all levels of government to address the problem of homelessness with renewed urgency.

We also appeal for social housing resources specifically for those homeless recovering from illness or an operation. We want there to be somewhere they can safely go if they survive their illness or trauma and are ready to leave hospital. We can't be expected to send them back to the streets with fresh wounds, infections and the like.

Michael Goodwin is a resident in the department of surgery, faculty of Medicine, University of British Columbia.

 (c) The Vancouver Sun 2008