Letter From East St. Louis
THE LAST ANGEL OF MERCY IN A DYING CITY
Gary Triplett lies on a gurney in the emergency room of St. Mary's Hospital, East St. Louis, Ill. Plastic tubes stick up his nose; others wind their way to a vein in his left arm. Bare-chested except for a white gauze bandage, he still wears his stone-washed jeans, but his sneakers are on the floor. A few hours earlier, a Saturday-night drinking bout had erupted into an argument that left the young man bleeding from a stab wound in his chest.
The delicate tissue of his lung was punctured, but Triplett is alert at 2 a.m. He confides that he lost his job as a city hall clerk two months ago, during a round of layoffs by the bankrupt municipal government. About that same time, his girlfriend gave birth to his first child, a son. When a policeman shows up to take a report, Triplett declines to press charges. Instead, he asks: "Why did the city lay me off?"
"Don't know," answers the officer. "I don't know why the city didn't pay me yesterday, either."
The nurse and the cop leave. Triplett and I are alone. The emergency room is hushed, and the curtains around his bed are drawn. Triplett, who suddenly seems younger than his 22 years, tells me this is his third trip to the emergency room. Once, he was shot. Another time, he was hurt in a car wreck. At this rate, I ask, isn't he afraid he won't live to see his son grow up? "I don't fear death," Triplett tells me. "I fear life. It's harder to live than to die."
BURNT-OUT SHELLS. His words ring true in East St. Louis, a place where men are less likely to reach their 65th birthdays than in famine-plagued Bangladesh. The mortality rate among black infants in this city is more than twice that of New York City's Harlem and five times that of the nation as a whole. In 1990, East St. Louis reported 80 cases of hepatitis A, a disease spread by poor sanitation. That represents nearly 10 times the number of cases per capita recorded by Chicago.
Predominantly black, with 40% of its citizens on public aid, East St. Louis has a level of social and economic stress that is hard to imagine. Burnt-out shells of buildings line the streets of this city of some 40,000 across the Mississippi from St. Louis. Hustlers and prostitutes parade down Collinsville Avenue, the main drag. Spray-painted gang symbols split the projects into turfs. Paralyzed by an ongoing fiscal crisis, city government has all but collapsed, no longer providing many basic services. In 1987, the city quit picking up garbage, forcing its citizens to pay up to $120 a year for private contractors to haul away their trash. Because many people here wouldn't or couldn't pay, garbage is strewn on streets, alleys, and lots. The decaying sewer system has repeatedly heaved raw human waste back up through toilets and sinks, forcing schools to close for days at a time because of the health risk and the stench.
But nowhere can the distress of this city be felt more deeply than at St. Mary's. With the closure of Gateway Community Hospital a year ago, this battered doyenne of the city's northwest side became East St. Louis' sole remaining hospital. St. Mary's emergency room is often the first and only provider of health care for the city's poor, most of whom don't have regular doctors. It also is the biggest private employer in a city where the official unemployment rate is nearly twice the national average. It operates the city's only ambulance service and is the only trauma center in the county.
St. Mary's has become a haven of last resort. Rocking back and forth in her chair, a teenage girl waits outside the emergency room. Her hair is pulled into half a dozen puffs on top of her head. A roll of toilet paper peeks out of her purse. On her feet, she wears a pair of dirty white slippers with powder blue ribbons at the toe. She has been in the beige-tiled waiting room for several hours. A blaring television mounted on the wall keeps her company. Dapper talk-show host Arsenio Hall whoops it up with his studio audience. Hollywood couldn't be farther from East St. Louis on this bleak winter night.
Inside the emergency room sits the nurse responsible for the shift, an exhausted woman with an outline of lipstick that has smudged off her lips. She rapidly phones local shelters begging a place for the young woman to stay the night. "The problem is that all the shelters are filled up," says the nurse, explaining that the 19-year-old, who has had ongoing psychiatric problems, came to the emergency room after a fight with her mother. "There's no room at the inn," says the nurse.
And people do show up at St. Mary's looking for little else than a room. Every year, a few mothers try to check their kids in at Christmastime to make sure they get a present and a warm place to sleep. Healthy children aren't admitted, but Santa Claus does visit those who end up spending the holidays in the hospital. Older people try to check into St. Mary's just to find some companionship.
FROZEN CHICKEN. But whether this hospital will be around next Christmas is unclear. Ancilla Systems Inc., a health care company owned by the Poor Handmaids of Jesus Christ, an order of nuns, is weighing whether to shut it down. In 1989, the hospital lost $4.4 million, compared with a $1.36 million loss the previous year. Its 1990 losses have been projected at $7.3 million. In part, St. Mary's is in such difficult straits because it provided $3.7 million in uncompensated care last year. But it's also suffering from dependence on government payments: Fully 78% of its patients are enrolled in the medicaid and medicare programs. For many treatments, these programs pay the hospital less than the cost of the care. St. Mary's is reimbursed just $73 for an emergency-room visit by a medicaid patient. The average cost of caring for a stabbing or gunshot victim, who typically requires the services of surgeons, anesthesiologists, and lab technicians, is $2,300--before room costs.
St. Mary's occupancy rate has dwindled to 48%, as patients with private insurance have shunned it in favor of suburban hospitals, such as Belleville Memorial, that offer more services. Last summer, new management laid off 100 of the hospital's 500 employees and shut a new cancer clinic. To cut costs, the hours for CT scans and ultrasounds are now restricted. The hospital cafeteria, once known for its homemade fresh fried chicken, is currently closed evenings and weekends. And these days, it often serves frozen chicken.
St. Mary's new chief executive, Charles E. Windsor, recently recruited from Harlem Hospital in Manhattan, expects losses to narrow to $2.5 million in 1991. But the belt-tightening is taking its toll. Patients wait longer for important tests if they get hurt on weekends. Doctors complain that because test results take longer, patient diagnoses are often delayed. And to the people in pain, the wait in the emergency room on a Saturday night can seem endless.
"I'm hurting," says Ernest Rodriguez, with a bowed and bandaged head. In the fleshy area between his thumb and forefinger is a homemade tattoo, "Rico Robin," and his right wrist is handcuffed to his wheelchair. Next to him stands Shelby Boyce, a policeman from the neighboring town of Washington Park. Rodriguez, says Boyce, was hit over the head with a glass bottle in the afternoon after pulling a straight razor on another man. At 4 p.m., Rodriguez and Boyce came to the emergency room. By 1:30 a.m., they're still waiting for the results of a CT scan that the doctor has ordered to make sure no glass has lodged inside Rodriguez' brain.
WAR ZONE. "They closed down the other hospital in East St. Louis," says Rodriguez, a Texas native. "That was a bad mistake. They'd take care of you if your ass was shot, stabbed, anything. I sat in here for hours, and nobody's taken care of me." With long, dirty fingernails and dark splatters of blood on his shirt, Rodriguez looks more and more miserable as the night wears on. Several times, he asks Officer Boyce to find him a cigarette. That's not an easy task in a no-smoking hospital, but somehow Boyce manages.
This shift is nothing special, though. Every night, East St. Louis's fiscal crisis is played out in St. Mary's emergency room, thick with the smell of blood and frustration and death. "I fight a war here every day," says Dr. Frederick D. Cason, a Navy-trained surgeon who operates on the wounded who pass through St. Mary's doors. "We have injuries here that are every bit as bad as we saw in the Vietnam War." And like the U. S. in Vietnam, St. Mary's is waging a war of attrition that it will eventually lose.JULIA FLYNN SILER