24 Harrowing Hours Inside the ER

"In Dallas County, we're blessed to be supported by taxpayers. They gave us $400 million a year. But we do $550 million worth of charity care work."

He hopes the public and Washington will recognize the crisis -- and quickly.

"[Emergency medicine] is as much a part of homeland security as anything else can possibly be. Without trauma systems, without these emergency systems, it's a disaster waiting to happen. And it will happen."

The hour 7 p.m. brings a shift change at Parkland, while an ambulance across town brings in a man suffering the ravages of diabetes and HIV. To a veteran EMT like Lindon Britt, you can't talk about the health care crisis without talking about poverty, addiction and crime.

"Everyone is quick to pull a knife or gun," he says. "They shoot and stab rather than settle things with their fists."

While Parkland is not the sort of "knife and gun club" ER seen in many cities, it sees its share of crime wounds, which is one more factor weighing down the entire system.

"We need to be able to provide care for everyone," says Pillow. "But a person who drinks and smokes crack and shoots himself in the head -- it's hard to know how liable I should be. I care about people. But they get in that position for a reason."

At 3 a.m., an apartment fire rages across town, and Debbie Jackson is brought in coughing smoke and shaking with fear. Her daughters jumped from their third-story balcony but survived with scrapes.

"I was so scared," she says. "I was about to pass out from all the smoke."

She needs more comfort than medical care, and despite the waiting crowd, she still gets a few moments of TLC from the doctor and nurses.

"What's surprising to me is how quickly I become attached to the patients even though you may only see them for a very short period of time," says Dr. Heather Owen.

"You can't insulate yourself. If it didn't bother me, I wouldn't do it."

At 7:35 a.m., 24 hours after our arrival, Dr. Paul Pepe, the head of emergency medicine, stands before a room full of star medical students, all of them searching for a residency.

"If you are here to wear the white coat and be an important doctor, we don't want you," he says. "We're like the Statue of Liberty. Give us your poor, tired, huddled homeless yearning to breathe free. This is a safety net hospital."

If they need further convincing, they can simply step down the hall where another 24 hours of trauma has already begun.

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