In 1988 Robert Simon accepted the position of chairman of the department of emergency medicine at Cook County Hospital and took on the task of cleaning up its once-notorious ER. “We’ve set up a good model program. We built a brand-new ER. Our ER is excellent in terms of its morbidity and mortality rate–it’s probably the best in the county. All of our physicians are board certified or are board eligible. We have the second-largest residency in the country, the largest faculty in the country at any one hospital in emergency medicine, and we have a huge amount of grant support for research. So we’ve really done exactly what we wanted to do.”
He won full scholarships to college and medical school, entering Wayne State University in 1968. His intensity and single-mindedness got him through the college premed courses in just two years, even though he was also working washing trucks and busing tables. “I used to average about four hours of sleep a night, then every ten days or so I’d sleep for eight or ten hours. I didn’t know what the scholarship situation would be, and I wanted to get done with it.” From 1970 to 1974 he attended medical school at Wayne State and worked nights as a janitor.
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In 1983 Simon made a radical change in his life. He sold his house in Malibu and went to Afghanistan, where he set up his first war-zone medical clinic, an experience that would help shape his later thinking about emergency-room medicine. Why go to a war zone? “I guess because that was the critical need then. At that time I was not married, I didn’t have any kids, and I felt that if something were to happen to me it would not be a big loss for anyone. So I could do it. Other people who had obligations to their families couldn’t.
Simon applied to various organizations for funding for the clinic he’d set up and was turned down. “I still have a letter from the World Health Organization. I asked them if they would support the clinic, and they refused. It wasn’t that they were against the clinic. It was that their charter forbids them to go into a country unless the government in charge of that country permits them to do so. The same with the Red Cross. So the Red Cross could go into Hitler’s Germany only if Hitler said that it was OK to go and only where Hitler told them they could go. Same with the Soviet Union’s Afghanistan situation. Same with Cambodia. If they wanted to go where the Khmer Rouge controlled the area they had to get the permission of the people who controlled that piece of earth. The Red Cross has that in their charter, the WHO has that in their charter, the UN has it in their charter–everybody.” He also found that lots of groups were happy to work with refugees. “Refugee camps are easy to access. If there was an attack on America and we all went to Canada, then [refugee organizations] would go to Canada and set up tents and feed people. They’re basically welfare camps.”
“So I’m not into this to go to heaven, number one. Number two, I’m not into it because I feel like I have this great debt to society. I do it purely for one reason: it makes me feel good about myself. The reason that I live an ethical life and the reason I make these sacrifices is purely because it makes me sleep at night feeling very good. It’s like the Ayn Rand concept of the virtue of selfishness, if you will.
“This is a new unit, about three years old,” says Tom Scaletta, a young MD with a stethoscope slung around his neck. “We’re focusing on security these days, and that’s real new.” It used to be that anyone could wander in off the street, which led to everything from petty theft to necronapping–gang members swiping the bodies of their deceased victims. Violent patients remain a problem; offenders have their sins added to their records, a process known as coding, and will be watched the next time they appear. “That’s prevalent not because it’s Cook County Hospital, but because they’re on drugs, or alcohol, or they’re involved with gang violence,” explains Scaletta. “Violent patients are prevalent in all ERs.” Trauma patients are now quickly undressed, to reveal their wounds–and to check them for weapons. Some people get upset when they have to wait too long and become another source of disruption. Security guards are much in evidence, and all visitors must wear ID tags. Patients have bright orange bands around their wrists, and they must wait alone, except for those who require translators.
