Ventura’s Own ‘ER’: DRAMA IN SMALL DOSES : Mostly it’s kids with diarrhea and the drunk with a busted head. Still, death sometimes wins at the County Medical Center.

You know the scenes: Accident Victim gets wheeled in, Nurses circling like angels of mercy, Heroic Doctors snapping orders; amid the ER’s continual chaos, confusion and conflict, Overworked Staffers struggle with deep personal and interpersonal problems; Patients fight for their lives against deadly diseases and strange rashes.

All those overused hospital cliches on “ER”--TV’s biggest new hit--also materialize at Ventura County Medical Center’s emergency room. There is a difference, of course, between reality and TV: While the preceding situations can all happen in a single shift on “ER” (and usually do), they occur only occasionally at County ER in Ventura, where even Hollywood’s oldest hospital cliche--staffers frantically pushing a gurney down a hallway--almost never takes place, and only a few cases a week would be dramatic enough for prime-time television.

“We’re not like TV,” says Dr. Jon Yoshiyama. “Instead of life-and-death situations all the time, we have a lot of kids with diarrhea and vomiting.”

Many times, however, County ER staff wishes for a Hollywood ending. Last Christmas Eve, for instance, a 17-year-old girl with massive head trauma from an auto accident was prepped for surgery but died minutes before the neurosurgeon could even try to work a Christmas miracle.

County ER, the busiest emergency room in the county, treats some 50,000 patients a year but doesn’t get the same action as big-city ERs like Los Angeles County-USC Medical Center (which treats about 300,000 people a year). Attribute the slower pace to Ventura County’s smaller population, below-average crime rates and a countywide decline in drunk driving.

The tense, relentless excitement on “ER” also reflects the large number of actual emergencies treated at Chicago’s fictional Cook County Hospital. The 24-hour-a-day County ER, barred by federal law from denying treatment to anybody, sees everybody--regardless of urgency--and serves as a de facto public health clinic, “the safety net for the county,” says Dr. Nat Baumer, the ER’s longtime director. “People come here for problems that have no business being in an ER, but they have no other place to go.”

On most days, the admitting room at County ER fills up with the sick and the ailing: babies and children mostly, but also the homeless, the disabled and the mentally ill, “people at the end of their rope,” says Dr. Tom Dillon.

While a sense of immediacy is often missing--sore throat and fever are the ailments of the season, and appendectomy is the most common operation--County ER shares an element of bedlam with the TV show. When the admitting room runs out of chairs and the ER’s 23 beds are occupied, life imitates art and the place rocks. Friday nights, weekends and Mondays are usually whirlwinds--as many as 200 patients are seen on those days--but even during the week, “at any given moment, things can get absolutely bonkers,” said Iris, a head nurse.

Beyond the red door, within the cheerful, bright blue and green walls of the ER, there’s a staff of two attending doctors, three residents, six nurses, an administrative supervisor and several technicians, clerks and orderlies. They work eight-hour shifts, which often stretch into 12-hour or even round-the-clock marathons.

Somehow, they cope with the hard work, the stress, the uptight hospital bureaucrats, the constant doses of misery, lunacy and death.

“In the face of adversity, they hold up, maintain their humanity and keep their cool,” Baumer says. “This is the toughest and most gratifying ER in the county, and people here are highly motivated and dedicated.”

A typical rockin’ day at County ER:

Accompanied by the melody of wailing babies, staffers dispense nonstop care from morning through evening, swirling around the nurse’s station in streaks of hospital blue and white. No major emergencies. A cop brings in a handcuffed prison inmate hurt in a fight, a drunk moans on a gurney and a young man who broke several fingers punching a wall asks a nurse for 8-by-10 glossies of his X-rays.

Writing with a marker on a porcelain board, shift supervisor Denise Stewart juggles beds as the ER begins sending a steady flow of patients into the 252-bed hospital. “I’m backed up,” she frets to a clerk. Like a general deploying troops, Stewart moves patients on the board until all of them have been assigned a bed.

“My worst-case scenario,” says Stewart, a nurse for 21 years, “is this board completely full, the ER completely full, the admitting room completely full, and a lot of angry people out there.”

The wave of patients subsides about 9 p.m. The lull provides time to fill out reports and forms, grab a sandwich or a nap, recheck patients, return a pregnant woman’s call. “It could be morning sickness,” Dillon says on the phone. “Drink cool liquids, go easy on your stomach.”

But the calm explodes when a shrill bell announces an incoming emergency call. Two nurses and a doctor scramble to the closet-size radio room. Calling from an ambulance hurtling south on California 126, a paramedic provides “a head-to-toe survey” of an injured motorcyclist.

As Iris checks the appropriate boxes on an evaluation sheet, the paramedic lists the problems: “Deep lacerations . . . painful inspiration . . . can’t lie him down.” Yoshiyama tells the paramedic: “Maybe his rib’s fractured and he (punctured) a lung . . . at least put a rib collar on him.”

It’s decided to send the ambulance to Santa Paula Memorial Hospital, which is closer than the Medical Center. County staffers go off alert and ease back into the soothing rhythm of paperwork and patient care.

“The ER,” Iris says, “is totally unpredictable.”

So are some patients. A few patients a month turn violent, Baumer says, and about twice a month the police have to be called.

“Some patients are very belligerent and intoxicated,” Baumer says.

So security is a concern. At the nurse’s station, TV monitors scan the admitting room, and a red phone hooks directly to the Ventura County Sheriff’s Department. While hospital security officers dutifully guard the ER entrance, Ventura police patrols are only minutes away.

“The staff worries about people becoming violent,” Baumer says.

An imposing figure in a long white lab coat, the 6-foot-3, 46-year-old Baumer, a former basketball teammate of the late Pistol Pete Maravich at Louisiana State University, thinks of himself as the ER’s head coach. Staffers say he stresses teamwork and avoids the kind of juicy conflicts worthy of “ER.”

“Maybe because this is a small hospital, there’s relatively little animosity between people,” says Dillon, a second-year resident.

Baumer oversees the hospital’s 40 residents when they rotate into the ER and trusts them to do their job. “If you’ve been here in the residency program for a while, Dr. Baumer backs off and let’s you go, which is kind of nice. Other attending (doctors) will hover around more,” says Dr. Tom Kozak, who finished his residency last June and now works part time in the emergency room.

While County ER doesn’t provide the constant thrills of “ER” or even County-USC Medical Center in Los Angeles, residents like working there. The daily routine “isn’t anything like dealing with trauma patients coming in by helicopter all day long, but to me, it’s just as rewarding,” Yoshiyama says.

Dillon appreciates “the good amount of pathology and weird things” that come into the hospital. For instance, several months ago, a resident sent a construction worker complaining of headaches to radiology, where X-rays revealed a nail from a nail gun embedded in his skull.

And Kozak is treating a patient with “an interesting rash.”

“Fun is when you can play Sherlock Holmes and figure out what’s wrong with somebody,” he says. “To think about what’s causing the rash is intellectually challenging.”

But residents also find frustration in the ER. “There’s the alcohol abuser who comes here because he got drunk and hit his head and needs to be sewn up, but after he leaves he’s still going to drink and still going to hit his head,” Yoshiyama says. “So when you look at it, we really did nothing for him.”

Interns make rookie mistakes--few among them haven’t had sutures come undone or diagnoses turn out wrong--and they get the jitters. “At first I was scared, nervous, a huge difference from where I am now,” says Dr. Leslie Johnson, who is halfway through her first year of residency.

And what about those wild parties, mandatory in every Hollywood Young Intern story? “As residents, we’re pretty tight socially,” Dillon says, “but wild parties? No. Well, occasionally. I guess we’ve had three wild parties, and by wild, they don’t really compare to what it used to be. Some months you work 120 hours a week and there’s not much time for anything.”

Not even romance? “It happens in the residency program, but not so much in the ER,” Baumer says. “I can’t think of anybody” who became involved.

While residents form the backbone of the staff, nurses are the heart. Passionate and devoted, they backstop residents and buttress attending doctors, work all night Christmas Eve so they can stay home with their kids on Christmas and seldom stop moving, the barrage of patients making their shifts a blur.

“Sometimes,” says Iris, who has spent 11 years as an ER nurse, “I can’t remember the details of what happened the day before.”

Outwardly, nurses project confidence and calm, but sometimes not even their closest associates can perceive inner turmoil. The opening episode of “ER,” in which the head nurse overdosed on pills in an unsuccessful suicide attempt, struck a melancholy chord with County ER staff: Three years ago, their head nurse committed suicide, a tragedy even more shocking because not even medical professionals suspected it would happen.

“Here you work in medicine with someone who is having a depression, suicidal ideas, and either it wasn’t recognized or she didn’t want to seek counseling, which is kind of interesting when you work in an emergency room,” Baumer says.

Death is a constant presence in the ER. “When you have a tragedy, especially involving innocent victims like children, it’s really hard on the staff,” Baumer says. “Sometimes we have to talk about it among the staff and have therapy.”

Staffers lean on one another for strength. “When you’re with a group of people in an intense experience, joyful or sad, miserable or devastating, you bond,” Baumer said. “But you also need their support.”

In the ER, laughter is always the best medicine. “Every day you have sickness, pain, death and horror,” says Eileen, a nurse. “It would be unbearable if you didn’t also have humor. Something funny always manages to happen.”

On the TV show, a napping intern had his foot encased in a plaster cast. At County ER, staffers have been known to sing Christmas carols, ride the dumbwaiter between floors and do ballroom dancing to enliven an otherwise dull graveyard shift, but nothing outrageous occurs, they say.

Baumer encourages levity with his hearty, rolling laugh and needling humor. Passing Dr. Kozak, he says: “Whatta ya say, Kojak?”

Baumer, who gets a kick out of “ER,” does see another similarity between reality and TV. “The show goes by so quickly,” he says at the end of a long day, “and so does working here.”