From her vantage point inside a busy emergency room, Stephanie Jones has seen big changes in the world outside the hospital's walls.
Over the past 22 years, Jones, a registered nurse, has been witness to an ever-evolving parade of people on the receiving end of gunshots, knives, fists, careening cars and other instruments of mayhem--interspersed between the more routine cases involving broken arms, high fevers and chest pains.
It's hardly the fictional "ER" of prime-time television, but her job in a real-life emergency room has given her a chance to gauge the escalation of violence in society by treating and comforting the victims.
And yet she still looks forward to each working day, because somewhere in this mix of trauma and tragedy, the 44-year-old Western Medical Center emergency room manager and mother of three teen-agers sees signs of hope.
"There's a whole variety of programs out there that are addressing our problems, but people don't always know whether they're working or not," Jones said. "They are working."
Laws requiring the use of motorcycle and bicycle helmets, seat belts and child safety seats are reducing the number of trauma patients, she says.
"There has been a very gradual decline in the number of our trauma patients since these kinds of laws have gone into effect. Our patient load has definitely reflected that."
Even the most troubling aspect of her job--the rising numbers of abused women and children who end up in the emergency room--indicates to Jones that society is taking the problem more seriously.
"People just used to cover it up. A lot of battered wives grew up from an environment of being a battered child, and they became a battered wife and they felt like they deserved it," she said. "It seems to be more prevalent, but I have a question in my mind: Was it always there? It certainly was there in a greater volume than we were aware of."
Jones estimates that more than half of all women who seek emergency room treatment are victims of abuse.
She also has seen an evolution in the way the wounded are cared for.
Eight months after Jones began her nursing career in 1973 at Western Medical Center-Santa Ana, then located on Washington Avenue, she was granted her professional wish, to be put on emergency room duty. It was a time of change for emergency medical care in Orange County, when the first few paramedic units were beginning to treat victims of auto accidents and heart attacks at the scene before they were sent to the hospital.
"We saw very little of that when I first came into the emergency room," Jones said. "In those days our treatment for heart attack victims was completely different. We didn't have the knowledge that we have today. We'd just basically give them something for pain. Now we can give them medicines that dissolve the clot that is causing the heart attack to begin with.
"Trauma patients would come to us without any care. And they may have waited hours to get to us."
During her first few years as an emergency room nurse, she saw the occasional victims and perpetrators of crime, but gang violence was rare.
"I don't remember any gang activity at that time," she said. But during the past five years, Jones has witnessed a significant increase in the number of gang-related shootings.
"We have about 120 gangs in Santa Ana now. All of our staff, in all areas of the hospital, are impacted," Jones said. "When we deal with gang members, we have to place them on different floors so we don't have rival gang members on the same floor. We have much more security than we ever had before. The concerns about violence extend to all care givers."
While rising numbers of illegal immigrants and indigent patients have increased the burdens of the health-care system in general, Jones says the advent of health maintenance organizations has decreased the number of patients using the emergency room for routine medical care.
"We're actually seeing fewer patients in emergency rooms in general," she said. "Emergency rooms have slowed down because you have managed care and HMOs that have their own clinics. Patients are being directed and being educated by their health-care clinics. Only if they need further care are they directed to the emergency room."
The Western Medical Center-Santa Ana emergency room treats about 2,000 patients a month, including about 100 trauma patients.
Jones says the most heart-breaking emergency room patients are abused children, who are all too often the victims of sexual abuse.
"Nothing will upset the staff more than child abuse and child death. It's like there's a helplessness there. Here's a child that we're not always able to help. The staff has a real awareness of abuse and we make sure we get social services involved, quick. We need to step in. That's our role and that's our responsibility, to step in for these children who can't fend for themselves."
In a job that is focused on the rougher edges of reality, Jones says there is a surprising lack of turnover among the hospital's 45 emergency room nurses and staff members.
"All the public can see is the blood and guts. That's not all this profession involves," she said.
"Most people really like this job. They get real satisfaction from making people feel better. If a patient is seriously ill and you bring them back from the edge, or if it's a small child that's having stitches for the first time, or a parent with their first child, who needs parental guidance, you can walk home with immediate recognition from almost every patient."
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Profile: Stephanie Jones
Residence: Huntington Beach
Education: Nursing degree, Golden West College; certification in emergency room medicine; currently completing a bachelor's degree in nursing at Cal State Dominguez Hills
Family: Husband, Rick, and three children ages 14, 17 and 18
Background: Began nursing in 1973 at Western Medical Center-Santa Ana, then called Santa Ana Community Hospital; became emergency room supervisor in 1989 and emergency room manager in January, 1995
Career choice: "It's a real challenge, a constantly changing environment. You have to like that sort of thing. To me, being a teacher with a whole classroom full of children bouncing up and down would be more of a challenge than I'd like to take on."
Source: Stephanie Jones; Researched by RUSS LOAR / For The Times