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South Carolina Level I Trauma Center Offers Glimpse of Action

She's 53 years old, she thinks.

She's from Adams Run - no, Walterboro, she decides.

"I drink a couple beers a day," she tells several nurses. Then, she chuckles. "As much I can, really."

She stashed these particular beers, the cans she drank before she fell, under a mattress, "so the old man couldn't see them."

Her feet fidget underneath the yellow hospital socks, the kind with a grip pattern on the bottom, as she lay in a bed in the Medical University Hospital's trauma bay.

She turns her petite body to look at each new person who walks in, even in the neck brace supporting the bone she broke, the bone that sits dangerously close to a major artery.

Her blood alcohol level is 0.280, nearly four times the legal limit of 0.08 for driving.

"This is not unusual for my folks," says Dr. Bruce Crookes, the attending trauma surgeon on this Friday night, as he walks over to check out his new patient. "It's all good."

When Crookes tells the woman that her blood-alcohol level seems higher than two beers, she suggests it's only because she hadn't been drinking much before that.

"It doesn't work that way, Missy," Crookes says with a smile.

As the trauma surgeon moves on to his next chart, his next patient, a nurse walks out from behind a curtain surrounding the woman's hospital bed. She carries a plastic bedpan, pleased with the woman's ability to aim.

"I work trauma," the nurse says. "I've seen it all."

The Medical University of South Carolina recently became the state's only nationally designated Level 1 trauma center. That means it's the first hospital in South Carolina to be recognized by American College of Surgeons for the highest level of care for unexpected, life-threatening injuries: the shootings and stabbings, the second-story falls, the metal-bending car wrecks.

Making Rounds

For the crew assigned to trauma patients, especially on unseasonably warm winter weekend nights such as this one, an alcoholic woman with a broken neck and a quick wit seems pretty pedestrian. From her bedside, Crookes will head upstairs to the surgical trauma intensive care unit.

In one room, blood drips down a woman's head as leeches dine on her scalp. A napkin-folding machine ripped the skin from her body, and now the bloodsucking worms will keep it alive, no matter how medieval, by promoting circulation.

A jar of live worms swims around in a clear jar atop a pushcart in her room. Beside it sits a second jar of engorged leeches in red-tinted water with a skull-and-crossbones label, "the leech graveyard," one doctor jokes.

Nurses talk to the woman as they attend to her, though her physicians won't wake her up from an induced sleep until the leeches have finished their duty and a plastic surgeon has done the same.

Crookes pops into several more rooms before heading back downstairs to check the trauma bays within the emergency room.

A man with second-degree burns on his right hand from a cooking mishap waits for paramedics to fly him to a designated burn center in Augusta. An inmate in a gray jail jumpsuit screams incoherently from another bed as he comes down off his marijuana, cocaine and anxiety pill high, while two uniformed officers stand watch.

Paramedics roll in a drunken young woman, the passenger in a car accident with dried tears streaking her face. After getting body scans, she walks out to use the restroom, uncertain of her own steps and clinging to a nurse's arm.

Crookes takes a look at her and then heads back upstairs for his first surgery of the night: A man who came in from another hospital with an incisional hernia, a problem caused by a previous surgery, which destroyed some of the man's bowel and caused blood and stool to empty into his body.

Crookes walks briskly toward the operating room. Unprompted, he says, "It's a special breed of folks who work here at night."

Expressed Confidence

Dr. Samir Fakhry, director of general surgery for the hospital, likens trauma surgeons to fighter pilots. They suffer a similar addiction to adrenaline and bring the same dedication to the job, even at the expense of their personal lives.

A trauma surgeon begins a 16-hour shift when most people clock out for the day, and the busiest times correspond directly to weekends and special occasions, when the general public goes out to play.

"How many people want to stay up all night, miss holidays and birthdays?" Fakhry asks.

The surgeons arrive without knowing what their day could bring, and they thrive on that rush. Fakhry, a transplant from the Washington area, mobilized a trauma center to treat patients from the Sept. 11, 2001, terrorist attack on the Pentagon.

"It stirs our grits, as they say in the South," he says. "Is that right?"

Fakhry keeps a complaint button with a mouse trap affixed to his office door and a cartoon explaining a common misconception taped to his wall: "I am a trauma surgeon. I do not work in the E.R."

The truth, as Fakhry sees it, is that the longer a patient with a traumatic injury spends in the emergency room, the more likely it is that the patient will die. A trauma team includes a dozen professionals, everyone from pharmacists to chaplains ready to handle the most urgent cases that roll in on stretchers.

Fakhry resents his own job security. He says trauma happens when people "over-express confidence," and he keeps an archive of video clips on his computer of traumatic injuries to people who made poor decisions. He takes particular issue with people who don't wear seat belts, who drink and drive and who text and drive.

"A 3,500-pound vehicle moving 80 miles per hour? A bullet is nothing compared to that," Fakhry says. "That's not an accident. That's a statistical probability."

He says traffic crashes - he refuses to call them "accidents" - account for 60 percent of trauma patients. Falls, such as the drunken middle-aged woman, claim another 30 percent. Gun and knife wounds make up the remaining 10 percent or so.

Break-room Photos

Trauma nurses take their break in a windowless room, just a closed door away from the screams and smells. They hastily heat up food, brew coffee and glance up at a television for a few moments.

Their lockers offer glimpses into the lives they leave behind when they put on scrubs: photos of families, graduations, nights out on the town. The surgeons can rest in their offices, but most work straight through their shifts.

Upstairs on this particular night, Crookes learns that surgery for the man with the damaged bowel has been pushed back, because another patient came in with a brain bleed. It's 1:10 a.m. before Crookes gets into the operating room with his patient.

A tube pumps air into the elderly man's body. Each breath forces his swollen stomach, stretched pink and balloon-like, to rise and quiver.

A nurse tape-records basic information about the surgery.

What will you find? she asks.

"I don't know what I will find," Crookes answers.

How long will it take?

"As long as it's gonna take," he says.

How much blood loss do you expect?

"About that much."

It's 1:24 a.m. when Crookes steps over to an iPod dock that looks like an old-fashioned boom box. The Black Keys' song "Lonely Boy" begins to play, its electric guitar riff setting the tone, as Crookes cuts into the man and the smell of burning skin fills the room.

But I came to love you

Am I born to bleed?

Any old time you keep me waiting.

The surgeon found that two-thirds of the man's colon had died. The operation to reconnect the remaining colon with the intestine and to remove the hernia took six hours. The patient lost only about 10 ounces of blood.

Crookes will operate on the man again soon. From that patient's bedside, Crookes rolled right into another operation, a 7 a.m. emergency appendix removal, and an emergency gall bladder removal after that.


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