Just Another Day and Night
for Dr. Trauma
By Susan Glick
The Governor’s physicians at Cooper University Hospital. Sitting (l–r):
Robert Ostrum, MD, Director of Orthopaedic Trauma Surgery;
Steven Ross, MD,
Head of Trauma. Standing (l–r): Michael Goldberg, MD, Chief of Anesthesiology; Ronak Desai, MD, Attending Anesthesiologist
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n the evening of April 12th, the SUV driving Governor Jon Corzine to Drumthwacket for a meeting with radio announcer Don Imus and the Rutger’s women’s basketball team sped across three lanes and over a guard-rail on the Garden State Parkway. Corzine’s solid, 6 foot, 3 inch-body suffered 15 broken bones, including fractures in 11 ribs, a vertebra, the sternum and collar bone. By far the most serious was the compound break of his left femur, exposing bone through the thigh, and causing significant blood loss. The 911 calls of passing motorists, most unaware to whom the car belonged, triggered the emergency response system and those behind it: the trauma response team.
Within minutes, SouthSTAR, southern New Jersey’s air medevac service, was transporting the State’s number one man directly to the Level I trauma center at Cooper University Hospital in Camden. Assembled and waiting on the hospital roof were Steven Ross, MD, UMDNJ-Robert Wood Johnson Medical School (RWJMS) professor of surgery, and the trauma team of anesthetists, respiratory therapists, trauma nurses and technicians. Other team members, including a critical care nurse, anesthesiologists, x-ray techs, a unit secretary, orthopedic surgeons, surgical and emergency medicine residents, and the trauma fellow all waited 10 floors below, in the trauma admitting area. The operating room staff, blood bank, laboratory, and trauma intensive care unit (TICU) were notified and ready to provide care.
“When I first heard the call, I didn’t believe it,” says trauma leader Ross, who was at the hospital. He wouldn’t let himself believe it until he saw the Governor himself. Michael E. Goldberg, MD, chief of anesthesiology at Cooper and an RWJMS professor of anesthesiology, received a call while at a sushi restaurant. The anesthesia service typically has a team on active duty, a second team on call and a third team on back-up. The core of a medical trauma team includes surgeons, anesthesiologists, nurses, critical care and surgical technicians, nurse anesthetists, and rotating residents and students. But, as Ross and Goldberg explain: “The team includes everything from housekeeping to public relations. The trauma care received by the Governor was and is the same care anyone would receive.” In fact, to ensure the best care possible, they made sure to follow protocol and training. Ross confesses, “There can be a syndrome of VIP care. You can actually make someone worse by treating them as a VIP.” He explains that trauma response is like being on a sports team. You have to practice six days a week to play well on the seventh. In other words, you can’t do something different at the last hour and do it well.
SouthSTAR touched down at 7:06 p.m. Corzine was transported to a resuscitation area on the roof for immediate care, and then was moved down to the trauma admitting area within seven minutes. During those seven minutes the team conducted an initial evaluation, assessed his airway, breathing, circulation and neurological function, and undressed him. Within the next five minutes the team inserted a breathing tube for support, due to his chest injuries, and conducted blood work and inserted large intravenous lines and sent blood to the laboratory and blood bank. In short, all immediate care required to stabilize him was finished within 12 minutes. After that the Governor had diagnostic tests such as x-rays for fractures and CT scans to determine the extent of any internal injury, which, amazingly, he did not suffer. This timeline is typical for a patient with the type and extent of injuries suffered by the Governor, explains Ross. “If it were a penetrating injury, the fastest time from arrival [at Cooper] through trauma admitting and out to the operating room for surgery is under five minutes. What victims of penetrating injury need is surgery.” The care of a blunt trauma victim, such as the Governor, “must frequently be slower, as identification of the specific injuries takes longer,” he says.
(l -r): On the helipad: Alberto Gonzalez, trauma tech; trauma nurses: Patti Scharff, RN; Susan Hoffman,RN, CCRN
Support Services (l – r): Joyce Coleman, Tennille Harris, Michelle Trusty
Nutritional Services (l – r) Freda Spearman, Maryann Codd, Terri Cooper, Fran Cassidy, (sitting)
Within one hour and 20 minutes, Corzine was in surgery in the skilled hands of orthopaedic surgeon Robert Ostrum, MD, RWJMS professor of surgery, and other members of the trauma surgery team as they worked to the pulse of some indy rock and roll music. “Things go better with rock and roll,” Goldberg proclaims. With a steel rod securing his realigned femur, the Governor was moved to the TICU for recovery, where he stayed for 11 days, eight of them on a ventilator to help him breathe.
If trauma admitting is the heart of the trauma service, the TICU is the gut. This unit is where highly skilled nursing, doctoring, and various therapies are conducted to support recovery, and it is also the site of much physician training. In this unit, the patient-nurse ratio is 2:1. The Governor had one-on-one nursing care for security and family access reasons. Corzine was not exempt, however, from being the teaching subject for RWJMS medical students and residents. “If he was teaching material, which he was, then we used him to teach,” says Goldberg.
For training purposes, a trauma attending surgeon typically makes patient rounds every morning with an entourage of about 10 others. In this case, the Governor received daily visits from the trauma surgeon on duty, two surgery fellows, a critical care fellow and several emergency room and surgery residents. “The TICU is a small, open room with 10 beds. We usually overcrowd the place
during rounds,” says Ross.
“For trauma residents and students, doing surgery is really gravy,” they both say. “Teaching encompasses evaluation, assessment and decision-making, not just medical procedures.” Recently, a simulation center (“sim lab”) has changed how trauma and emergency medicine is taught. While RWJMS students at Cooper are already working in their small sim lab, the medical education building currently under construction will have a larger lab where students will be able to perform surgeries and learn how to handle resuscitation or a patient code.
Corzine was stepped down to the dedicated trauma floor for another six days before leaving the hospital. His recovery was remarkably quick for the severity of his injuries. As the team would attest to, the Governor was not only a good patient, but highly motivated to return to his life and his work. “He did much better and continues to do much better than expected. These are injuries that if someone were not motivated, they could be permanently disabled,” states Ross.
But, shoring up the Governor’s motivation was the well-oiled machine of the trauma team. And what makes that team tick? Perhaps it takes a certain type of personality to belong to this special subset of care providers. Tolerating stress, working with the unknown, and avoiding the mundane are all traits of successful trauma providers. From a surgical perspective, trauma is unlike general surgery. “In trauma, when you get someone who is injured, until you do the exploratory laparotomy, you don’t know what you have. It is like unwrapping a present. You don’t know until you see it.” And until they see it, a team stands ready and practiced to address any situation.
Top:The 7th floor nurses who treated the Governor after he left the Trauma ICU (l – r) nurse associate Iris Orlando, Sherry Wright, RN, Doris Bell, RN
Bottom:Governor Corzine chats with son Jeff while
recuperating in his room at Cooper University Hospital.
“Trauma is a team sport—both horizontal and vertical. Surgeons are very egocentric, but a trauma surgeon has to recognize that even though he or she is a team leader, every person on the team is important. That is the vertical part of it. Horizontally, I work with surgical colleagues very closely. We have to trust each other,” states Ross.
He continues: “There are four or five trauma surgeons taking care of all the trauma patients on any given day. They are not my patients, but the trauma team’s patients.” Goldberg adds, “When they post a case in the operating room suite, they don’t post the name of the surgeon, they post Dr. Trauma. They ask, “Who is Dr. Trauma today?”
April 12th was just another day for Dr. Trauma. It certainly wasn’t for Governor Corzine.
Life in “Mortaritaville”
Captain Jesse C. Kooker, MPH '02, UMDNJ-School of Public Health, with Major Stephanie Barton
“They don’t refer to Balad Airbase, also known as Camp Anaconda, as ‘Mortaritaville’ for nothing,” explains Captain Jesse C. Kooker, MPH, ’02, UMDNJ- School of Public Health (SPH). “We get hit by mortar attacks more often than any other base” in Iraq.
Deployed to Iraq in August 2006, Captain Kooker has been the Preventive Medicine Officer for the 13th Sustainment Command since May. He has more than 20 years of U.S. Army service dating back to 1986, re-enlisted to active duty after 9-11, and credits his SPH courses for preparing him for anything. “Oftentimes, the troops practice behaviors that would make most health educators faint. To that end, I have to be the epidemiologist, the health educator, the industrial hygienist and the environmental consultant.” Kooker finds himself doing everything from reviewing inspection reports of dining facilities and investigating outbreaks of illness, to analyzing the medical diagnoses and discharge papers of soldiers being treated there. In fact, “water… where it comes from, how much we have, what kind is being used for what purposes” is one of his most difficult health issues. His unit, with 26,000 soldiers, “provides all logistical support for the entire war theater of operations in Iraq. The bottom line is that if it supports the war fighter, we move it. We are the convoys on the road, moving everything from beans to bullets, as they like to say.”
Captain Kooker starts his day with a five mile run at 5:30 am and will keep going until 8:45 pm, or even later, taking time out only for a gym workout at 5:00 pm. “Except for a half day on Sunday, there isn’t much time for social interaction. Then, we usually play racquetball, watch a movie or eat at Sami’s, a Turkish restaurant on base.”
And, in spite of its funny, yet foreboding nickname, “Mortaritaville” or Balad, located 68 kilometers north of Baghdad, “is where you want to be,” Jesse reports. “There is a lot of distance between you and most dangers of the war zone.” Incoming mortars haven’t seriously injured anyone on his base recently. “When you need to go beyond the wire, you take all the precautions you can to be safe, with armored vehicles, varied routes of travel and protective gear. However, if an Explosively Formed Penetrator (EFP) hits your truck, all the armor in the world is not going to do a bit of good.” His military obligations will be up in the fall when he hopes to return to working in managed care as an epidemiologist and clinical data analyzer — a far but welcome distance from EFPs and much closer to his son, Benjamin.
Two Pictures
Worth
2,000 Words
Geraldo Rivera and wife Erica Michelle Levy (photo by Pete Byron)
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 Brenda Natal (photo by Pete Byron) |
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The spotlight was not on TV personality Geraldo Rivera on the morning of Monday, May 21, when soon-to-be graduates of UMDNJ-New Jersey Medical School (NJMS) gathered at the New Jersey Performing Arts Center (NJPAC) in Newark for their convocation ceremony. Most eyes were on members of the NJMS class of ’07, who were celebrating the successful culmination of their four years of hard work.
Rivera — an invited guest — attended to witness the realization of a promise made 18 years ago to Brenda Natal, NJMS ‘07, and her eighth grade classmates. Underlining his conviction that education is essential for all, the journalist made a commitment in 1989 to subsidize the college education of all of the 28 students from this class at the Rafael Cordero Middle School in East Harlem — contingent upon their completion of high school. In 1990, Rivera founded the Maravilla Foundation, a non-profit organization dedicated to equal opportunity education.
Natal was one of the small number of students from the class who fulfilled that long-ago “contract,” graduating from Long Island University on May 21, 1998. While Rivera’s commitment to Natal officially ended on that date, he continued his financial support of her education through first nursing school and then medical school.
The long-awaited moment of Natal’s stepping to the podium to receive her medical school diploma brought tears of joy — and pride — to Rivera’s eyes. Emulating her sponsor’s generous support of students-in-need, Natal and her husband created a $2,000 scholarship in the newsman’s name.
Famous Faces
in Our Familiar Places
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 Atul Gawande (courtesty of Harvard Gazette) |
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“The Ethicist” seemed to walk right off the pages of his column in The New York Times Magazine on to the UMDNJ Newark campus on April 24, and Atul Gawande, MD, who “Rocks in the O.R.,” according to an April 3rd headline in The New York Times, made his appearance at the University’s graduation ceremonies on May 22. So maybe it’s UMDNJ that “rocks”—hosting two such stirring personalities in a period of just a couple of months.
Randy Cohen, the real-life “ethicist,” made moral dilemmas come alive, inspiring not only rapt attention, but frequent laughter, in the standing-room only crowd that gathered in the New Jersey Dental School Atrium at 9 AM to hear his take on ethics and higher education.
Lucky again, UMDNJ faculty, staff and students were treated to a graduation address from noted surgeon, thinker and author Atul Gawande, who has made the details of life in the O.R. household conversation. His most recent book, Better, A Surgeon’s Notes on Performance, was released to rave reviews just a month before he donned cap and gown to join the appreciative crowd gathered to celebrate the achievements of the University’s class of ’07.