The heat of summer typically brings a steady stream of accident victims to the Elvis Presley Memorial Trauma Center at The MED. But in hard times, people don't even have the money to find trouble.

 

Surgeon Martin Croce, MD, the trauma center's medical director, is doing rounds, quietly taking in the whir of activity. Only nine of the 14 critical care assessment rooms are occupied this Friday night, a light number for late June. Staffers say normally they'd be doubled up, were it not for the economy.

Here, human suffering knows no bounds. There was the zookeeper who was
bitten by a tiger, the teen who broke his neck diving into a pool, the brothers who slugged it out with hammers over a beer, the weekend warrior who tumbled from his roof. There is gun violence, too, of course, "But that's just a small percentage of what we see," said Croce. "Only 25 percent (of our patients) are people who get shot or
stabbed. Two-thirds are people in car wrecks, industrial accidents, and motorcycle crashes."

His staff treats more than 17,000 people annually, a number that places The MED among the busiest trauma centers in the nation.

When a patient arrives at the center via ambulance or helicopter, it is often with a constellation of injuries. The trauma team quickly does an assessment, followed by a diagnosis, and treatment. They know the importance of the "Golden Hour," when dealing with the most significant injuries promises the best chance for survival.

 

"Each patient usually doesn't have just one thing wrong, there are several and we have to prioritize. That differs from patient to patient, depending upon their overall level of health. When you combine blood loss with an injury, it sets off a physical cascade that can be difficult to slow down," said Croce.

But that is part of the challenge for Croce. He was named the center's medical director in 2000, after serving for several years as assistant director. During his 20 year tenure at The MED, his job has been multifaceted: surgeon, mentor, administrator, professor,
prognosticator, and devil's advocate, when necessary.

"I've always had a strong interest in trauma, because every day is different, every patient is different. And there is a beauty to this place, there is passion here," said Croce. "The nurses have it, the X-ray technicians have it, the unit secretary has it — and that's what
makes this unit work."

He is quick to credit his predecessors, Timothy Fabian, MD, and Jim Pate, MD, who were instrumental in helping The MED receive the state designation. Being a Level 1 trauma unit requires key medical specialists and equipment be available 24/7. Not only does the trauma center accept the Mid-South's most devastating cases, but their
resident program trains the doctors of tomorrow.

"Trauma is the leading cause of death and disability for people under 40. It represents more years than lives lost to cancer and heart disease combined," said Croce. "Trauma knows no socioeconomic lines. It can be any violent act, intentional or unintentional. And it's horribly funded by the government."

Funding woes, along with the kaleidoscopic changes at work in healthcare today, can make managing a trauma center a bit like bailing water from a leaking boat, admits Croce. But other improvements balance the equation: better CAT scans enable doctors to assess internal damage, ultrasound and blood banking helps to save lives, along with better antibiotics and sedation.

 

"I don't know where we'd be without the help of the pharmacy. The word teamwork is overused a lot, but I'm here to tell you, there's a team that's dedicated to trauma patients and they're here 24/7," he said.

Back in the shock bay, the medical team prepares for the arrival of a 30-year-old man who fell from a speeding car. It's not hard to imagine what happens when the body meets the pavement at 30-miles an hour.

Nurses, residents, and anesthesiologists encircle the bed, attaching tubes to the man's body to check his vitals. After an initial assessment, the patient is readied for a CAT scan. Croce walks into the control room, Michael Jackson's Thriller throbbing in the
background, and checks the computer monitor as pictures of the skull appear. Irregularities indicate a pooling of blood within the brain or brain swelling. Neither are good signs.

"Wow, this looks terrible," Croce states as he shakes his head. The patient is clinically brain dead. He confers with another doctor before determining how best to proceed.
Many people live to tell about their visit here, though most would as soon forget. Except for the city cop, who survived being shot on duty. He returns each year on his anniversary, a basket brimming with food, his way of saying thank you to those who saved his life.