THE TRAUMA ALERT WENT OFF IN PARKVIEW MEDICAL CENTER’S emergency department. Four miles from the hospital there had been an accident.
“I have a sixteen-year-old female involved in an MVA,” a paramedic informed the triage nurse at Parkview by CB radio. “She is awake at the scene, arousable. But she appears to have some head and neck injuries as well as chest and abdominal injuries involving the steering column.”
The girl’s Volkswagen Jetta had jumped the curb and hit a telephone pole at high speed. Although she was wearing a seat belt, the front end of the car was crushed and the steering wheel driven back into her, pinning her to her seat. Rescue personnel had tried to move the seat back, but the tracks were jammed and they were forced to squeeze her out the best they could. Using all his strength, a fireman pulled the wheel a few inches away from the girl while paramedics carefully tugged on her until she was freed.
“We’re arriving code three in four minutes,” the paramedic said.
Ted Cogan, the senior trauma surgeon in the hospital that evening, came down to the emergency department from his on-call room on the second floor just as the paramedics were wheeling the victim into the hospital. Cogan was a tall man of medium build made to look even taller by the clogs he was wearing, which, when he walked on the hard, bare floors of the hospital, came out sounding like the slow clip-clop of a horse pulling a tourist carriage.
Only a few minutes earlier, he’d been resting comfortably in bed, dozing. One side of his hair, graying at the temples, was standing on end and his green scrub shirt was not tucked into his pants in the front. Rumpled as he was, though, the look didn’t add years to him. Instead, it gave him a boyish charm, as if he were late for school, rather than on time for work.
The paramedics steered the victim into the trauma room. White and young with blond hair, she was looking up at the ceiling, her mouth covered by an oxygen mask. In the room, the head trauma nurse, Pam Wexford, started barking orders at an intern: “We need you on that side. No, there. OK, on three, we lift.”
They transferred the girl, who was strapped to a hardboard stretcher, her neck stabilized by a cervical collar, from the paramedics’ gurney to the trauma-room gurney. Cogan moved into the room, but stood off to the side, trying to stay out of the way of the emergency workers. Although he was at the top of the pyramid and technically in charge, there were few, if any, instructions he had to give in these early moments because standard procedure was in effect. The team would make sure the victim had an airway, they’d take her vital signs, start an IV, draw a blood sample, and strip off her clothes. Then they’d take preliminary X-rays of her neck, chest, and pelvis.
“Dr. Cogan, so nice of you to join us.”
This was John Kim, the chief surgical resident, talking and working on the girl at the same time. Kim was thirty but he looked twenty. A baby-faced Korean-American. Cogan liked him, if only because he possessed the two qualities that made just about anybody tolerable: he was competent and had a good sense of humor.
“Wouldn’t miss it for the world,” Cogan said. “What happened?”
The girl’s blood count was normal. But her blood pressure was lower than normal and her heart was running fast, which probably meant she was losing blood—the question was from where. She didn’t appear to have any major external lacerations, so they were probably looking at a fracture, some sort of chest trauma, or the laceration or rupture of an organ, Cogan thought.
“We’re going to have to cut your clothes off,” Wexford said to the girl. “So please try to remain still.”
The girl responded by opening and shutting her eyes and groaning. She was wearing jeans, which made the cutting more difficult, but Wexford, a real-life version of Edward Scissorhands, still managed to shred her pants, mock-turtleneck shirt, bra, and underwear in under a minute. When she was finished, Cogan went over to a counter where there was a latex-glove dispenser, and pulled out a couple of gloves. He stretched a glove over each hand, then turned his attention to