Just to answer the dated tan plastic phone at the R Adams Cowley Shock Trauma Center, you have to take an annual two-hour course. And when it rings, with its two-tone signal like an old British ambulance, everyone pays attention.

A voice on the other end, an EMT somewhere in Maryland, rattles through the need-to-knows over a speaker: age, gender, and manner, severity and location of injuries. Whether a patient is lethargic, immobilized, disoriented or unresponsive. All is scribbled shorthand onto translucent marker board, known to all as "the board," as a crowd of staff looks on.


The board reads as a preview of what's to come for the doctors, nurses and other staff of Shock Trauma, and what they already have on their hands. On one Friday evening, as Marylanders everywhere head off to start one of the last weekends of summer, it's a lot of car accidents; one woman is found fallen from a horse, another grazed by a car's side-view mirror. Other nights, in the wee hours of morning, street violence pervades.

Once the details are there in writing, it's only a matter of time. Within minutes, the patients are wheeled into the Trauma Resuscitation Unit, rushed from the ambulance bay two floors below or the helipad on the roof six floors above. More than a dozen bodies in those pink scrubs surround each patient until they are stable or no longer have a pulse.

It's a rush of what staff and veterans call "organized chaos" that was responsible for saving more than 8,000 lives last year. The routine at Shock Trauma, the nation's oldest — and, they say, busiest — trauma center, meanwhile has informed trauma care around the country and world with its focus on the "Golden Hour" — the idea that rapid treatment of traumatic injuries prevents deaths.

It evokes a pride, if not an arrogance, in the health care workers there that has helped drive both high admissions and survival rates.

"I'm not allowed to say, 'Oh my God, that's awful,' " says Dr. Thomas Scalea, physician-in-chief. "I absolutely believe I am saving that person's life, even right up until they die. We believe we can do the impossible, and sometimes we do."

The staff swarms

In a snap, Shock Trauma doctors evaluate whether what they have heard from EMTs in the field warrants bringing a patient there. Shock Trauma is the only hospital in Maryland deemed a Primary Adult Resource Center, the highest level of trauma care for adults.

The decision tree reads like a menu of death. After a traumatic event like a fall or car crash, any combination of low blood pressure, difficulty breathing or reduced ability to open the eyes, speak or move is enough to get a patient to Shock Trauma, particularly when there is a possibility of internal injuries. More serious benchmarks include crushed or mangled extremities; auto crashes involving ejection from a vehicle or damage that intrudes a foot or more; falls of more than 20 feet for adults and 10 feet for children. The most common admissions are from crashes (a third), falls (a quarter) and violence (one in six).

The patients, for the most part, do not stay more than three to four hours in the trauma unit, and 40 percent of patients are sent home from it, but each case varies. On this night, at one end of the unit's horseshoe of 13 bays, a teenage boy sits up awake and alert, a man and a woman at the foot of his bed; across the room, an elderly woman is alone in the corner and breathing through a ventilator, part of her hair shorn off and white tape holding tubes to her upper lip.

Much of the scene is what you might expect to hear or see on an episode of "Grey's Anatomy."

When a patient is wheeled in after her car was T-boned, the staff swarms. More than a dozen surround her, each with his or her role, and six or so more stretch beyond a curtain. They quickly cut right down the middle of her jeans and blouse.

"Can you hear me?" a doctor shouts.

"Are you allergic to anything?" a nurse asks.

Nurses, standing to the left of the bed, are responsible for inserting IVs and taking samples of blood. Residents, doctors who are still in training, stand to the right while the attending physician stands at the head, responsible for ensuring that the patient can breathe, through a ventilator kept by each trauma bed if need be.


Once the woman is stabilized, the area clears. Technicians wheel in a portable X-ray machine to check for bone breaks while nurses go through the woman's purse, documenting every item down to the cash inside her wallet and scanning through her cellphone for emergency contacts.

"She is in stable condition. She wanted us to call you," Shock Trauma nurse Marcy James said into the voice mail box of the woman's daughter. Perhaps sensing the terror the center's well-known name could incite, Marcy adds that the woman was brought to the center "just to evaluate her and make sure she's OK."

Luckily, the woman was alert enough to tell nurses the code to unlock her phone and whom to call. Nurses call from their hectic bank of beeping workstations, so that patients' loved ones will be able to call the hospital staff back if necessary.

Earlier, a county police officer paces the unit looking for patients involved in a different car crash, told they are in bays two, six and eight.

"He didn't slow down at all," the officer tells one of the patients. He asks nurses to retrieve a car key from one of the patients' belongings so he can download crash data from a recording box inside the vehicle. The nurses marvel at this technology, and one reluctantly hands him the electronic key.

"This key fob's going to come out of your pay," the nurse says, demanding its return to the owner. The officer promises it.

Nearby, a young man in a neck brace has blood on his face. He asks where his mother is. A tattooed arm peeks out from beneath white blankets, which are kept in a warming cabinet (cold patients bleed more).

"All things considered, you're pretty healthy," a caregiver tells him as he readies to wheel the patient to a nearby bay. "I assure you, you're not dying."

Some days you say, 'Why?'

Work at Shock Trauma long enough, and staff members develop peeves when it comes to preventable injuries. (None will use the term "accident" when referring to auto crashes, which, they say, can be prevented.)

Jake Smith, a surgical tech, grimaces at the mention of motorcycle crashes.

"I've got this thing about motorcycles," says the 25-year-old, who has worked at Shock Trauma since graduating from Fallston High School. Trauma work started as a punishment for him — he was assigned to help out volunteer EMTs as community service as a teen — but is now a passion. And it has changed his outlook on reckless behavior.

"I discourage doing a lot of things I used to do when I was a kid," he says. He still looks the part of the rebel, though, with a sleeve of tattoos punctuated by Mr. Boh, the National Bohemian beer mascot who also covers Smith's head on a cap a friend sewed for him.

For Jane Aumick, a nurse and 33-year veteran of the neurotrauma unit, the job has created a distraction at the beach as she watches children frolic in the waves and bodysurf.


"No one remembers there's a ridge of sand just before the beach," Aumick says, referring to common head and spinal injuries that occur when swimmers diving through a wave land headfirst on the sand. Too many times, she has seen those people flown from Ocean City to the center and asked them to hold up fingers or wiggle a toe.

But like others, she says the reward of fixing what is broken makes up for it.

"The first time they hold up those two fingers, it's like hitting that $500 million mega ball," Aumick says. "We believe we can make everybody better, so that's why we work so hard."

For 68-year-old nurse Harold Hardinger, one of the biggest changes noticed over his nearly 40-year career is the graying of patients, as more people live to older age. They are increasingly admitted for falls or auto crashes, often occurring while making left-hand turns, and their cases are frequently complicated by pre-existing conditions or prescriptions for blood thinners, he said.

But the hardest are still the young ones who go before their time, he said.

"Over the years, it doesn't get easier," Hardinger said. "Some days you say, 'Why? Why? Why?' And you don't have an answer."

Confident, not cocky

Shock Trauma doctors acknowledge it takes a particular breed to do their job.

"You have to have a specific level of ego to cut somebody open," says Dr. Andrew Pollak, who speaks with that confidence. "But you can't be cocky. Cocky is dangerous."

It is perhaps that confidence that has helped make the trauma center so busy in recent years.

Admissions have risen by more than 3,000 in the past decade to more than 8,600 last year. That is despite the fact that the center is built to accommodate 3,500 patients annually; a new tower slated to open by year's end but already largely in use improves that, adding 64 critical-care intensive-unit beds, five operating rooms and a larger waiting area.

"When people ask for help, we figure out a way to say yes," Pollak said. "It's easy to find reasons to say no."

For Scalea, that translates to 100-hour work weeks all year but for one week each summer he spends on Cape Cod with his family. Scalea acknowledges that he earns much more time off but adds, "It's not like you have to be like me to do this."

He isn't the only one who thrives on Shock Trauma's fast pace.

"I don't think it tires me. I think it excites me," says Gina Sellers, a 25-year-old nurse with golden curls who works on the multi-trauma care unit.

But staff members are conscious that a busier shift means more families grieving a loss or worrying over a sick relative. They don't invite the drama, and they're afraid to jinx it into being.

"We don't use the 'Q' word around here," says Terry DiNardo, a petite nurse manager with a deep rasp, before mouthing "quiet" softly enough so the fates can't hear.

Some rare downtime comes as nurse Susie Breeback and techs Dan Goodman and Becky Gibbons await a patient airlifted from Baltimore County, found after falling from a horse. "This has been the longest five minutes of all time," one of them says.

They chit-chat about local road races — to run the Baltimore or Marine Corps marathon? Or what's that spring marathon in Washington? — until the whir of the incoming chopper drowns out their conversation.

They rush to meet the state police helicopter and whisk the patient into the elevators down to the trauma unit, where one of the officers launches the routine all over again, running down the details of the accident:

"You ready for a story?"