At 1:45 a.m. on a recent Saturday, a nurse whizzed by the staff lounge in the emergency room at Prince George's General Hospital, pausing only long enough to announce that a woman who had been hit by a car was coming in from Mount Rainier. "She's got an open head wound . . . . This is going to be a biggie," the nurse said.
Shortly after 2 a.m., paramedics rolled in the moaning patient, and Dr. Willie Clifton Blair, 38, chief of the trauma center, entered the operating room. "Let's get some blood out of her," he said as 10 doctors, technicians and nurses, all masked and dressed in hospital green, silently appeared through three doorways.
The groggy patient mumbled her name while 20 hands went to work cutting off her clothing, taking blood samples, inserting an intravenous line and running a catheter into her bladder. Within 75 minutes, X-rays were taken, Blair had determined that her left leg and pelvis were fractured, the torn flesh on the side of her head had been sutured and she was ready to be taken to a machine that scouts out possible brain damage.
To an outsider, the case had all the excitement of a TV drama, but for Blair, it was quite routine -- all in a night's work for the Shock Trauma Advanced Treatment Team (STATT) at the county's largest hospital, located in Cheverly.
The trauma unit centers around two operating rooms across the hall from the hospital's regular emergency room. Unlike the sprained ankles and asthma attacks that are treated in the emergency room, trauma cases involve multiple injuries that might require immediate surgical intervention, according to hospital administrator Les Alt.
Blair is the chief of STATT, a team of people who work in separate parts of the hospital and who are summoned by synchronized beepers when a trauma case arrives.
Such arrivals are increasing in number. Trauma admissions at Prince George's hospital have more than tripled since 1979, up to 742 cases last year despite a nurses' strike at the hospital. In the first six months of this year, STATT has handled 414 seriously injured patients.
Prince George's is part of the Maryland Institute for Emergency Medical Services Systems (MIEMSS), which coordinates services for the critically injured around the state. As such, STATT can be compared with MedSTAR at the Washington Hospital Center in the District of Columbia and the Shock-Trauma Center at the University of Maryland Hospital in Baltimore.
Next to the Baltimore facility, Prince George's is the busiest trauma center in the state, according to Marie Warner, a MIEMSS administrator. Part of the reason for the upswing in business, she said, is a rise in trauma cases generally. Medical authorities attribute the rise in part to an increase in violent crime in recent years. Also, ambulance crews are better trained to determine which cases are serious enough to go to a trauma center rather than an emergency room, authorities said.
Blair said that nearly 35 percent of his patients are victims of the "big-time knife and gun club." Most of the rest are involved in car accidents or are people who have been injured as a result of drugs, especially PCP, he said.
Prince George's hospital is beginning to lose its poor-man's image, Warner said, and some of the smaller local hospitals have begun transferring their seriously injured patients there. "They the Prince George's hospital do not have the beautiful facilities that MedSTAR has," Warner said, "but the quality of care I would put up against anywhere in the state."
Trauma surgeons in the District give the Prince George's center good marks as well. "They're doing a very credible job of being a community trauma center," said Howard Champion, chief of MedSTAR, which he said treats about 1,400 patients annually.
To hear the staff members tell it, Blair is one of the best reasons for being part of STATT. A hulking, fast-moving man, he has a soothing Southern drawl and a down-home, matter-of-fact bedside manner. He is full of stories, most of them about his patients.
Blair recalls, for example, the Howard University graduate student who has been in a coma for six weeks as a result of a car accident. Then there's the story about a kid with a body full of tattoos who was beaten severely with an ax handle because he wanted out of a gang. Blair once treated a "known hit-man who got hit . . . . He brought his own body guards to the hospital with him."
"They're real nice guys out of their element," Blair said with a chuckle.
Blair shares the trauma center with seven doctors.
During the early part of Friday evening, Nov. 9, things were quiet so he used that time to visit patients whom he had met weeks earlier on his operating table.
He visited two young men who appeared to be sleeping peacefully. He stroked their heads and called their names loudly; their eyes flickered but they did not speak. Blair explained that both were involved in car accidents and have been comatose for several weeks. But he continues to talk to them, he said, because he is convinced that they are aware of his presence and might awaken at any moment.
Severely injured people rarely remember much when they wake up from their ordeals, Blair said. "That's good," he added, "because we don't do very nice things to people. We put tubes in very intimate orifices and put holes where there are none."
Submitting to such unglamorous treatment is the only reason that Dottie Brazke, a heavyset, 67-year-old woman is still living, according to Blair. Because of her age and other illnesses, "she was absolutely the worst person in the world to get run over by a car," the surgeon said. Her ribs were broken and her aorta, the heart's major artery, was ripped out of place. Yet, less than one month after the accident, a cheerful Brazke greeted her doctor. "We're going to get you up and walking the halls to help take care of the patients around here," he teased.
At 9 p.m., the 21-year-old man who had been beaten with an ax handle in April stopped by the emergency room to see Blair. He lifted his shirt to reveal arms and a chest full of red and blue tattooed dragons and slogans, plus some small red sores that Blair diagnosed as a virus called shingles. The doctor prescribed antibiotics.
"He saved my life; he's a good doc," the man said.
By 9:30 p.m., it was time for dinner. For Blair, who always complains about his weight, the meal consisted of a few jokes, a Diet 7-Up and two beeper calls from nurses at Doctors Hospital who were checking on medication for an elderly patient on whom Blair had operated that day.
At 12:45 a.m., medics rolled in a 24-year-old man from a single-car accident. The green-masked surgical team slipped quietly into the operating room and Blair began poking at the patient's abdomen, looking for signs of pain or internal damage. "How much did you have to drink?" he asked the man whose head bobbed from side to side.
"Too much," he muttered, then he growled at a technician who was cutting a quilted vest from his chest. A few minutes later, he muttered, "I'm stupid, but I'm not hurt. I want my sister."
Blair determined there were no apparent internal injuries, so he asked, "What day is it?" Then "Who's president?" and "Who ran against him?" Upon getting the correct responses, Blair decided the patient's worst injuries were a high blood-alcohol content and facial scratches from the shattered windshield; but he admitted the patient for the night to make sure his condition remained stable.
At 2:10 a.m., paramedics wheeled the 23-year-old woman from the hit-and-run accident out of an ambulance and into the operating room. She struggled and grumbled at the nurses who tried to undress her and take blood samples.
Blair helped to pull away the trousers that medics had put on her to maintain her blood pressure. As the black, balloon-like pant came off her left leg, the calf portion flopped to the side at a sickening angle. Two pairs of gloved hands reached over to hold the leg in place while a third pair of hands placed a plaster splint underneath.
At 2:45 a.m., a nurse popped her head through the operating door and announced, "We got a shooting coming in." Barely 10 minutes later, the woman stuck her head in again. "Forget the shooting," she said, explaining that it was either a false alarm or the person was dead at the scene.
At 3:15 a.m., Blair sauntered into the waiting room to talk with the woman's frantic brother. Blair assured him that she will live, but her leg and pelvis were broken. "She won't be walking for a few months," he said.
In another room, friends of the woman explained that they had been drinking at a bar. The woman stepped out into the street and was struck by a car that kept going, they said.
By 3:35 a.m., Blair was going over X-rays again with Paula Miles, a radiology technician. A nurse leaned in the doorway to say that another accident victim was expected to arrive in 20 minutes.
At 3:55 a.m., paramedics slowly rolled in a stretcher, trying not to jar the handsome 31-year-old patient, whom they believed had a spinal injury. One of the medics explained that the man's Datsun 280 Z had flipped over several times on Pennsylvania Avenue near the District line and had landed upside down. It took firefighters about 45 minutes to cut the man out of the crumpled car. He was wide awake and did not appear to be drunk, the doctor said. There was no blood, but the man said he could not feel anything from his chest down.
Blair and his partner, Vincent Casibang, who had come in for another shift, looked over their new patient in the second operating room. Miles and another technician rolled in a portable X-ray machine.
By 4:25 a.m. when the man's fiance arrived, the pictures confirmed the doctors' fears -- a broken neck.
While a state police helicopter landed to transfer the man to Baltimore Shock-Trauma, where there are special facilities for spinal cord injuries, Blair took the girlfriend aside to tell her that the man to whom she was engaged may never walk again.
"It was a routine night," Blair said a short time later, peering into a plastic foam cup of black coffee.