Donna Rogers doesn't remember attending a rally in Reno called Street Vibrations, and she can't recall her last ride on the back of her husband's motorcycle. That's because on Sept. 29, 2002, as the couple headed home from the event on Highway 88, they smashed into the side of a mountain. Her husband merely broke his leg, but Rogers landed on a boulder – in a sitting position – and blacked out. Speaking about it now, she reflects, "You read about these kinds of accidents and you say, 'oh those poor people, that will never happen to me.' But it did."
Rogers was rushed to UC Davis Medical Center, which has the only Level 1 trauma center in the region east of San Francisco, south of Portland, west of Salt Lake City and north of Los Angeles. The American College of Surgeons gives this designation to institutions that offer a full array of emergency and ancillary services 24/7. Moreover, Level 1 trauma centers must be research institutions that use the latest, cutting-edge technologies – exactly what Rogers needed.
The 45-year-old woman from Merced arrived at UC Davis bleeding profusely from a huge laceration that ran up her back from her buttocks to her shoulder. She had no detectable blood pressure, and her pulse was barely palpable. Within 10 minutes, UC Davis trauma surgeon Lynette Scherer and a team of nurses, anesthesiologists and orthopaedic surgeons were operating on Rogers. They stopped the arterial bleeding using a technique called pelvic embolization, which involves using dyes to locate damaged arteries and then injecting gel foam pellets to initiate clotting.
Orthopaedic surgeon Philip Wolinsky then stabilized her shattered pelvis with a cage, and that helped control additional bleeding from the bones and veins. The team gave Rogers 100 units of blood products in the first 24 hours, and performed a colostomy because her rectum had been massively injured. Then Rogers went to the hospital's intensive care unit, where the health-care team continually warmed her up, kept her hydrated and supported her breathing with a ventilator. She was put in a chemically induced coma.
On the brink
Scherer told Rogers' family – including two sons, 13 and 15 years old at the time, and a 24-year-old daughter who had to help make medical decisions for her mother – that she had a 50/50 chance of survival.
"I think in a lot of hospitals she would have died," Scherer says now. "She survived because she came to a place that knew how to treat this. And she didn't have to wait for anything because everything needed to save her life is right at our fingertips."
Once her bleeding was controlled and blood pressure improved, Rogers still faced terrible odds in fighting off the infections that inevitably set in. During seven weeks in a coma, she underwent 11 surgeries and required care from eight groups of medical specialists that included trauma, interventional radiology, rehabilitation, physical therapy, surgical ICU nurses, orthopaedic surgery, reconstructive plastic surgery and wound-care specialists.
Now four years after the accident, Rogers jokes that her body looks like a roadmap of LA, yet she has never looked back. In fact, she's so grateful that every year she sends flowers to all the nurses and doctors on the anniversary of her accident.
"If it weren't for Dr. Scherer and the wonderful staff, I wouldn't be here," Rogers says. "I was like Humpty Dumpty. It would have been so easy for them to just sign me off, but they didn't."
By saving Rogers – and many others who seem to have little chance of surviving – UC Davis' trauma center has helped to lower the region's preventable death rate from trauma. When the program was established in the mid-1980s, Sacramento County's rate was 16 percent. UC Davis now maintains a preventable death rate of less than 1 percent. Trauma surgery professor David Wisner attributes this success to strong teamwork. Everyone on the trauma team takes part in decisions and knows the plan of care, he notes.
"It's much better for the patient," says Wisner. "We can do a more caring job."
For instance, the nurses not only attend to the patient, they also care for the patient's family.
"It's one of the things we do, and we do it well," says Bonnie McCracken, UC Davis' manager of trauma and orthopaedic nurse practitioners. "We make sure the families understand what's going on."
Such support was crucial in the case of Jeff Mains, a Sacramento native who was driving to the store on the evening of Sept. 9, 2001, and got caught in a shootout on Folsom Boulevard. A bullet pierced his truck door and his stomach. The 27-year-old plumber arrived unconscious at UC Davis with "penetrating trauma," unlike Rogers who had "blunt-force trauma" from a motor vehicle accident. The trauma team handles more cases like Rogers', which now make up about 85 percent of their caseload. But they're also experts in handling the 15 percent with injuries from gunshots and knives.
Wisner operated on Mains to remove the bullet and rebuild his stomach, repair his liver and fix his damaged intestines. And then with the help of nurses and other allied health-care professionals, Mains spent two months battling vicious infections. He recalls a scene during that period: "Every patient in trauma had a different set of problems. The staff was scrambling all night long. They had a helluva job! But one guy sat with me all night once when I had severe pain. That's the kind of care they gave." While Mains had been unconscious, the terrorist attacks on Sept. 11 occurred and that put extra stress on his family.
"It was a tough time for everyone," he recalls.
Holding everything together at these crucial moments is a core trauma team made up of 10 doctors and 13 trauma nurse practitioners (NPs). What's remarkable is that all of the trauma NPs bring a variety of experience and training to this specialized patient care, all of the doctors perform both trauma and emergency surgery (such as appendectomies and cholecystectomies), and all have been working here a long time – 10 years on average.
Their collective experience and training helps explain how they keep up with one of the nation's busiest trauma centers. In 2006, UC Davis admitted 3,500 trauma patients, which puts it in the nation's top five. That's a lot more patients than the 2,600 the hospital admitted a few years earlier.
"The numbers have mostly been going up," says Cheryl Wraa, UC Davis trauma program manager.
Critical to region
As California's population grows, so will the need for trauma care in the Central Valley.
"The public has come to depend on the trauma care we offer, like they depend on the fire department or the police," says Wisner. "You don't know how important it is until you need it."
That point is not lost on Mains, who says, "I'm a very lucky person; I don't think I would have lived if I hadn't gone to UC Davis."
Indeed, both Wisner and Scherer say that their greatest reward is fixing up injured people like Mains and Rogers and then watching them go forward with their lives.
"Trauma often affects people during their most productive years," says Scherer. "To preserve our healthy young population, we need to be able to help make them well when catastrophe strikes."
UC Davis' trauma center has immense value to individuals, but also to the region and its communities. Mains, now 32, says life became particularly sweet after his injury; he was inspired to study art and now works at the Crocker Art Museum. Rogers, now 49, has also started a new career path – in an accounting firm. But her experience at UC Davis had another, perhaps greater, impact.
"The nurses were so good to me and my family that my son Donny has decided to take courses to become an R.N. – and he wants to work in trauma at UC Davis," Rogers says proudly. "The experience was not only life-changing for me, but for my whole family."