trauma doctor: ‘i was dying’ - emily walkenhorst · 2018. 9. 17. · trauma techniques...

Trauma doctor: ‘I was dying’EMILY WALKENHORSTARKANSAS DEMOCRAT-GAZETTE

Arkansas Democrat-Gazette/THOMAS METTHEDr. Todd Maxson works out at Arkansas Children’s Hospital on Thursday. Maxson helped create the state’s trauma

Arkansas Democrat-Gazette | Tuesday, September 04, 2018 | 1A http://digital.olivesoftware.com/Olive/APA/Wehco/Print.Article...

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Arkansas Democrat-Gazette/THOMAS METTHEDr. Todd Maxson was hit by a drunken driver while driving home on his motorcycle from Arkansas Children’s Hosp

Shortly after a Jeep Cherokee crashed into his motorcycle, ToddMaxson lay in his critical-care hospital bed, broken and bruised all overhis body, and told his wife, Amy, he was going to dance with her again.


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“I thought he was going to die,” she recalled later.

The severity of her husband’s accident was immediately clear, andeven clearer after days of hours-long surgeries.

After being struck by a drunken driver in Little Rock, Maxson, theconsultant for the state’s trauma system and a surgeon who runsArkansas Children’s Hospital’s trauma department, told two passers-byto call 911 and his boss at Children’s Hospital to tell him that he couldn’tbe on call that night.

“I was dying,” he said.

Some say Maxson is alive today because of the trauma system hehelped create. He says the trauma nurses and doctors saved his life andothers.

Maxson was rushed to UAMS Medical Center on the night he was hit.He also worked at UAMS and recognized the faces of colleagues andpeople he once called students rushing him into surgery. Still wearing hisscrubs, Maxson snapped back into his day job, directing people in thetrauma bay and the emergency room.

“I think that helped me keep my focus away from dying,” he said.

The doctors and nurses working on Maxson didn’t let theirrelationship with him get in the way. They are trained in school how tocompartmentalize work and emotions so they can perform at their bestno matter who they are treating.

Maxson was just a guy with a bad pelvic injury and a systolic bloodpressure of only 70.

“He’s just a patient now,” trauma surgeon J.R. Taylor III rememberedthinking.


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CREATED IN ’09

As described by trauma doctors, the trauma system takes entities andtypes of care once isolated from one another and makes them worktogether on the behalf of the patients who need them.

Trauma, as defined in the system, is an injury caused by an externalforce. Such forces include a fall, an accident, a gunshot, a stab wound orsuicide, but not a stroke or an aneurysm.

When Arkansas’ trauma system was created in 2009, ArkansasChildren’s Hospital hired Maxson to run its trauma department. Thestate hired him to be the trauma medical consultant for the system’screation.

Maxson came from Dell Children’s Medical Center in Austin, Texas,which he and a team had just turned into a Level 1 trauma center, the topverification by the American College of Surgeons. Years before, he turnedChildren’s Medical Center of Dallas into a Level 1 trauma center.

At the time, Arkansas was the only state that didn’t have a designatedtrauma hospital, and health officials estimated 1,200 preventabledisabilities occurred in the state each year.

Since 2009, the state has established a trauma communications centerthat helps find the best places to transport patients in an emergency;created a trauma image repository so radiologists can look at an injurybefore the patient arrives at his destination; telemedicine for handinjuries; designated dozens of hospitals as varying levels equipped tohandle trauma (59 currently); and implemented other things such asbracelets identifying trauma patients.

The state also provided as much as $811,550 annually to hospitals foreducation on trauma-care practices and techniques, although that


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funding and its use has declined since rules were changed on how it’sdistributed.

The state spent more than $20 million annually in the height of theestablishment of trauma system components.

Dr. Brian Eastridge, head of trauma research at the University of TexasHealth Science Center San Antonio and a member of the AmericanCollege of Surgeons, said Arkansas has been fairly innovative. He saidthe trauma bracelets are a low-cost and effective way of tracking andidentifying patients quickly.

By 2014, the state had reduced its preventable mortality rate from 30percent to 16 percent, according to a study conducted by the Universityof Arkansas for Medical Sciences and the American College of Surgeonsthat was published last year. The value of those lives in their projectedfuture economic contributions — estimated to be about $186 million ayear — far outweighs the money the state spent on the trauma system,the study determined.

The study analyzed 672 individual cases — considered representativesamples of total trauma deaths — from 2009 and 2013 to 2014.

No independent studies have been done of the trauma system. Whenthe system was created, all records and data related to the system’s or ahospital’s performance were exempted from public disclosure.

Dr. Bill Beck, a trauma surgeon and assistant professor at UAMS, saidhe believes that without the trauma system the state would see higherdeath rates for victims of car accidents or violent crime.

The creation of the trauma system may only be part of the story.

Around the the time the trauma system began, improvements in


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trauma techniques nationwide — learned first from urban U.S. hospitalsand then from wide use at military hospitals during the Iraq andAfghanistan wars — were credited with saving lives, too, said RonRobertson, a UAMS surgeon.

Several shorter surgeries have replaced one large surgery, and patientswho have lost a lot of blood are receiving blood products moreimmediately instead of a saline solution first. Outside the hospital, moreemergency workers, law enforcement officers and everyday citizens arebeing trained in wrapping tourniquets around wounds, which can makethe person’s condition better upon arrival at the hospital.

CARE AND RECOVERY

Maxson was struck by a drunken driver while riding his TriumphBonneville south on Woodrow Street, between Seventh and Lamarstreets just north of Interstate 630, last Sept.

1. It was about midnight and he’d just gotten off work.

A responding police officer concluded that the driver was headingnorth and then entered the southbound lane, throwing Maxson off hismotorcycle and dragging it underneath his sport utility vehicle for 166feet.

Maxson asked first responders to take him to the UAMS hospital,where doctors determined he was suffering life-threatening injuries.Emergency surgeons gave Maxson plasma and stopped the bleeding inhis pelvis, an example of the changes in trauma care nationwide.

In a tumult of five days, Maxson had five surgeries. He would go in forone surgery, go back to the intensive-care unit, resuscitate, and then goback to the operating room.


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Most of Maxson’s body was stabilized on the inside with outsideobjects. He got pins, a rod, stabilization bars in his legs and even a chainon his pelvis, which had to be reconstructed. Doctors had to rebuild anarm and a knee, too.

After being cooped up in the hospital for several days, he developedpsychosis — common in the intensive-care unit, where patients often getlittle sleep — and began hallucinating that the walls were on fire.

So his wife, Amy, took him outside. They got fresh air and posed forpictures, one of which featured Todd smiling in his hospital gown andsitting in his wheelchair.

He looked fine for social media. Maxson’s face was undamaged — hewore a helmet — but he couldn’t walk or move much. He said hereminded himself of “the dead guy in Weekend at Bernie’s .”

After some fresh air and getting out of the ICU, the psychosisdissipated.

And after two weeks at the hospital, Todd and Amy would spendmonths together, closer than ever before. She bought a lift for him to getinto bed, which she and some friends moved to the dining room foreasier access. She bathed him and dressed him.

“It was real challenging there for a while,” she recalled. “I didn’t get outof my pajamas till noon.”

Todd was restless, so Amy rented a wheelchair-accessible van to takehim places to ward off depression. The first day they left the house, heput on a suit and went to watch over Children’s trauma verification inNovember. In the following days, they met up with friends and he wentto work.


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Amy Maxson doesn’t know how other people might have fared in hersituation, especially those who couldn’t afford a lift, which cost about$5,000 without insurance.

“I’m a nurse practitioner, and I don’t know how someone who didn’thave a medical background could have helped him,” she said.

Aftercare could be better set up in the trauma system, Todd Maxsonsaid.

“There’s no part of the health care system tasked with shepherdingpeople post-discharge,” he said. “Complications can arise from notcoordinating care afterwards. People with catastrophic injury or illnessshould have a caseworker.”

Maxson credited the lift and talk therapy with making a big differencein his recovery. He lamented that insurance often doesn’t cover thosethings, and acknowledged his recovery had a lot to do with his havingexperience in trauma medicine and having means. He knew what to do,and he could pay for it.

Without those things, he said, he could still be lying in his bed at home.

“It would have been pretty easy to imagine a scenario in which I’mtotally disabled and unable to go back to work,” he said.

IDEAS FOR IMPROVEMENTS

As the Arkansas Department of Health awaits comment on updatingits trauma-system standards, Maxson has a few ideas for how he thinksArkansas’ trauma system can improve.

For instance, the state’s hospitals could bill insurance for assemblingtrauma teams to treat incoming patients, called trauma activation fees,Maxson said. That would make them money to improve their systems.


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Maxson thinks a trauma doctor should be ready to be at a patient’sbedside within minutes at large hospitals outside central Arkansas, suchas in Jonesboro, Fort Smith and Northwest Arkansas, but they aren’tcurrently required to. Maxson said he benefited from that at UAMS.

In some states, those activation fees have varied widely acrosshospitals and have been criticized for often being exorbitant andnontransparent. Maxson says written rules can prevent abuse, which heagrees has occurred in other places.

Arkansas funds each hospital in the trauma system based on its rating:Level 1 hospitals get $1 million, level 2 get $500,000, level 3 get$135,000, and level 4 get $40,000.

Most states don’t pay hospitals to be in their trauma systems, saidGreg Brown, trauma branch chief for the Arkansas Department ofHealth. Brown believes Arkansas’ setup incentivizes hospitals to be a partof the system. He said some have chosen to withdraw but many of themcome back.

Maxson also thinks the trauma call center should give more advice tohospitals about what services should be available and what patients needas they go through the system, based on the center’s bird’s-eye viewperspective.

Arkansas standards mirror American College of Surgeons standards,Brown said, with a few exceptions. Arkansas has level 4 hospitals, but theAmerican College of Surgeons does not.

Eastridge said he didn’t think Arkansas was behind on any majordevelopments and didn’t think the state needed to make major changesin its upcoming revision of standards.

DANCING AGAIN


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Maxson underwent months of physical therapy sessions. He liftedweights and practiced moving in water. Walking was painful at first.

Nowadays, Maxson says he’s back to dancing, recently with Amy to thetunes of the late Aretha Franklin at their lake house with friends andfamily. He acknowledges he’ll never move like he used to and will likelyneed a cane for the rest of his life. (He still needs two more leg surgeries.)

“But Amy can boogie,” he said. “The woman can get down. So any timeI can dance with her is good.”

A lot has changed for Max-son. He thinks he’s living a better life.

His motorcycle days are over, but he flies planes now. He meditates,reads more and swims. His cardiovascular endurance is better thanbefore, he said.

Maxson also is prioritizing his family more. He and Amy bought ahouse on Greers Ferry Lake for the family to relax.

“It was very unusual for me to have extended blocks of time with them,and I’ve loved it,” Maxson said. “I’ve loved being with them.”

He’s back to doing surgery, which along with teaching is what heenjoys most. Co-workers admire his positive attitude and talk often aboutit when he is and isn’t around.

He now brushes aside little things that used to annoy him and tries tonot have a “destructive and negative” perspective on what’s happened tohim.

“Lying on your back for a couple of months gives you time to reflect,”Maxson said.

He remembers his first few weeks of being injured, worrying about


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what he might never be able to do again and how long it might take himto get back to work. He had been told nine months.

“I was terrified,” he said.

He started working from home after six weeks and was back in theoffice, at least part time, after three months.


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trauma doctor: ‘i was dying’ - emily walkenhorst · 2018. 9. 17. · trauma techniques...

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