Behind The Scenes

It’s 10:30 on a Saturday night, and University of Cincinnati Medical Center trauma surgeon and UC College of Medicine professor of surgery Dr. Jay Johannigman has just spent nearly three hours repairing the intestines of a young patient who was whisked into emergency surgery.

As the team around him counts every instrument and towel to ensure they’re accounted for, Dr. Jay, as he is known, asks for a pack of sterile wipes. He gently cleans the torso of the patient, who is then personally escorted by Dr. Jay to the Surgical ICU to spend the night recovering from the procedure.

Dr. Jay has already been on duty for 14 hours, but as the attending surgeon, his work is far from finished. Over the next eight hours, he will be called to the Emergency Department (ED) multiple times for acute trauma injuries, oversee the resuscitation of a patient whose heart has stopped and conduct another life-saving, four-hour surgery.

It’s a pretty typical night in Greater Cincinnati’s only adult Level 1 Trauma Center, where surgeons and a team of professionals are standing by 24/7, ready for anything.

"Most people don’t realize that, at midnight on a Saturday night, there are probably 70 people here working to keep them safe — the best trauma team in the region," Dr. Jay said.

At an academic healthcare system like UC Health, that team includes capable fellows and residents, licensed physicians who are completing specialized training. On this particular night, the trauma surgery team includes fellow Dr. Josh Person, chief trauma resident Dr. Teresa Rice and resident Dr. Jared Ham. Working as a single team in concert with emergency medicine physicians and highly trained shock resuscitation nurses, the trauma team needs to be ready to handle anything at a moment’s notice.

"The Emergency Department is the gateway to the hospital,” said Dr. Ham, a second-year ED resident who is completing a rotation on the trauma service. “You don’t know what’s going to come through the door — it could be anything, day or night. To be an emergency physician, you have to be able to establish a quick rapport with someone on what’s probably the worst day of their lives."

In addition to the trauma and emergency medicine teams, a fleet of nurses, anesthesiologists, respiratory therapists, radiologic technicians, pharmacists, social workers and many others work to ensure each patient receives the best possible care no matter the hour. This care begins with the first responders in our community: the police, firefighters and EMS personnel who provide life-saving care before the patient even arrives at the hospital.

On this particular Saturday night, the UC Medical Center ED will see dozens of cases, including victims of car crashes, motorcycle and ATV crashes, and other forms of trauma.

Defined as an unanticipated injury, "trauma" spans the entire spectrum: from a fall from standing height, to industrial accidents, to car crashes and assaults. Over the course of a single year, the UC Medical Center’s Level I Trauma Center will evaluate more than 4,000 seriously injured trauma patients, most of whom arrive through the Emergency Department.

Not every patient ends up on Dr. Jay’s operating table. But every patient who arrives with the label "acute trauma" gets a visit on this night from Dr. Jay, whose three decades of trauma experience, including extensive military service, enable him to assess a case quickly. As the faculty trauma surgeon on duty, he will personally respond to every "trauma stat" page.

At 8:59 p.m., the operating room fills with the sound of the trauma pager beeping.

"It’s a stat: fall, ladder, ETA 15 minutes," reports Linda Beerman, RN, the operating room circulating nurse.

At 9:15 p.m., Dr. Jay strides down the hospital’s nearly empty corridors to the ED, stopping briefly for a Diet Coke to help refuel for the night ahead.

In the ED, a team is already reviewing the patient’s records. After a quick consultation, Dr. Jay approaches the gurney and greets the patient, who is alert enough to engage in conversation. Within just a few minutes, the veteran trauma surgeon is working with Dr. Ham to stitch up a sizable gash in the patient’s head.

At this time of night, most people in Cincinnati are sleeping safely in their beds. Inside UC Medical Center, however, a team of hundreds — physicians, nurses, respiratory therapists, radiologists, pharmacists, social workers and others — are working around the clock to save lives.

It’s 2:30 a.m., and pagers across UC Medical Center begin to beep insistently with a message that a surgical patient on the second floor needs urgent, life-saving care.

Two nurses run by at full speed as Dr. Jay continues his brisk, steady pace toward the room with the flashing lights: White, green, red, red. White, green, red, red. The lights and the sound of calm, but loud, voices in the patient’s room show the intensity of the situation — a "code," in hospital-speak.

The patient’s heart had stopped beating in the middle of the night, and Dr. Ham and others gathered in the room are performing chest compressions.

Dr. Jay enters the room and takes a position at the head of the bed.

"May I see the monitor, please?"

Then: "Epi, please."

After only a matter of seconds, Dr. Jay determines that the patient needs an airway. He carefully inserts a tube into the patient's trachea, creating a pathway to provide the patient with oxygen. These and other efforts would ultimately save the patient’s life that night.

Afterward, Dr. Jay heads back to the OR, while Dr. Ham heads for the trauma residents’ lounge to refuel with a salad while completing notes and reviewing scans in his patients’ charts.

Ever the teacher, Dr. Jay has answered many questions already tonight. But while striding down the same hallway he’s traveled at least six times already, he fields one more:

"Do you ever get used to being wide awake in the middle of the night?"

"It’s like being in Las Vegas," he jokes. "There are very few windows, so you don’t actually know what time it is."

Among the two dozen operating rooms on the second floor of UC Medical Center is one that has a single word on the door: “Trauma.” No matter what else is happening in the hospital, that room is reserved 24/7/365 to provide emergency surgical care to trauma patients.

Tonight, Dr. Rice and Dr. Person are in the third hour of surgery to reconnect parts of a young patient’s small intestine, which had been separated as a result of multiple gunshot wounds. The patient has already undergone one surgery, and there are likely more in the future.

The surgeons move in perfect harmony. They work calmly and quietly together, both fully focused and using a myriad of skills to suture, tie, staple, cut and repeat as two pieces of intestine are returned to a continuous tube, repairing the patient’s digestive tract.

Light jazz music had been playing earlier, but now the only sound in the room is the steady beep of the heart monitor as the two surgeons, a scrub nurse, anesthesiologist and circulator — a nurse assigned to keep the flow moving and replenish supplies — focus upon their patient.

Multicolored cords hang like long, tangled hair from a mobile computer station near the head of the bed. Every now and then, Dr. Rice lifts a foot and rotates her ankle.

"Time to scan," says Lin, the scrub nurse.

Everyone takes a step back from the bed as Dr. Rice sweeps a large, circular, wand-like instrument over the patient’s open cavity three times, listening for an indication that a microchipped sponge or gauze might have been missed in the visual inspection. Hearing no beeps, the surgeons begin the work of closing the incision that extends from the patient's breast to belly.

For Dr. Jay and many other physicians at UC Medical Center, teaching young physicians this delicate dance — a surgical ballet, you might say — is what sets an academic hospital apart from others.

Teaching as part of an academic care model is a primary reason a majority of the faculty across all disciplines choose to work here,” he said. "We try to teach the young physician the responsibility and privilege it is to care and operate on a patient. We also try to build into them a bit of a 'worry index' so they remain vigilant and watchful."

It’s a lesson the physicians studying under Dr. Jay have taken to heart.

Standing just outside the OR doors, never losing sight of her patient, Dr. Rice is asked how she is able to maintain such focus and calm while handling organs inside of a living person.

"You can’t ever disconnect," she replies. “If this were my parent on the line, I wouldn’t want someone to disconnect. I never forget that this is a person.”

It’s 4:30 a.m., and Dr. Jay has just finished caring for a patient who had been in a traffic crash earlier in the night and was transferred to UC Medical Center from a community hospital.

Dr. Jay had been worried about the patient for hours, even hopping on the phone with the referring hospital to track down important medical records.

It took longer than Dr. Jay would have liked, but the patient was eventually stabilized and taken to the second floor Surgical ICU, where Dr. Ham and the trauma team would continue to monitor the patient's condition.

Back in the OR, Dr. Jay takes a thorough look at the X-rays of his patient and checks on the progress of Dr. Rice and Dr. Person. The surgery is concluding exactly as it should, so he logs onto the hospital’s electronic medical record system to check the charts of the many other trauma patients under the care of his team.

The “worry index” is relieved — for now.

A little bit later, Dr. Jay is spotted at a desk on the fifth floor, bent over with his head on his arms.

After all, even surgeons need their sleep.