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Trauma: Condition critical
Number treated has nearly doubled in past five years One man's journey to life begins at death's door
Greenville News
In a split second, their lives converge.
A mundane trip to Bi-Lo turns tragic for Bill Nichols and his wife, Ruth, when their 1981 Buick collides with another car and crashes into a brick wall.
At Golden Lanes across town, Dr. Rick Miller is enjoying cake and pizza at his youngest daughter's birthday party. Eight-year-old Stephanie has only begun opening presents when her daddy's pager echoes through the Simpsonville bowling alley.
Minutes later, Miller and the Nichols -- strangers until 2:45 p.m. Jan. 8 -- meet in the most unexpected of places.
In the brightly lit trauma bay at Greenville Memorial Hospital, nurses and doctors in gowns and paper booties cut off the Nichols' clothes, insert tubes and begin diagnosing injuries.
It's a place Miller has been hundreds of times during his seven years as one of Greenville Memorial's three trauma surgeons.
Since 1991, when the hospital became a Level 1 trauma center, paramedics have whisked about 8,000 seriously injured people through the automatic sliding doors to the trauma bay.
While some shifts are slow, leaving time to lecture to medical students and check on patients, others are so busy a surgeon must catnap on a twin bed in the trauma services office. The record since the specialized trauma bay opened in 1995 was 17 during a 24-hour shift.
The designated room within the emergency department is kept at 95 degrees to help prevent blood loss and is lined with medical equipment so doctors don't have to move patients from room to room.
Ruth and Bill Nichols are whisked into the room where the trauma team begin evaluating the extent of their injuries.
At the accident scene, Bill appeared pale but OK when two of his daughters, Carolyn Austin and Janice Jones, and son-in-law Frank Watts arrived. The couple were both wearing seat belts at the time of the accident.
But here, X-rays show Ruth has a broken left ankle. Bill, her husband of 53 years, has a broken back, broken neck, cracked sternum and broken ribs.
Broken bones can be fixed.
But when his belly begins to tighten and swell, doctors suspect internal bleeding. It's about 3:30 p.m., more than an hour after the accident and a critical time when doctors must restore vital functions or risk brain damage and possible death.
Minutes later, the space next to Ruth in the trauma bay is empty and the doors close on an elevator leading to operating room 4.
Bleeding won't stop
A dozen nurses and doctors working beneath three round lights vainly try to staunch the bleeding.
At 4:24 p.m., three surgeons discover more than two liters of blood, a torn spleen and a crushed pancreas.
It's nearly 60 minutes past the golden hour.
In urgent motions, the surgeons shove wads of white cotton cloth below and above his organs -- one after another -- while a clear tube suctions blood into a nearby container.
Miller's hands move steadily but swiftly to remove his spleen, an organ that filters and stores blood but isn't essential to live.
"More suture. Big needle," Miller says after placing his spleen in a blue plastic container and moving on to the pancreas, an elongated gland that secretes hormones and glucose and regulates the digestive system.
It's 4:33 p.m. when he finds the vital organ's consistency is like wet toilet paper. The surgeons stitch the pancreas, put staples in it and cauterize it with a laser.
The bleeding won' t stop, but Miller knows he must try. "If I have to keep trying to fix this, he'll die on the table," he says.
Surgeons pack eight pieces of cotton cloth inside Nichols' body and sew him up.
It's 4:54 p.m.
"We're coming back to the O.R. tomorrow," Miller says. "If he survives."
Breaking bad news
Last year, 78 trauma patients treated at Greenville Memorial died. That number has held steady over the past five years, despite the fact the number treated has nearly doubled from 889 to 1,600.
Doctors credit faster response times and improved technology for the better odds.
That doesn't make it any easier for Miller, a runner and father of two, to break bad news to the families and friends who hold vigil in nearby waiting rooms.
On this day, Nichols' family is with Ruth in room 249.
Miller heads down a silent stairwell and then pulls aside family members.
At 5:18 p.m., in a quiet, carpeted hallway, the couple's daughters hear that more than bones are broken inside their father. A granddaughter learns her grandfather may not live through the night.
Miller -- his surgical mask still dangling from his neck -- gives them realistic odds and a glimmer of hope.
"He has a very high risk of not surviving, but he has a chance," he says. "We'll take it one hour at a time."
Tears fall.
Back in room 249, Miller faces the 75-year-old.
"Your husband is real sick," he says softly.
He takes her hand.
"You take care of him," Ruth says.
Miller must then explain that only a few people can visit Nichols in the intensive care unit during these crucial post-surgery hours.
Daughters Kathy Watts and Kandi Ann Nichols, along with grandson Brad Fowler and Watts' husband, Frank, ride an elevator to the fourth floor.
It's 6:04 p.m., and all is quiet in the dimly lit trauma ICU. Like most days, its six beds are full.
Brad, 25, sidesteps a sea of cords and tubes to the left of the bed and leans over his grandfather. The soft whooshing of a ventilator sounds in tandem with the rising and falling of his grandfather's chest.
Kathy, 39, thoughtfully smoothes over her father's soft white hair, and makes a promise to herself that she'll take care of his dogs, a Pekinese named Missy and a poodle named Max.
Family prays
The day after the accident, a drizzly Sunday afternoon, Nichols returned to the operating room.
Earlier that day, just after 3 a.m., Miller's pager beckoned him to the trauma bay to treat two people hurt in a car crash. Police haul one to jail, charging him with drunken driving. Doctors declare the passenger brain-dead and prepare the body for organ donation.
An increasingly tired Miller focuses again on Nichols' internal injuries. He removes the cotton cloth that overnight had acted as a Vise-Grip to stop the bleeding.
"There were a couple more bleeders on the pancreas, and I sewed them up," Miller says. "We put in a feeding tube and got the belly closed."
Nichols' broken neck is put in traction, and tubes are inserted into his badly bruised lungs to drain fluid.
"He's alive and actually getting better, but still having problems neurologically," Miller says.
Bill Nichols' family is spending hours by his side.
"I believe he hears us," says Kathy Watts.
She tells her father that when he gets better, she'll be there with two of his favorite treats -- hot Krispy Kreme doughnuts and ice cream.
Often, her thoughts travel to childhood days, when her father taught her to push the toothpaste from the bottom of the tube, and how to put chains on tires in the snow.
But mostly, she prays.
"I know he hears the prayers," she says. "I tell him to pray in his mind and ask the Lord to heal his body."
A CAT scan reveals her father's brain is bruised.
Sometimes when patients go into shock, they don't get enough blood to the brain. That, combined with the bruising, may have caused him to go into a coma.
If he escapes infection, he will likely need months of rehabilitation.
Four days after the accident, Nichols opens his eyes in front of his surgeon.
It is a brief moment, but a promising one.
Number treated has nearly doubled in past five years One man's journey to life begins at death's door
Greenville News
In a split second, their lives converge.
A mundane trip to Bi-Lo turns tragic for Bill Nichols and his wife, Ruth, when their 1981 Buick collides with another car and crashes into a brick wall.
At Golden Lanes across town, Dr. Rick Miller is enjoying cake and pizza at his youngest daughter's birthday party. Eight-year-old Stephanie has only begun opening presents when her daddy's pager echoes through the Simpsonville bowling alley.
Minutes later, Miller and the Nichols -- strangers until 2:45 p.m. Jan. 8 -- meet in the most unexpected of places.
In the brightly lit trauma bay at Greenville Memorial Hospital, nurses and doctors in gowns and paper booties cut off the Nichols' clothes, insert tubes and begin diagnosing injuries.
It's a place Miller has been hundreds of times during his seven years as one of Greenville Memorial's three trauma surgeons.
Since 1991, when the hospital became a Level 1 trauma center, paramedics have whisked about 8,000 seriously injured people through the automatic sliding doors to the trauma bay.
While some shifts are slow, leaving time to lecture to medical students and check on patients, others are so busy a surgeon must catnap on a twin bed in the trauma services office. The record since the specialized trauma bay opened in 1995 was 17 during a 24-hour shift.
The designated room within the emergency department is kept at 95 degrees to help prevent blood loss and is lined with medical equipment so doctors don't have to move patients from room to room.
Ruth and Bill Nichols are whisked into the room where the trauma team begin evaluating the extent of their injuries.
At the accident scene, Bill appeared pale but OK when two of his daughters, Carolyn Austin and Janice Jones, and son-in-law Frank Watts arrived. The couple were both wearing seat belts at the time of the accident.
But here, X-rays show Ruth has a broken left ankle. Bill, her husband of 53 years, has a broken back, broken neck, cracked sternum and broken ribs.
Broken bones can be fixed.
But when his belly begins to tighten and swell, doctors suspect internal bleeding. It's about 3:30 p.m., more than an hour after the accident and a critical time when doctors must restore vital functions or risk brain damage and possible death.
Minutes later, the space next to Ruth in the trauma bay is empty and the doors close on an elevator leading to operating room 4.
Bleeding won't stop
A dozen nurses and doctors working beneath three round lights vainly try to staunch the bleeding.
At 4:24 p.m., three surgeons discover more than two liters of blood, a torn spleen and a crushed pancreas.
It's nearly 60 minutes past the golden hour.
In urgent motions, the surgeons shove wads of white cotton cloth below and above his organs -- one after another -- while a clear tube suctions blood into a nearby container.
Miller's hands move steadily but swiftly to remove his spleen, an organ that filters and stores blood but isn't essential to live.
"More suture. Big needle," Miller says after placing his spleen in a blue plastic container and moving on to the pancreas, an elongated gland that secretes hormones and glucose and regulates the digestive system.
It's 4:33 p.m. when he finds the vital organ's consistency is like wet toilet paper. The surgeons stitch the pancreas, put staples in it and cauterize it with a laser.
The bleeding won' t stop, but Miller knows he must try. "If I have to keep trying to fix this, he'll die on the table," he says.
Surgeons pack eight pieces of cotton cloth inside Nichols' body and sew him up.
It's 4:54 p.m.
"We're coming back to the O.R. tomorrow," Miller says. "If he survives."
Breaking bad news
Last year, 78 trauma patients treated at Greenville Memorial died. That number has held steady over the past five years, despite the fact the number treated has nearly doubled from 889 to 1,600.
Doctors credit faster response times and improved technology for the better odds.
That doesn't make it any easier for Miller, a runner and father of two, to break bad news to the families and friends who hold vigil in nearby waiting rooms.
On this day, Nichols' family is with Ruth in room 249.
Miller heads down a silent stairwell and then pulls aside family members.
At 5:18 p.m., in a quiet, carpeted hallway, the couple's daughters hear that more than bones are broken inside their father. A granddaughter learns her grandfather may not live through the night.
Miller -- his surgical mask still dangling from his neck -- gives them realistic odds and a glimmer of hope.
"He has a very high risk of not surviving, but he has a chance," he says. "We'll take it one hour at a time."
Tears fall.
Back in room 249, Miller faces the 75-year-old.
"Your husband is real sick," he says softly.
He takes her hand.
"You take care of him," Ruth says.
Miller must then explain that only a few people can visit Nichols in the intensive care unit during these crucial post-surgery hours.
Daughters Kathy Watts and Kandi Ann Nichols, along with grandson Brad Fowler and Watts' husband, Frank, ride an elevator to the fourth floor.
It's 6:04 p.m., and all is quiet in the dimly lit trauma ICU. Like most days, its six beds are full.
Brad, 25, sidesteps a sea of cords and tubes to the left of the bed and leans over his grandfather. The soft whooshing of a ventilator sounds in tandem with the rising and falling of his grandfather's chest.
Kathy, 39, thoughtfully smoothes over her father's soft white hair, and makes a promise to herself that she'll take care of his dogs, a Pekinese named Missy and a poodle named Max.
Family prays
The day after the accident, a drizzly Sunday afternoon, Nichols returned to the operating room.
Earlier that day, just after 3 a.m., Miller's pager beckoned him to the trauma bay to treat two people hurt in a car crash. Police haul one to jail, charging him with drunken driving. Doctors declare the passenger brain-dead and prepare the body for organ donation.
An increasingly tired Miller focuses again on Nichols' internal injuries. He removes the cotton cloth that overnight had acted as a Vise-Grip to stop the bleeding.
"There were a couple more bleeders on the pancreas, and I sewed them up," Miller says. "We put in a feeding tube and got the belly closed."
Nichols' broken neck is put in traction, and tubes are inserted into his badly bruised lungs to drain fluid.
"He's alive and actually getting better, but still having problems neurologically," Miller says.
Bill Nichols' family is spending hours by his side.
"I believe he hears us," says Kathy Watts.
She tells her father that when he gets better, she'll be there with two of his favorite treats -- hot Krispy Kreme doughnuts and ice cream.
Often, her thoughts travel to childhood days, when her father taught her to push the toothpaste from the bottom of the tube, and how to put chains on tires in the snow.
But mostly, she prays.
"I know he hears the prayers," she says. "I tell him to pray in his mind and ask the Lord to heal his body."
A CAT scan reveals her father's brain is bruised.
Sometimes when patients go into shock, they don't get enough blood to the brain. That, combined with the bruising, may have caused him to go into a coma.
If he escapes infection, he will likely need months of rehabilitation.
Four days after the accident, Nichols opens his eyes in front of his surgeon.
It is a brief moment, but a promising one.