In the Heart of Trauma
It was barely dawn that July morning when Mary Dufour began her 15-mile commute from Parker, Colorado, to the Medical Center of Aurora. With little traffic and clear roads, Dufour estimated the trip would take less than 25 minutes, leaving her plenty of time to prepare for the day's first heart surgery.
An operating room nurse with 15 years' experience, she knew it would be a busy day.
What Dufour had no way of knowing was that a medical condition would cause her to lose consciousness just moments later. Her Chevy Malibu would cross three lanes of traffic and crash into a 16-inch gas pipeline, mangling the concrete-reinforced steel cage surrounding it. The forceful impact would collapse her lungs, lacerate her spleen and liver, break all of her ribs, and shatter her right leg.
Orthopedic surgeon, Patrick McNair, M.D., would later tell Dufour her left arm required three metal plates and 23 screws to reconstruct. Her right thigh bone, he added, was "in too many pieces to count."
While Dufour's orthopedic trauma was beyond severe, the most life-threatening effect of the crash would prove to be an aortic transection-a transverse tear across the large trunk artery that transports blood from the heart to the branch arteries.
The injury is one seen most often in multitrauma high-speed car accidents and major blunt thoracic trauma, explains cardiovascular surgery nurse practitioner Christie Kanka, RN, MSN. "If you're going 70 miles an hour and come to a sudden stop, there's a shearing force on the body's soft tissues." Kanka adds that Dufour's transection was just beyond the aortic arch where the arterial ligament attaches-an area particularly vulnerable in such traumas.
So, Dufour notes-a full year of recovery later, and with a hint of irony in her soft voice-she would be in a cardiac operating room much of that day. But it would be at St. Anthony Central Hospital. And she would be the patient on the table.
Top flight to T-10
Dufour was taken by ambulance from the accident scene to Littleton Adventist Hospital, then transported by Flight For Life Colorado to the Level I Trauma Center at St. Anthony Central Hospital. The severity of her trauma made her a prime candidate for treatment in T-10, Colorado's first dedicated trauma-operating suite (see sidebar). Trauma surgeon Robert Madayag, M.D., took charge of the case, working with vascular surgeon Jon Burch, M.D. Given the critical concern of the aortic transection, they decided Dufour should proceed to the dedicated cardiovascular surgical suites, where E. Lance Walker, M.D., was just completing another open heart surgery.
Dr. Walker and his surgical team would spend the next eight hours repairing the transection. Dufour would spend the next three weeks in ICU.
"Each of the groups involved in my care came to see me there," Dufour notes. "There were so many."
It's not just the number of individuals involved in Dufour's survival that Dr. Walker finds powerful, but the seamless collaboration across disciplines and departments.
"The success rate in a surgery of this type really depends on the whole team," he states. "We can manage that torn aorta-we've got lots of experience in that area. But it's the start-to-finish coordination that's critical. From prehospital to emergency, anesthesia, surgery, orthopedics, ICU and beyond-it's everyone at every step. And we have strengths in every position."
Pamela Bourg, RN, MS, director of the Trauma program at St. Anthony Central Hospital, takes it a step further. "Mary Dufour's story is remarkable. It does show how integrated our services are. But what I'd like people to know is that are stories like this being written here every day of the year."
Written by Carla Carwile