TBO.com - TBO is Tampa Bay Online

Trauma And Teamwork: VA Hospital Leads Way In Treatment

ADVERTISEMENT

By LINDSAY PETERSON

lpeterson@tampatrib.com

Published: October 25, 2008

Updated: 10/25/2008 12:14 am

TAMPA - Physician Steven Scott had never seen soldiers with these kinds of wounds. Burns combined with head injuries, shattered limbs and lacerations from flying shrapnel.

They began arriving at the James A. Haley Veterans' Hospital in 2003, and their numbers rose as the Iraq invasion spawned a vicious insurgency with a new weapon, the roadside bomb, or IED, improvised explosive devise.

"These were catastrophic injuries," said Scott, 58, chief of physical medicine and rehabilitation at the Tampa veterans' hospital. "We had to change our way of treating people." So he began to reach through the barriers that separated the hospital's medical disciplines.

Scott pulled together teams of therapists, neurologists, orthopedists and others into the beginnings of what would become a new model of care for wounded soldiers. Instead of each doctor seeing patients separately and coming up with separate diagnoses and treatments, doctors, nurses and therapists began combining their knowledge to sort through the complications, often gathering around the soldiers' bedsides.

In a medical world defined by specialization, the collaboration came naturally to Scott. He's an osteopathic doctor, trained to work holistically.

"As you start to look at people holistically, you have to look at every type of problem they have," he said.

Today, he leads the Department of Veterans Affairs' Polytrauma Rehabilitation Center in Tampa, one of five across the country dedicated to treating the most severely wounded soldiers from Iraq and Afghanistan.

The idea for the centers began with a group of doctors and therapists at the small conference table in Scott's windowless office in the hospital.

"We needed everyone to be involved with this," Scott said.

The son of a veterinarian, Scott was drawn to this kind of collaborative medicine from the beginning of his career, he said. Its goal was simply to help people heal and live their lives. "To me that's what it was all about. ... Isn't that what we're all about in this country?"

Scott served his residency in physical medicine and rehabilitation at the Mayo Graduate School of Medicine, in Rochester, Minn., and spent eight years at the Mayo clinic before coming to the Tampa veterans hospital in 1990.

He was always busy, but since the Iraq casualties began arriving, "it's been full-speed, 24/7," said hospital spokeswoman Carolyn Clark.

"The important thing to understand is that we are in a war," Scott said. "We know that as the war on terror continues, we are going to see even more of these blast injuries in the future."

In 2003, when the first Iraq soldiers began coming to Haley, the great fear was a terrorist with a container of anthrax, or some other deadly chemical, Scott said. The blast injuries caught doctors unaware, even though for decades, fighters from Ireland to Lebanon have been waging war by planting explosives in public places.

"When we first started to see these injuries we went to the medical literature and there wasn't much written about them," Scott said. "Nobody was doing any kind of research. ... I was overwhelmed."

Cascade Of Injuries

In 2004, then-Florida Sen. Bob Graham asked Scott how he could help the hospital deal with these new cases. He proposed legislation that shifted resources to the Tampa veterans' hospital for a center to study blast injuries.

"We copied thousands of pages of research and got people all over the hospital reading," Scott said.

Bombs have been used for hundreds of years to kill people in war. The bombings in Iraq and Afghanistan would have killed more soldiers, if not for advances in military body armor and battlefield care.

In the cascade of injuries people suffer in explosions, Scott said, the most fearsome and complicated is head trauma. Scott calls it the "signature wound" of the Iraq war because it affects so many soldiers and affects nearly every aspect of their treatment and rehabilitation.

It's one thing to heal someone to the point where he can take a shower on his own. But imagine the soldier getting into a shower and not knowing what to do with the soap.

As the specialists at Haley talked about the myriad effects of blasts on the body, they envisioned a whole new kind of rehabilitation center, one devoted to polytrauma. Soon the VA created polytrauma rehabilitation centers in Tampa and three other cities, Richmond, Va., Minneapolis, and Palo Alto, Calif. Since then, a fifth has opened in San Antonio.

"This is new territory in the practice of medicine," said Michael Kussman, retired Army brigadier general, doctor and the VA's undersecretary for health. The VA "is seeing heart-breaking and extremely difficult cases, but we also are seeing remarkable success stories."

On any given day, Haley has about 20 polytrauma patients; about 400 have come to the center over the past five years. The multiple specialists and therapists who see them share one goal: To help the soldiers go home with as much control over their lives as possible.

Many have none when they arrive.

When Army Sgt. Garry Thompson entered the hospital, Scott didn't expect to ever see him on his feet.

Thompson, 41, with a military police company in Afghanistan, was shot through the spine by a would-be suicide bomber, who was killed before he could detonate his explosives.

Thompson had no idea how badly he was injured until he saw the blood trailing out of his body as one of his troops dragged him to safety.

But after less than five months at Haley, he is getting ready to go home, to Cocoa Beach. The key has been a nonstop work schedule in the hospital's gym, full of high-tech rehabilitation equipment - including a wheelchair that works merely on puffs of air through a straw.

Expecting The Impossible

One of Scott's jobs is to keep the soldiers pushing.

"We get to go home at night," he said. "But these people are still here. And when they wake up at 3 a.m. and can't think or don't know why they should keep going, they need something, any little thing to keep them stretching."

During Thompson's treatment, Scott learned he loved the Green Bay Packers, so he began quizzing him on famous plays and player statistics.

"He helped me with my memory skills without me ever knowing it," Thompson said.

Thompson swore to Scott that he was going to walk out of the hospital. Scott was skeptical. But one day recently, Thompson met Scott in the hospital's gym to show him what he could do.

Sitting in a wheelchair, Thompson positioned a walker to help him stand up. Scott teased him, in his gentle but prodding way, as Thompson fumbled at first to get the walker in place. "I don't want to put any pressure on you but Christmas is pretty good in the hospital."

Thompson lifted himself up and slowly moved one leg forward, then the other. "Keep coming," Scott said, studying Thompson's feet as he took another step, and another, leaning heavily on the walker.

Thompson couldn't use his ankles to control his feet, but with persistence, Scott predicted, he'd reawaken those neural connections, as he did the connections that enabled him to regain the use of his legs.

"Now here's your challenge," Scott said after Thompson had gone about 15 feet. "In another year, I want you to come back and run to me."

In addition to the challenge, Scott had a gift for Thompson - his pick of one of four collector Packer trading cards, Bart Starr, Herb Adderley, Jim Taylor and Paul Hornung. They came from Scott's personal collection.

Thompson grinned like a kid, flipping from card to card. Scott said he's convinced Thompson will soon be free of his walker. "He's going to walk independently. I know that. But I want more than that.

"These are exceptional people," he says. "I don't think America understands how exceptional these people are. In combat we ask them to do impossible things, and they do it. So why not in rehab?"

Reporter Lindsay Peterson can be reached at (813) 259-7834.

Loading Comments...

Email Print

ADVERTISEMENT