By Anne Bennett Swingle | Photographs Keith Weller
At Hopkins Hospital, Trauma Chief Eddie Cornwell, the attending on call, is in his office on Osler 6 when his beeper goes off. At age 42, he’s still wiry, athletic and full of energy, which helps since he has just five minutes to run down six flights of stairs, sprint through a subterranean hallway, swipe his badge at the ED’s internal entrance, and take charge of whatever rolls in on the gurney.
The 16-year-old comes in first. A lucky gunshot to the head, Cornwell says, examining the laceration near the boy’s ear. There’ll be no need to admit him. The older man, though, is a different story. His name is Frank Rose (changed for this article). He’s been shot five times, and one of the bullets has left him with a major injury in the left shoulder. The arm is completely flaccid. The bullet, bright and opaque on the X-ray, is lodged between the upper and middle branch of the brachial plexus. These intricate nerve trunks give movement and sensation to the muscles of the chest, shoulders and arms. Cornwell suspects extensive injuries to the arteries and nerves and knows he’ll have to operate immediately to save the arm.
A Genuine, Good Man
Eddie Cornwell came to Hopkins in 1998 from the trauma center at Los Angeles County/University of Southern California Medical Center, a place that treats a vast number of injuries, including some 1,200 gunshot wounds a year. (Hopkins treats about 320.) Cornwell, in fact, has spent his entire career at level I trauma centers, the high-volume units commonly affiliated with academic medical centers where victims of the worst kinds of accidents usually are treated. In the process, he earned a national reputation as a trauma surgeon of extraordinary talent.
So, a couple of years ago when Surgeon-in-Chief John Cameron began looking for someone who could build the Hopkins service, Cornwell was a natural for the job. The state of Maryland’s emergency medical service was about to name Hopkins a Level I Trauma Center, a designation chiefly dependent on a hospital’s ability to provide round-the-clock care to the most severely injured patients by a variety of specialists. The certification also requires that the center participate in research, public education and outreach. So, besides wanting a trauma specialist who could handle the volume of patients flowing in from all over the area, Cameron wanted a researcher who could forge bridges with the community.
Cornwell does all that and more. Activity on the trauma service is up by about 25 percent in the last year. The adult trauma center evaluated approximately 2,300 accident cases and admitted about 850 of them to the Hospital. Cornwell’s trauma team now consists of six full-time surgeons, one of whom is on in-house duty 24 hours a day. And just as he did in LA County, Cornwell is volunteering with nearby youth groups.
Cornwell thrives in the environment of a large inner-city academic medical center. In the 16 years since he took his first position, he’s performed specialized surgeries and carried out research that is changing the approach to trauma patients. He is immensely popular among residents. “I’ve never known him to be put off by my asking questions or calling him at midnight,” says assistant chief of service Bob Moesinger. “He’s a genuine, good man, who also happens to be fun to hang out with.”
And whereas many surgeons wouldn’t consider working at an inner-city hospital where injuries often result from drug-related violence, for Cornwell, the gritty world of the big city—home to so many large university-affiliated trauma centers—is everything he’s ever wanted. “I’ve been around cities all my life,” says the Washington, D.C., native. “This is where you do trauma. This is where you can make a contribution.”
“The Wrong Crowd”
“We had to take him up [to the OR] to save the arm,” Cornwell is explaining to Frank Rose’s mother in the general operating room waiting area. “It was challenging, but he tolerated it well.”
Cornwell and the chief surgical resident had found the bleeding artery in the brachial plexus, removed the injured portion and performed an arterial graft. It was a tedious, five-hour procedure, but when the patient came out from under the anesthesia, he moved his hand and had pulses. That was a high point, a small celebratory moment. Rose’s other gunshot injuries in the arm, leg and face were not serious—not even the one that had gone in through the nose and wound up at the base of the brain. Miraculously, that one had caused little more than a soft tissue wound.
That’s the beauty of a bullet. It goes in hot, sterilizes adjacent tissues and quite comfortably remains inside the body for a lifetime. “We don’t chase bullets,” Cornwell always says. “We fix the structures they injure.”
Now, talking to Rose’s mother (in 16 years, Cornwell has almost never seen a father), he lays it out in honest terms. “He’s had lots of injury, but he’s got youth on his side. We’re hopeful.”
She responds predictably: “Frankie’s a good boy, but he got mixed up with the wrong crowd.” That’s an old one, Cornwell thinks. “I know the ‘wrong crowd’ is out there, but no one who comes into my hospital ever seems to be part of it.”
Meanwhile, the police are waiting in the hall. They have asked that the patient’s right hand, his shooting hand, be covered during surgery to preserve possible traces of gunpowder.
A nurse beeps from the OR. The patient is bleeding. Cornwell strides back down the hall, past the waiting cops. “He’s bleeding from the wound,” he says. “We have to go back in.”
One policeman exclaims: “If you’d take away the drugs, you wouldn’t have this!”
In operating room 1, the surgical nurses are again following their memorized checklists, breaking out supplies, padding about in their paper booties, deftly stepping over the network of cords and tubing scattered about on the floor. Plastic bags filled with plasma and blood hang at the ready. Like a busboy preparing to set the tables in a big family restaurant, the surgical tech brings in a big wire basket neatly stacked with rows of stainless instruments. Chief surgical resident Susan Demeester paints Rose’s rich brown skin, studded now with dozens of silvery staples, with an orange antibacterial solution. It gleams garishly in the brilliant light.
It is 8 p.m. Even before the incision is completely open, blood spurts out, an astonishing red, soaking the sterile drapes and splashing the surgeons’ plastic face shields. The graft, though, has held. Taking care not to damage it or the intricate network of nerves in the brachial plexus, the surgeons pick their way down into the wound in search of the tiny bleeding artery. There is a subtle sense of urgency in the air as Cornwell hunches over and probes the wound and the minutes turn into hours.
Meanwhile, the patient’s mother is still in the waiting room. The police continue to stand by in the hallway. They are tired of the small, unforgiving chairs, of the fluorescent lights, the mindless banter with the residents who occasionally pass by.
Back in the OR, the monitors beep out an entire language, decipherable only to the anesthesiologist. A suction device slurps blood. At last, with the Doppler confirming the healthy sound of a pulsing swoosh of blood as it courses through the wrist, the operation is nearly over. At 11 p.m., Cornwell emerges from the OR. For eight hours, he has operated on this patient, and now as he passes the policemen on his way to the waiting room, one leaps off his chair, raises a clenched fist and points in the direction of the OR. “He’s a killer!” he yells.
Medics in an Unwinnable War?
Johns Hopkins is a place where inner city trauma patients receive state-of-the art care. “Our job is to do the best for every patient. We really don’t want to know who they are or what they were doing,” says ACS Moesinger. “We try to distance ourselves.” Cornwell does not know, for example, nor does he care to, that this patient has a rap sheet with a long string of charges, including one for attempted murder. Just four years ago, in fact, he was the shooter whose victim was saved by surgeons in this very operating room.
Despite their resolve, the surgeons sometimes can’t help but feel, as Cornwell himself has written, “like medics in an unwinnable war, resuscitating and patching up one victim after another.” Says Demeester: “We fix them up and send them right out again, and they’re involved in things they shouldn’t be doing.”
At Hopkins, says Cornwell, “the disenfranchised find the elite of the elite.” But in this crucible, it’s easy for practitioners to become desensitized. “I pay close attention to how people conduct themselves. After surgery, when it’s 4 in the morning, it’s a challenge to one’s professionalism to resist the temptation to blame the patient. Sometimes I’ll be at a conference out of town, and I’ll overhear a couple of doctors talking about two gang members who killed each other. ‘Isn’t that great,’ they say. ‘That’s two less for us to deal with.’ I say the next thing you know, I’ll come in here and someone will call me a ‘dirt ball.’ I have little tolerance for that on my service. I don’t want to play judge and jury. As soon as I fall into the game of trying to judge, that’s when I get out of the business.
“By the time they get to me, they’re at the end of the line,” he says of the gunshot victims. “The only one behind me is the medical examiner who does the autopsy. It’s too late to do prevention.” That realization has led Cornwell to accept speaking engagements on urban violence around the United States, which he adds on to his 80-hour work week. He also acts as a mentor to kids in East Baltimore as part of the Police Athletic League, a network of after-school centers at city recreation centers.
An Easy Mover
Edward E. Cornwell III describes himself and his five brothers and sisters as “people persons,” able to move easily in all circles, old and young, black and white. His late father, a surgeon on the faculty at Howard University Medical Center, and his mother Shirley, a schoolteacher turned realtor, raised their children in northwest Washington and sent them to top-notch schools. Each went on to college and graduate work in either medicine, law or business. In this family of gregarious, smart achievers, Cornwell had to hold his own. “If you could come away from the dinner table unscathed, you could tolerate anything society could throw at you,” he says.
He graduated from Washington, D.C.’s Sidwell Friends in 1974 and went on to Brown and then Howard University School of Medicine where he was president of his class. After an internship and residency in general surgery at LA County and a fellowship at the Maryland Institute for Emergency Medical Services Systems, he joined the faculty, first at Howard and then at USC.
An avid football (Redskins) and basketball fan, Cornwell lives outside Baltimore in Ellicott City with his physician wife Maggie Covington Cornwell, who is a niece of Children’s Defense Fund leader Marian Wright Edelman, and their 3-year-old son Michael.
Now, it is 11:15 p.m. Frank Rose is being readied for the Surgical Intensive Care Unit, but Cornwell has returned to the ED, where another gunshot victim has been admitted. The patient is young, just 16, and small. He wears his hair in short dreds. Tattooed across his narrow chest, stretching from nipple to nipple, is a string of numbers and letters, an inscrutable but likely sign of gang membership. He is moaning, long, low cries of pain. But he is awake, alert and able to supply the answers to all the standard questions: Name? Address? Have you ever been shot before?
This, in fact, is his first bullet, and it has entered the right chest, grazing the right lung. Now it is leaking air, like a deflating balloon, filling the pleural cavity, compressing the heart and forcing the blood pressure to a low 92 over 60. Deftly, Cornwell makes a small incision between two ribs on the right side. Sticking a gloved finger into the incision, he gently pushes the lung aside and inserts a tube, releasing a whoosh of blood and air, step one in treating the pneumothorax.
Stab Wound in the Neck
At 11:35, a whispered phrase, “stab wound in the neck,” begins to ripple among the small crowd gathered in the ED hallway. Minutes later, the gurney rolls in carrying a 21-year-old male with two knife wounds in the neck, one in the back. Cornwell checks him out. The stabs to the neck are merely lacerations, the vital signs are good. He, too, is lucid.
In many trauma centers, this patient, as well as the previous one with the pneumothorax wound, would go directly to the OR. Here, both will be admitted for observation to the trauma admitting unit, a two-bed monitored unit located in the middle of the surgical floors, where patients can be easily assessed and, if necessary, rapidly prepared for surgery.
Cornwell is keen on using data and its scientific collection to improve trauma care. His own research, which ranges from violence prevention to infection therapies, is leading to new approaches to penetrating trauma. In a study of more than 300 patients with gunshot wounds to the abdomen, he has found that among the 100 or so admitted for observation and not surgery, about 90 percent were discharged and did well. The remaining 10 percent eventually did wind up in the OR and, despite the delay for observation, did well.
Out of this study came Cornwell’s innovation, the trauma admitting unit (TAU). These two patients are its direct beneficiaries. (A report the next week will show that the patient with the pneumothorax wound was sent to the floor and then discharged. The stabbing victim developed pain in the abdomen and was taken to the OR later that day, where Cornwell removed his spleen and part of the distal pancreas. Ultimately, both patients did well.)
Just now, however, Cornwell and Demeester are still in the ED when the OR nurse beeps. It’s Frank Rose—his wound is bleeding again.
Again, OR 1 is being prepared. Cornwell stands at the foot of the operating table, eyes closed, head bowed. This is the tough time, when it’s easiest to blame the patient for causing at least six people—two surgeons, an anesthesiologist, nurses and techs—nine hours of toil, all for an injury that didn’t have to happen. But Cornwell holds on, marshaling from within himself the disciplined professionalism he instills in his staff.
This time no blood spurts out when the incision is opened. “It looks okay,” says Cornwell. A little mopping up, a little compression, and for the third time tonight he begins to close up the wound.
It’s 1 a.m., a little more than 12 hours since Frank Rose was shot on the sidewalk. It feels more like a week. And with the background music in the OR—Gladys Knight’s Midnight Train to Georgia—low and mellow, it feels late, like being in a bar that’s closing for the night.
When he leaves the OR, Cornwell heads to his office. On the way, he’ll look in on the TAU. Then he’ll kick back and catch some sleep in the call room. Until the trauma beeper calls again.