Shortly after a Jeep Cherokee crashed into his motorcycle, Todd Maxson lay in his critical-care hospital bed, broken and bruised all over his body, and told his wife, Amy, he was going to dance with her again.
"I thought he was going to die," she recalled later.
The severity of her husband's accident was immediately clear, and even clearer after days of hours-long surgeries.
After being struck by a drunken driver in Little Rock, Maxson, the consultant for the state's trauma system and a surgeon who runs Arkansas Children's Hospital's trauma department, told two passers-by to call 911 and his boss at Children's Hospital to tell him that he couldn't be on call that night.
"I was dying," he said.
Some say Maxson is alive today because of the trauma system he helped create. He says the trauma nurses and doctors saved his life and others.
Maxson was rushed to UAMS Medical Center on the night he was hit. He also worked at UAMS and recognized the faces of colleagues and people he once called students rushing him into surgery. Still wearing his scrubs, Maxson snapped back into his day job, directing people in the trauma bay and the emergency room.
"I think that helped me keep my focus away from dying," he said.
The doctors and nurses working on Maxson didn't let their relationship with him get in the way. They are trained in school how to compartmentalize work and emotions so they can perform at their best no matter who they are treating.
Maxson was just a guy with a bad pelvic injury and a systolic blood pressure of only 70.
"He's just a patient now," trauma surgeon J.R. Taylor III remembered thinking.
CREATED IN '09
As described by trauma doctors, the trauma system takes entities and types of care once isolated from one another and makes them work together on the behalf of the patients who need them.
Trauma, as defined in the system, is an injury caused by an external force. Such forces include a fall, an accident, a gunshot, a stab wound or suicide, but not a stroke or an aneurysm.
When Arkansas' trauma system was created in 2009, Arkansas Children's Hospital hired Maxson to run its trauma department. The state hired him to be the trauma medical consultant for the system's creation.
Maxson came from Dell Children's Medical Center in Austin, Texas, which he and a team had just turned into a Level 1 trauma center, the top verification by the American College of Surgeons. Years before, he turned Children's Medical Center of Dallas into a Level 1 trauma center.
At the time, Arkansas was the only state that didn't have a designated trauma hospital, and health officials estimated 1,200 preventable disabilities occurred in the state each year.
Since 2009, the state has established a trauma communications center that helps find the best places to transport patients in an emergency; created a trauma image repository so radiologists can look at an injury before the patient arrives at his destination; telemedicine for hand injuries; designated dozens of hospitals as varying levels equipped to handle trauma (59 currently); and implemented other things such as bracelets identifying trauma patients.
The state also provided as much as $811,550 annually to hospitals for education on trauma-care practices and techniques, although that funding and its use has declined since rules were changed on how it's distributed.
The state spent more than $20 million annually in the height of the establishment of trauma system components.
Dr. Brian Eastridge, head of trauma research at the University of Texas Health Science Center San Antonio and a member of the American College of Surgeons, said Arkansas has been fairly innovative. He said the trauma bracelets are a low-cost and effective way of tracking and identifying patients quickly.
By 2014, the state had reduced its preventable mortality rate from 30 percent to 16 percent, according to a study conducted by the University of Arkansas for Medical Sciences and the American College of Surgeons that was published last year. The value of those lives in their projected future economic contributions -- estimated to be about $186 million a year -- far outweighs the money the state spent on the trauma system, the study determined.
The study analyzed 672 individual cases -- considered representative samples of total trauma deaths -- from 2009 and 2013 to 2014.
No independent studies have been done of the trauma system. When the system was created, all records and data related to the system's or a hospital's performance were exempted from public disclosure.
Dr. Bill Beck, a trauma surgeon and assistant professor at UAMS, said he believes that without the trauma system the state would see higher death rates for victims of car accidents or violent crime.
The creation of the trauma system may only be part of the story.
Around the the time the trauma system began, improvements in trauma techniques nationwide -- learned first from urban U.S. hospitals and then from wide use at military hospitals during the Iraq and Afghanistan wars -- were credited with saving lives, too, said Ron Robertson, a UAMS surgeon.
Several shorter surgeries have replaced one large surgery, and patients who have lost a lot of blood are receiving blood products more immediately instead of a saline solution first. Outside the hospital, more emergency workers, law enforcement officers and everyday citizens are being trained in wrapping tourniquets around wounds, which can make the person's condition better upon arrival at the hospital.
CARE AND RECOVERY
Maxson was struck by a drunken driver while riding his Triumph Bonneville south on Woodrow Street, between Seventh and Lamar streets just north of Interstate 630, last Sept. 1. It was about midnight and he'd just gotten off work.
A responding police officer concluded that the driver was heading north and then entered the southbound lane, throwing Maxson off his motorcycle and dragging it underneath his sport utility vehicle for 166 feet.
Maxson asked first responders to take him to the UAMS hospital, where doctors determined he was suffering life-threatening injuries. Emergency surgeons gave Maxson plasma and stopped the bleeding in his pelvis, an example of the changes in trauma care nationwide.
In a tumult of five days, Maxson had five surgeries. He would go in for one surgery, go back to the intensive-care unit, resuscitate, and then go back to the operating room.
Most of Maxson's body was stabilized on the inside with outside objects. He got pins, a rod, stabilization bars in his legs and even a chain on his pelvis, which had to be reconstructed. Doctors had to rebuild an arm and a knee, too.
After being cooped up in the hospital for several days, he developed psychosis -- common in the intensive-care unit, where patients often get little sleep -- and began hallucinating that the walls were on fire.
So his wife, Amy, took him outside. They got fresh air and posed for pictures, one of which featured Todd smiling in his hospital gown and sitting in his wheelchair.
He looked fine for social media. Maxson's face was undamaged -- he wore a helmet -- but he couldn't walk or move much. He said he reminded himself of "the dead guy in Weekend at Bernie's."
After some fresh air and getting out of the ICU, the psychosis dissipated.
And after two weeks at the hospital, Todd and Amy would spend months together, closer than ever before. She bought a lift for him to get into bed, which she and some friends moved to the dining room for easier access. She bathed him and dressed him.
"It was real challenging there for a while," she recalled. "I didn't get out of my pajamas till noon."
Todd was restless, so Amy rented a wheelchair-accessible van to take him places to ward off depression. The first day they left the house, he put on a suit and went to watch over Children's trauma verification in November. In the following days, they met up with friends and he went to work.
Amy Maxson doesn't know how other people might have fared in her situation, especially those who couldn't afford a lift, which cost about $5,000 without insurance.
"I'm a nurse practitioner, and I don't know how someone who didn't have a medical background could have helped him," she said.
Aftercare could be better set up in the trauma system, Todd Maxson said.
"There's no part of the health care system tasked with shepherding people post-discharge," he said. "Complications can arise from not coordinating care afterwards. People with catastrophic injury or illness should have a caseworker."
Maxson credited the lift and talk therapy with making a big difference in his recovery. He lamented that insurance often doesn't cover those things, and acknowledged his recovery had a lot to do with his having experience in trauma medicine and having means. He knew what to do, and he could pay for it.
Without those things, he said, he could still be lying in his bed at home.
"It would have been pretty easy to imagine a scenario in which I'm totally disabled and unable to go back to work," he said.
IDEAS FOR IMPROVEMENTS
As the Arkansas Department of Health awaits comment on updating its trauma-system standards, Maxson has a few ideas for how he thinks Arkansas' trauma system can improve.
For instance, the state's hospitals could bill insurance for assembling trauma teams to treat incoming patients, called trauma activation fees, Maxson said. That would make them money to improve their systems.
Maxson thinks a trauma doctor should be ready to be at a patient's bedside within minutes at large hospitals outside central Arkansas, such as in Jonesboro, Fort Smith and Northwest Arkansas, but they aren't currently required to. Maxson said he benefited from that at UAMS.
In some states, those activation fees have varied widely across hospitals and have been criticized for often being exorbitant and nontransparent. Maxson says written rules can prevent abuse, which he agrees has occurred in other places.
Arkansas funds each hospital in the trauma system based on its rating: Level 1 hospitals get $1 million, level 2 get $500,000, level 3 get $135,000, and level 4 get $40,000.
Most states don't pay hospitals to be in their trauma systems, said Greg Brown, trauma branch chief for the Arkansas Department of Health. Brown believes Arkansas' setup incentivizes hospitals to be a part of the system. He said some have chosen to withdraw but many of them come back.
Maxson also thinks the trauma call center should give more advice to hospitals about what services should be available and what patients need as they go through the system, based on the center's bird's-eye view perspective.
Arkansas standards mirror American College of Surgeons standards, Brown said, with a few exceptions. Arkansas has level 4 hospitals, but the American College of Surgeons does not.
Eastridge said he didn't think Arkansas was behind on any major developments and didn't think the state needed to make major changes in its upcoming revision of standards.
DANCING AGAIN
Maxson underwent months of physical therapy sessions. He lifted weights and practiced moving in water. Walking was painful at first.
Nowadays, Maxson says he's back to dancing, recently with Amy to the tunes of the late Aretha Franklin at their lake house with friends and family. He acknowledges he'll never move like he used to and will likely need a cane for the rest of his life. (He still needs two more leg surgeries.)
"But Amy can boogie," he said. "The woman can get down. So any time I can dance with her is good."
A lot has changed for Maxson. He thinks he's living a better life.
His motorcycle days are over, but he flies planes now. He meditates, reads more and swims. His cardiovascular endurance is better than before, he said.
Maxson also is prioritizing his family more. He and Amy bought a house on Greers Ferry Lake for the family to relax.
"It was very unusual for me to have extended blocks of time with them, and I've loved it," Maxson said. "I've loved being with them."
He's back to doing surgery, which along with teaching is what he enjoys most. Co-workers admire his positive attitude and talk often about it when he is and isn't around.
He now brushes aside little things that used to annoy him and tries to not have a "destructive and negative" perspective on what's happened to him.
"Lying on your back for a couple of months gives you time to reflect," Maxson said.
He remembers his first few weeks of being injured, worrying about what he might never be able to do again and how long it might take him to get back to work. He had been told nine months.
"I was terrified," he said.
He started working from home after six weeks and was back in the office, at least part time, after three months.
A Section on 09/04/2018