Repairing debilitating injury

william reismanOn the roster: more than 600 patients a year, victims of car or motorcycle accidents, falls, bullets, anything that can break or mangle bones. -Chief of orthopaedic trauma surgery at Grady, William Reisman

Day 7: Grady Memorial Hospital

The four college students were singing when they stepped off the sidewalk at 3:00 am, right into the path of a speeding car. Only Kara was hit.

Emory faculty and residents provide 85% of the care at the publicly funded Grady Hospital, where patients receive extraordinary care, often in Emory-led programs not widely available elsewhere in the region, including poison control, high-risk pregnancy, burns, HIV/AIDS, stroke, cancer, diabetes, and sickle cell disease.

By the time orthopaedic surgeon William Reisman arrived at the Grady ER two hours later, the young woman had been stabilized by general surgeons. They stepped back from the table to let Reisman assess the damage. The impact had fractured Kara's tibia and pulled her pelvis apart like a turkey wishbone. The surgeons had cleaned the large open wound and performed a temporary colostomy to prevent bowel contamination.

Reisman began work. He fitted pins into the young woman's shin and pelvic bones, then connected them to an external frame. This would hold the bones in position until the following day when he would rebuild the shattered pelvis with metal rods, plates, and screws.

Two days after this second surgery, a clot developed in a blood vessel severely damaged by the impact. Reisman called in his vascular surgery colleagues to remove the clot, but the vessel was too damaged. The surgeons looked at each other over their masks. Without blood carrying oxygen to the lower leg, tissue would die. Reisman had feared this. He would have to amputate.

He waited until Kara was conscious to explain what he needed to do—and to promise he would do everything he could to save her knee. That would make using a prosthesis much easier.

Emory faculty provided $27.1 million in uncompensated care at Grady in fiscal year 2015-2016. All payments for Emory services for patients who do have some coverage go to the Emory Medical Care Foundation, which uses this revenue—$46 million last year—to support Emory's mission at Grady.

A week later, after three surgeries to remove the tissue that died each night, Reisman was able to close the gaping wound with a skin graft.

Two weeks later, Kara left Grady in a wheelchair. Reisman never knew if he, his colleagues, or the hospital were paid. He only knew, because she told him, that she couldn't get her prosthesis until her application for Medicaid was approved. He saw her regularly over the next year, checking how her bones were healing and changing hardware as needed. In these visits, still ongoing, a smiling Kara keeps him updated on her life. After finishing college, she found a job in health care. She got interested, she said, because of her own firsthand experience.

The surgeon explained he would do everything possible to save her knee, which would make wearing a prosthesis much easier.