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The Human Mechanic: UMC Trauma Surgeon Dr. Jay Coates

The X-ray of Andrew Linn, whose unusual accident gave Dr. Coates some big viral buzz

Dr. Jay Coates isn't the kind of doctor that people seek out.

He's fine with that.

"If you wake up to find out I've been working on you," he says, "then you know something has gone terribly wrong." Take the case of Andrew Linn - you know, the man with the pole in his face. On Nov. 29, Linn fell asleep while driving late at night, running his car into a chain-link fence. The accident drove a metal pole through Linn's face. Shockingly, the impalement did not kill him, and rescuers were forced to saw through the pole in front and behind Linn's head in order to extract him from the wreckage of his car.

At the University Medical Center Trauma Unit, Dr. Coates and his team were on duty when paramedics wheeled Linn in, with a section of the two-inch diameter pole still embedded in the Las Vegas native's face.

"The funny thing is, he seemed totally conscious and was sitting up when he came in," Dr. Coates says. "He was even trying to text his wife, even though he could barely turn his head without knocking stuff over."

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Further examination found that the pole shattered Linn's jaw but missed vital blood vessels in his neck. It had also missed Linn's spine and windpipe.

"As catastrophic as his injury looked, it's really amazing that it didn't do more damage," Coates says.

Dr. Coates and his team, which included oral surgeon Dr. Jeff Moxley and cardiovascular surgeon Dr. Nancy Donahoe, rolled their patient into the operating room, where they improvised a way to remove the pole from Linn's face without compromising his breathing or blood flow.

"Because the pole wasn't smooth and the ends of it were jagged, we couldn't just pull it out from one end or the other," Dr. Coates says. "Basically, we had to open an incision from behind his ear down to his collar bone." The story quickly went viral. Dr. Coates went on a whirlwind tour of the national morning news shows, and he still gets requests for interviews about the incident. Even so, Dr. Coates is relatively dismissive of the media attention. "It's nowhere near as gratifying as being able to catch up with one of our patients six months after my team treated them," he says.

As Vice-Chairman of the Trauma Department, Dr. Coates is naturally proud of his institution. He points out that UMC is a public hospital serving the medical needs of the entire region.
[HEAR MORE: Listen to Dr. Jay Coates share some of his harrowing stories on KNPR's "State of Nevada."]

"I don't think the general public realizes what a resource they have here," he says. "Level 1 is the highest designation that any trauma center can have. It means we have capabilities here that most hospitals don't. It's expensive, sure, but it's worth it. It saves lives."

Dr. John Fildes, chairman of the Trauma Department, puts it a different way. "Las Vegas doesn't get to say it's number one in many categories that we can be proud of," Dr. Fildes says. "But this is one: we have the best kind of trauma center you can build."

Dr. Coates adds a more practical context. "Think about it," he says. "Up to the age of 45, the leading cause of death for everyone is injury. And, while cancer and heart disease affect large portions of the population, almost all of us get treated in an emergency room at some point in our lives. Some of us may need emergency medical care several times during our lifespans."

Dr. Coates leans in to emphasize his next point. "And when the time comes when you or your loved one needs critical emergency care, whether it's from a car accident or they're a victim of a crime, or they're having some kind of seizure," he asks. "Wouldn't you want the best, most comprehensive care available?"

As a trauma surgeon working in Nevada's only Level 1 Trauma Center, Dr. Coates is used to dealing with dramatic injuries. He has even treated his share of celebrities, including Roy Horn of Siegfried & Roy, whose injuries from the fangs of Montecore the white tiger effectively ended an era of Las Vegas entertainment.

"But I don't get to develop the kind of patient-doctor relationships that, say, a general practitioner does," Dr. Coates says. "I see my patients once, when they're brought into the Trauma Unit. Maybe I do some follow-up while they recuperate. Then they're gone, sometimes without regaining enough consciousness for me to get to talk to them while they were my patient."

Still, the challenge and excitement of emergency medicine attracted Dr. Coates long before he ever dreamed of attending medical school, let alone becoming Vice Chairman of the Trauma Department at UMC.

"I was a Chaparral High School graduate attending UNLV on a marching band scholarship when I got a job as an E.M.T. for a local ambulance company," Dr. Coates says. "A fraternity brother got me the gig so I could pay my bills."

At the time, Dr. Coates's aspirations were to play drums in a rock band. He chuckles now at the memory of who he was 20 years ago.

"I never intended to become a doctor," he says. "And I had the grades to prove it."

But his first visit to UMC as a paramedic changed all that. "That first night I took a patient into that emergency room, I thought it was the coolest place on the planet," he says. "I couldn't believe I was getting paid to work there."

It was then that the erstwhile drummer began applying himself to his studies. After graduating from UNLV, Coates got accepted into medical school in Iowa only after the University of Nevada Reno turned him away.

"That really stung," he admits. "Though now I can say that I sit on the admissions committee of the medical school that wouldn't take me."

After medical school, and after further training in Detroit, Coates found himself back at UMC, as a surgical fellow under the tutelage of Dr. Fildes, the man who helped the Trauma Unit at UMC earn its Level 1 designation - and who offered Dr. Coates a permanent position.

"Without a doubt, Dr. Fildes is the man who has had the most profound impact on my career," Dr. Coates says. "Before I met him, I gave serious thought to joining the Navy after my residency, if only to get my medical school loans paid off." "You have to remember that trauma care, at its highest level, is a team effort," Dr. Fildes explains. "And what I saw in Dr. Coates was that, not only was he a fine surgeon, he was also a leader. When the stakes are at their highest, Dr. Coates keeps a keen eye and a cool head."

His whole life is tied to UMC," says Ginny Crews, a nurse who has worked with Dr. Coates for years. "Between his on-call shifts, his clinic hours, his administrative duties, his lectures, and the constant meetings and consultations, there are weeks where he barely gets more than a half-day away from the hospital."

Despite this workload, Dr. Coates insists that he leads a fulfilling life.

"I think it was Albert Schweitzer who said the only truly happy people are those who have found a way to serve others," he says. "I'm fortunate to fit that description."

Dr. Coates' dedication becomes especially apparent as he conducts rounds with a group of residents. As they move from patient to patient, Coates peppers the group with questions, admonishing them when their answers don't come quickly enough. "Come on, guys," he says. "This is an environment where your decisions have to be quick as well as right. You can't be both if you don't have a firm grasp of all available information." "What makes him a great teacher is that he's not afraid to hold others to the same high standards he holds himself," Crews explains.

Adding to his responsibilities is Dr. Coates' new appointment as Medical Director for UMC's Burn Unit, where he plans to help it earn national accreditation the same way the Trauma Center earned its Level 1 designation.

"All he needs is another reason to be at UMC," Crews adds.

"He's like one of those guys who'd rather work than spend time at home."

She should know. She and Dr. Coates are engaged to be married in September.

t's nearly midnight as Dr. Coates quickly finishes a burrito in the lounge just off the Trauma Unit. He is 16 hours into a 24-hour shift, but he does not look tired.

"Busy shifts don't exhaust me as much as the slow ones," he says. "Of course, wishing for a busy shift means wishing for someone to get hurt, so I don't know how that works karmically."

He balls up the burrito wrapper and takes a long sip of soda before throwing it all into a trash can just as his beeper goes off. It's another patient - a motorcycle accident. "When I was a resident, I learned the three basic rules of surgery," he says as he heads back into his unit. "Eat when you can, sleep when you can, and don't screw with the pancreas."

Not that he minds the long hours.

"Maybe in another specialty I could make more money working less hours," he says. "But when what you love also saves lives, why fight it?"
 Dr Coates
"Dr. Coates knows when to use his rather sharp wit to defuse the tension of a situation," says Dr. Fildes, Chairman of the Department of Trauma and Coates' boss. "When the pressure is high, a little humor can go a long way."

The UMC Trauma team in action. As Dr. Coates often tells them, their decisions have to be both quick and right.
A middle-aged man falls while rock-climbing at Red Rock and is airlifted to UMC. Paramedics roll him into a trauma bay, and soon the air is filled with medical jargon as they relay information to a team of specialists - nurses, a pharmacist, an orthopedic surgeon, an X-ray technician, and several residents and medical students, all looking at Dr. Coates for direction.

"Assembling a team like this is expensive," Dr. Coates explains. "But it saves lives. With all these people here, we can handle just about anything."

An intricate choreography ensues, prompted by Dr. Coates, who often just says yes or no as a particular team-member performs a task on the patient.

"This team is well-trained and very experienced," Dr. Coates says. "They've seen it all, and they generally know what to do as soon as they see it. I'm just here to oversee it all and step in when something particularly difficult or novel occurs."

The X-ray technician goes to work, imaging the man from head to toe, searching for signs of broken bones and other internal injuries. Once the team determines that the man's head and spine are uninjured, the neck brace is removed.

Meanwhile, nurses cut away the man's clothing, searching for contusions or other signs that the paramedics might have missed. Another nurse stands just above the patient's head, cradling it while speaking in a soothing monotone as she monitors his respiration and level of consciousness.

The fallen man's injuries seem largely minor, except for his right foot, which is splinted and wrapped in thick layers of bandages. As an orthopedic resident removes the splint and the bandages, the extent of the damage becomes clear. The man's right foot is sitting next to his leg, seemingly held on only by the skin, as if someone had snapped the man's ankle and rolled the foot up against the side of his shin.

Dr. Coates turns to the resident next to him.

"That's what we call B.T.H.O.," Dr. Coates mutters. "Broke The Hell Off."

The assembled team emits a collective chuckle.

The orthopedic resident offers to roll the foot back into place manually. Dr. Coates agrees to the attempt, but is skeptical.

"The tendon keeping that foot up against the leg is thick as my pinkie," Dr. Coates says. "I bet we won't be able to stretch it enough to get the foot back onto the end of the tibia."

The patient is given a sedative, and the team waits until the nurse at the man's head indicates he is unconscious. Then, as another resident holds the patient's leg immobile at the knee, the orthopedic resident takes the man's foot and pulls with both hands, trying to roll it back onto the end of his leg. With each pull, blood pours from the man's open wounds.

"The technical term for this is Brute Force Medicine," says Dr. Coates. "It looks medieval, but since it was a clean break and the tissue surfaces look relatively pristine, it's worth a try to avoid going into the operating room."

After a couple of unsuccessful attempts, Dr. Coates' team eventually resorts to surgery.

"That ankle is probably going to bother him for the rest of his life," Dr. Coates explains. "But I think we managed to save it."
Not all of Dr. Coates' cases end well.

"As experienced as I am with mortality," he says, "it still gets to me when I have to deliver the bad news to a family. The confidence that we did everything possible to save a life is small consolation to a family that's facing such profound loss."

How do you tell a family about the death of a loved one?

"You have to be forthright and genuine and sympathetic," he says. "And you have to make yourself completely available for their reaction, whatever it is. Some families are very dramatic while others take the news stoically. But you have to be there for all of them."

At such times, Dr. Coates takes comfort in the purpose his work gives him.

"I know if there's a complete breakdown of human society, I'll still have a job," he explains. "After all, I'm a human mechanic."


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