Doctors and nurses at the University of Maryland's Shock Trauma Center in Baltimore see more than 8,000 severely injured patients each year. These are people who've been in bad car crashes, suffered gunshot wounds, or taken a serious fall. They arrive for treatment at a place that was the first of its kind when it opened more than 50 years ago. To this day, it's thought to be among the best in the nation.
On a Friday afternoon, the sun is shining on the roof of the Shock Trauma Center in downtown Baltimore. Slowly a helicopter comes into view, and staff run out to help offload the latest patient, a man who fell off a ladder, hit his head, and lost consciousness.
Seconds later, the patient is in the trauma unit downstairs, where about a dozen staff members in pink scrubs swarm around him.
"When things are going well, it's truly like an orchestrated ballet, says anesthesiologist John Blenko. "Everyone knows what everyone else is doing. They know where they are, they know what's just happened, and they know what's coming next. There's no repetition, nothing's missed."
Every patient who rolls through the elevator doors here comes in with grave injuries. So the decisions that doctors and nurses make in an instant can easily mean life or death. Those decisions need to be made fast, and in rapid succession.
"Usually Friday afternoon around 4 o'clock, 4:30, it's like somebody flipped a switch," says Blenko. "Things get busy, and they get busy real fast."
Especially when the weather is nice: people hit the road in cars and on motorcycles, and they hit the streets, and get caught up in violence. This particular afternoon, things do get very busy. Within the course of a few hours, ambulances and helicopters have brought more than a dozen seriously injured patients.
"It's kinda busy. It's not the busiest we've ever been, but it's kinda busy," says Dr. Thomas Scalea, the physician-in-chief in charge of the Shock Trauma Center. At Shock Trauma, doctors don't have the luxury of time to order a bunch of tests, and wait a week for the results.
"We have to make decisions sometimes based not on the greatest information, so you go on a lot of clinical feel, a lot of gut sense."
Everyone in the trauma center seems to thrive on this fast pace. Scalea compares it favorably to a rollercoaster. Nurse Ellen Plummer has another analogy.
"Your adrenaline's going all the time pretty much, and you're almost like a racehorse waiting to go out the gate," says Plummer.
She says as a nurse, you quickly get used to working 12-hour shifts with adrenaline pumping constantly. But for patients, whatever event brought them here was unexpected, and often life changing.
"These patients, and the families, they don't wake up today knowing that they're going to get in a car crash and they're going to get injured," she says. "And they have no preparation for that."
That's the bad part of the job, Plummer says, having to break the news to a family. Or finding a child's note to Santa in the pocket of a woman who just died after a car crash.
"We can't save everybody," she says. "And that's the worst part of this job. Totally the worst part of this job."
Even though they can't save everyone, the doctors and nurses at Shock Trauma do save most. Of the dozens of patients who arrive here in ambulances or helicopters each day, 96 percent survive their injuries.
[Music: Learning To Fly" by Guitar Tribute Players from Acoustic Tribute to Pink Floyd]