thedrifter
07-19-09, 07:36 AM
Sunday, Jul 19, 2009
Posted on Sat, Jul. 18, 2009
Dedicated burn doctor puts his expertise to use helping members of military
By CHRIS VAUGHN
cvaughn@star-telegram.com
SAN ANTONIO — The burned men, with ears and lips gone and giant scars from countless grafts, outnumber the amputees.
Not that many would know it outside of Brooke Army Medical Center, one of the nation’s biggest and busiest military hospitals the last six years.
Burn patients conjure up a mountain of fear in people, who wonder what it’s like to have an agile mind on the inside of a body so badly transformed, who wonder whether they could ever deal with that kind of unbearable pain or psychological scarring.
These patients are Dr. Steven Wolf’s people.
A Fort Worth native with no military background, Wolf left a position in Galveston to take over the Army’s burn institute just as the war in Iraq blew up, putting him on the front lines of the fight to keep wounded soldiers and Marines alive. He has also emerged as one of the most creative researchers in the field and is overseeing a futuristic-sounding project to see whether troops’ limbs can regenerate, given the right cellular blueprint.
"I didn’t want him to leave," said Dr. David Herndon, the chief of burn services at the University of Texas Medical Branch at Galveston and a mentor to Wolf. "But he’s always been destined to be a leader. I take great joy that one of the top doctors I’ve ever trained has become such a leader in burn care. And I’ll say this: He went to the right place at the right time."
Wolf’s life in the burn unit has slowed down, as the number of roadside bombs detonated in Iraq has tapered off and his responsibilities as chief of the unit switched back to the military.
But it is still very much a blur.
Besides treating patients at Brooke Army, he remains the director of burn research, a surgery professor and research leader at the UT Health Science Center in San Antonio, editor of a medical journal, and a trauma surgeon every fourth night in the county hospital, grabbing a couple of hours of sleep in between pages.
He is only 44, with barely a whiff of hair on his head, and bears a vague resemblance to the mercurial and arrogant doctor on ER played by Paul McCrane.
It is, however, only a physical resemblance.
'Just a good ol’ boy’
"He’s very likable," said Army Capt. Robert Schlau, who served as company commander of the Institute of Surgical Research for two years. "He has the mentality, 'I’m just a good ol’ boy.’ And the most impressive part about him is that he’s a brilliant man who can talk to the smart people, but he can dumb down a conversation about anything to where anyone can understand it. He uses words like stuff and thingamajig to explain the medicine."
Pushing the envelope of research into science fiction territory, Wolf is nevertheless an impressive bedside doctor, especially given the reputation of surgeons as better doctors than communicators.
Close to 1,000 troops have moved through the burn unit in the last five years, and Wolf remembers a surprising number by name, giving their approximate injury date, even details on what they’re doing now.
"He seldom talks about his patients, but when he does, you can tell how much he cares," said his mother, Peggy Wolf, who lives in the house where he grew up in Fort Worth. "We’ve seen him get choked up talking to us."
No matter the circumstances, treating burns is a messy business. It can’t be wrapped up neatly or quickly. Patients can suddenly up and die months later. Because people are irrevocably altered, unrecognizable as the people they once were, psychiatry and psychology are at least as vital as surgery.
But the men he knows, even the ones who are long gone from Brooke Army, made a lasting impact on him, too.
"There is a lot of heartache, a lot of psychological distress," he said. "In a lot of burn cases, it’s the person’s own fault for what happened to them. They were doing something they shouldn’t have been doing. But a soldier serving his country did nothing to deserve what happened to him. From our perspective, there is even more of a sense of responsibility to take care of them because they were protecting this nation."
Dedicated to treatment
Brooke Army, a seven-story structure just off Interstate 35, has two intensive-care units for burn patients.
The place quietly hums with squads of blue-gowned surgeons, anesthesiologists, nurses and therapists, who move from one isolated room to the next to treat patients who usually can’t speak, aren’t aware of what they’re doing and look nothing like they once did.
Underneath masks and gowns are beads of sweat. The ICU is kept north of 80 degrees — the operating rooms are kept at 100 degrees — because burn patients can’t regulate their body temperatures.
Every soldier, sailor, airman and Marine who is burned anywhere in the world is sent to Brooke, which remains the only Defense Department institution dedicated to treating that kind of injury. Close to 300 civilians arrive there annually, too.
During war, there isn’t an average number. Right now, two to five a month arrive.
During 2005 and 2006, though, 20 or more would arrive a month, a grim parade of young servicemen who survived roadside blasts and ended up in Texas 48 hours later with unspeakable injuries.
Ninety-five percent of them lived, Wolf said, an impressive statistic given the severity of injuries and that most had additional wounds.
A different breed
One of the survivors is Army Staff Sgt. Bobby Henline, who was serving in the 82nd Airborne Division when a roadside bomb blew up his Humvee in April 2007.
He had burns covering his torso, arms, face, and, most seriously, his head. The explosion, which killed four other soldiers in the Humvee, burned his head to the skull.
"We’re pretty optimistic people, but his injuries were so severe, we didn’t think he would live," Wolf said.
He still sees Henline in the burn unit, one of many servicemen who continue to receive treatment.
Henline told Wolf that he recently went horseback riding, to the beach with his family, even met the first lady during a trip to the White House.
As they moved on to talk of follow-up surgeries to reduce scar tissue and fix his teeth, Henline informed Wolf that he wanted his left arm amputated.
"I can’t do anything with it," he said, figuring a fake arm would be more useful to him.
Wolf didn’t approve of his decision, and he cautioned him about the irreversibility of cutting off a limb. But he has learned that men in the military are of a different breed.
"He should have died, and he beat it," Wolf said later when Henline’s conversation came up. "That, by itself, gives you a certain amount of strength. Burn patients do much better psychologically than people expect them to, and in the military, they do even better than that.
"I think raising your hand and enlisting to fight for your country puts you in a different class of people to begin with."
Devoted at a young age
The oldest of three sons (one of his brothers is an executive in sales; the other is a Navy lieutenant commander), Wolf pursued medicine from the time he must have first seen Marcus Welby, M.D.
Being a doctor was all he ever wanted. He remembers wearing a white coat on career day in second grade at Mary Louise Phillips Elementary School near the Ridgmar neighborhood.
"He never deviated from that plan from that day forward," said his father, Jerry.
For the most part, he motivated himself to do well in school, and from an early age he proved a very busy boy — select-team hockey, baseball at Arlington Heights High School, jobs parking cars at the Americana Hotel downtown and caddying at Shady Oaks Country Club.
After graduating from Arlington Heights in 1982, Wolf went to the University of Texas at Austin, then straight to the University of Texas Medical Branch at Galveston for medical school.
Surgery, more than any other discipline, captured his imagination in medical school. "I always envisioned myself coming back to Fort Worth and doing general-practice surgery after residency," he said.
But as a resident at a university hospital in Kansas City, Mo., he found that he liked operating on people who’d been in car wrecks and stabbed more than he liked removing appendixes and gallbladders.
"I liked the critical-care world," he said. "If you make the right call, people live. It’s a rush."
In the mid-1990s, Herndon did his best to lure Wolf from Kansas City back to Galveston to work in burn medicine, recognizing what he said were Wolf’s "immense talents bringing together patient care, research and education."
Once settling back in at Galveston, Wolf launched himself into research, turning into one of the most prolific young scientists in the field. To date, he has authored 215 papers and serves as the editor of the medical journal Burns.
"Dr. Wolf wakes up every day asking 'Why?’ " Herndon said. "Like me, he’s tried to make a study out of every 'why.’ "
'Right now’ attitude
Although Brooke Army Medical Center was for many years one of the top burn centers in the world under the leadership of Dr. Basil Pruitt Jr., it had fallen behind in research and clinical care in the late 1990s.
In 2002, the burn center even lost its verification — a sort of seal of approval — from the American Burn Association, setting off all sorts of alarms in the Defense Department.
"The Army performed an analysis and felt that it would benefit from some outside expertise," Wolf said.
But the government couldn’t pay a top burn surgeon enough to take the job as director, so the government created a joint position with the UT medical school to make it more financially attractive.
Wolf took the job.
"There is a lot of prestige to go to the place where most of the advances in burn care in the last 40 years came from," he said, not to mention the enormous number of resources for research in the military.
Even so, Wolf describes discovering what he believed was a lack of urgency at the hospital. Brooke Army’s burn unit, he said, had become too much of a government institution, too scheduled, too regulation-oriented, too inflexible.
He immediately started pushing people with a "right now" attitude.
"People would schedule a surgery for tomorrow or the next day, and I would say, 'No, we’re not. We’re doing it right now,’ " he said. "We’re going to go home when there’s nothing more that can be done today."
By the time the casualties spiked in 2005, his staff knew how to work his way.
Wolf knew that treating burns is not for the timid, not if the patient is going to survive.
"You have to be very aggressive," said his mentor, Herndon.
Wolf has made his own adjustments, becoming savvier in accomplishing his goals under the constrictions of the government and learning to admire the know-how of seasoned sergeants.
But he’s still not much for excuses.
More than once, someone in the military has told him, "Oh, we can’t do that. That will require an act of Congress."
"OK, then," Wolf says. "Congress does act. Get on it."
Restoration research
To the degree that Wolf is known outside the burn-care world, it is due to his research with what is known as "pixie dust." It has gotten him in Newsweek, on CNN and in several other media outlets, and for good reason. The research is almost unbelievable.
Wolf, along with researchers from the University of Pittsburgh, is using tissue from pig bladders to see whether it will spur the body’s stem cells to regrow its own tissue.
Staff Sgt. Shilo Harris, injured by a bomb in Iraq, volunteered to be the first human in the world implanted with the mixture, and in a few months, he started to grow his missing index finger. Although it grew only about half an inch, Harris told Wolf that it came with sensation too.
Because the mixture appears to work with limb regeneration, Wolf wants to see whether it will help similarly in restoring muscle tissue in burn or shrapnel patients. Cancer patients and diabetes patients could also benefit from this type of regenerative research, Wolf said.
"It’s still fairly young in the process, though," he said.
Much of Wolf’s job, outside of seeing patients, is to focus on groundbreaking research. Right now, 32 research projects are ongoing, almost half of them overseen directly by Wolf.
For instance, troops at the hospital were not getting enough calories, and their nutrition suffered as their bodies fought so hard to stay alive. So he is studying what kind of a diet to provide patients and when.
He also knew that many troops were coming to Brooke with too much fluid in them, which was causing renal and respiratory failure. The doctors in the war zone were doing what is standard practice — rapidly pumping fluids into a burn patient using what is known as "the Parkland formula."
That’s all well and good, except that Wolf believed that the fluid intake was causing other problems. Wolf met with a software developer, and they brainstormed a mathematical formula to better regulate fluid intake.
"We focused on fixing a military problem," Wolf said. "But this product will likely be used in adult burn patients nationwide."
All in a day’s work
Every evening, except when he has to work a trauma shift, Wolf spends the 30 minutes driving to his house in far north San Antonio decompressing.
He’s always made sure he lived away from whatever hospital he worked at, turning on music or talk radio to forget where he’s just been.
"I do not bring work home," he said emphatically.
He and his wife of 20 years have a 15-year-old son and 12-year-old daughter. He’s a competitive golfer and a gourmet who’s handy in the kitchen.
Try as he might to keep his job separate from his home life, it intersects in one way: his refusal to watch a tear-jerker film or read a sad book.
"My life is to see shocking, miserable, sad things every day," he said. "I do not want to watch sad on TV. I don’t want to read sad books."
Sometimes, though, he gets a front-row seat to watch, even participate in, a miracle.
This spring, Wolf was examining Michael Lammey, a 25-year-old sailor badly injured in an explosion that killed two men.
Wolf checked out Lammey’s neck because scar tissue prevents him from turning it well, and he asked about the movement of one of his arms. Both will require more surgery.
The conversation moved on to Lammey’s college classes and how well Lammey likes San Antonio, because, he said, even though people give him an extra glance or two, they "are understanding of your situation here."
Before heading out, Wolf patted Lammey’s leg.
"Thanks for coming in," he said. "You’re doing great."
Lammey called back to him.
"Thanks for saving my life."
Ellie
Posted on Sat, Jul. 18, 2009
Dedicated burn doctor puts his expertise to use helping members of military
By CHRIS VAUGHN
cvaughn@star-telegram.com
SAN ANTONIO — The burned men, with ears and lips gone and giant scars from countless grafts, outnumber the amputees.
Not that many would know it outside of Brooke Army Medical Center, one of the nation’s biggest and busiest military hospitals the last six years.
Burn patients conjure up a mountain of fear in people, who wonder what it’s like to have an agile mind on the inside of a body so badly transformed, who wonder whether they could ever deal with that kind of unbearable pain or psychological scarring.
These patients are Dr. Steven Wolf’s people.
A Fort Worth native with no military background, Wolf left a position in Galveston to take over the Army’s burn institute just as the war in Iraq blew up, putting him on the front lines of the fight to keep wounded soldiers and Marines alive. He has also emerged as one of the most creative researchers in the field and is overseeing a futuristic-sounding project to see whether troops’ limbs can regenerate, given the right cellular blueprint.
"I didn’t want him to leave," said Dr. David Herndon, the chief of burn services at the University of Texas Medical Branch at Galveston and a mentor to Wolf. "But he’s always been destined to be a leader. I take great joy that one of the top doctors I’ve ever trained has become such a leader in burn care. And I’ll say this: He went to the right place at the right time."
Wolf’s life in the burn unit has slowed down, as the number of roadside bombs detonated in Iraq has tapered off and his responsibilities as chief of the unit switched back to the military.
But it is still very much a blur.
Besides treating patients at Brooke Army, he remains the director of burn research, a surgery professor and research leader at the UT Health Science Center in San Antonio, editor of a medical journal, and a trauma surgeon every fourth night in the county hospital, grabbing a couple of hours of sleep in between pages.
He is only 44, with barely a whiff of hair on his head, and bears a vague resemblance to the mercurial and arrogant doctor on ER played by Paul McCrane.
It is, however, only a physical resemblance.
'Just a good ol’ boy’
"He’s very likable," said Army Capt. Robert Schlau, who served as company commander of the Institute of Surgical Research for two years. "He has the mentality, 'I’m just a good ol’ boy.’ And the most impressive part about him is that he’s a brilliant man who can talk to the smart people, but he can dumb down a conversation about anything to where anyone can understand it. He uses words like stuff and thingamajig to explain the medicine."
Pushing the envelope of research into science fiction territory, Wolf is nevertheless an impressive bedside doctor, especially given the reputation of surgeons as better doctors than communicators.
Close to 1,000 troops have moved through the burn unit in the last five years, and Wolf remembers a surprising number by name, giving their approximate injury date, even details on what they’re doing now.
"He seldom talks about his patients, but when he does, you can tell how much he cares," said his mother, Peggy Wolf, who lives in the house where he grew up in Fort Worth. "We’ve seen him get choked up talking to us."
No matter the circumstances, treating burns is a messy business. It can’t be wrapped up neatly or quickly. Patients can suddenly up and die months later. Because people are irrevocably altered, unrecognizable as the people they once were, psychiatry and psychology are at least as vital as surgery.
But the men he knows, even the ones who are long gone from Brooke Army, made a lasting impact on him, too.
"There is a lot of heartache, a lot of psychological distress," he said. "In a lot of burn cases, it’s the person’s own fault for what happened to them. They were doing something they shouldn’t have been doing. But a soldier serving his country did nothing to deserve what happened to him. From our perspective, there is even more of a sense of responsibility to take care of them because they were protecting this nation."
Dedicated to treatment
Brooke Army, a seven-story structure just off Interstate 35, has two intensive-care units for burn patients.
The place quietly hums with squads of blue-gowned surgeons, anesthesiologists, nurses and therapists, who move from one isolated room to the next to treat patients who usually can’t speak, aren’t aware of what they’re doing and look nothing like they once did.
Underneath masks and gowns are beads of sweat. The ICU is kept north of 80 degrees — the operating rooms are kept at 100 degrees — because burn patients can’t regulate their body temperatures.
Every soldier, sailor, airman and Marine who is burned anywhere in the world is sent to Brooke, which remains the only Defense Department institution dedicated to treating that kind of injury. Close to 300 civilians arrive there annually, too.
During war, there isn’t an average number. Right now, two to five a month arrive.
During 2005 and 2006, though, 20 or more would arrive a month, a grim parade of young servicemen who survived roadside blasts and ended up in Texas 48 hours later with unspeakable injuries.
Ninety-five percent of them lived, Wolf said, an impressive statistic given the severity of injuries and that most had additional wounds.
A different breed
One of the survivors is Army Staff Sgt. Bobby Henline, who was serving in the 82nd Airborne Division when a roadside bomb blew up his Humvee in April 2007.
He had burns covering his torso, arms, face, and, most seriously, his head. The explosion, which killed four other soldiers in the Humvee, burned his head to the skull.
"We’re pretty optimistic people, but his injuries were so severe, we didn’t think he would live," Wolf said.
He still sees Henline in the burn unit, one of many servicemen who continue to receive treatment.
Henline told Wolf that he recently went horseback riding, to the beach with his family, even met the first lady during a trip to the White House.
As they moved on to talk of follow-up surgeries to reduce scar tissue and fix his teeth, Henline informed Wolf that he wanted his left arm amputated.
"I can’t do anything with it," he said, figuring a fake arm would be more useful to him.
Wolf didn’t approve of his decision, and he cautioned him about the irreversibility of cutting off a limb. But he has learned that men in the military are of a different breed.
"He should have died, and he beat it," Wolf said later when Henline’s conversation came up. "That, by itself, gives you a certain amount of strength. Burn patients do much better psychologically than people expect them to, and in the military, they do even better than that.
"I think raising your hand and enlisting to fight for your country puts you in a different class of people to begin with."
Devoted at a young age
The oldest of three sons (one of his brothers is an executive in sales; the other is a Navy lieutenant commander), Wolf pursued medicine from the time he must have first seen Marcus Welby, M.D.
Being a doctor was all he ever wanted. He remembers wearing a white coat on career day in second grade at Mary Louise Phillips Elementary School near the Ridgmar neighborhood.
"He never deviated from that plan from that day forward," said his father, Jerry.
For the most part, he motivated himself to do well in school, and from an early age he proved a very busy boy — select-team hockey, baseball at Arlington Heights High School, jobs parking cars at the Americana Hotel downtown and caddying at Shady Oaks Country Club.
After graduating from Arlington Heights in 1982, Wolf went to the University of Texas at Austin, then straight to the University of Texas Medical Branch at Galveston for medical school.
Surgery, more than any other discipline, captured his imagination in medical school. "I always envisioned myself coming back to Fort Worth and doing general-practice surgery after residency," he said.
But as a resident at a university hospital in Kansas City, Mo., he found that he liked operating on people who’d been in car wrecks and stabbed more than he liked removing appendixes and gallbladders.
"I liked the critical-care world," he said. "If you make the right call, people live. It’s a rush."
In the mid-1990s, Herndon did his best to lure Wolf from Kansas City back to Galveston to work in burn medicine, recognizing what he said were Wolf’s "immense talents bringing together patient care, research and education."
Once settling back in at Galveston, Wolf launched himself into research, turning into one of the most prolific young scientists in the field. To date, he has authored 215 papers and serves as the editor of the medical journal Burns.
"Dr. Wolf wakes up every day asking 'Why?’ " Herndon said. "Like me, he’s tried to make a study out of every 'why.’ "
'Right now’ attitude
Although Brooke Army Medical Center was for many years one of the top burn centers in the world under the leadership of Dr. Basil Pruitt Jr., it had fallen behind in research and clinical care in the late 1990s.
In 2002, the burn center even lost its verification — a sort of seal of approval — from the American Burn Association, setting off all sorts of alarms in the Defense Department.
"The Army performed an analysis and felt that it would benefit from some outside expertise," Wolf said.
But the government couldn’t pay a top burn surgeon enough to take the job as director, so the government created a joint position with the UT medical school to make it more financially attractive.
Wolf took the job.
"There is a lot of prestige to go to the place where most of the advances in burn care in the last 40 years came from," he said, not to mention the enormous number of resources for research in the military.
Even so, Wolf describes discovering what he believed was a lack of urgency at the hospital. Brooke Army’s burn unit, he said, had become too much of a government institution, too scheduled, too regulation-oriented, too inflexible.
He immediately started pushing people with a "right now" attitude.
"People would schedule a surgery for tomorrow or the next day, and I would say, 'No, we’re not. We’re doing it right now,’ " he said. "We’re going to go home when there’s nothing more that can be done today."
By the time the casualties spiked in 2005, his staff knew how to work his way.
Wolf knew that treating burns is not for the timid, not if the patient is going to survive.
"You have to be very aggressive," said his mentor, Herndon.
Wolf has made his own adjustments, becoming savvier in accomplishing his goals under the constrictions of the government and learning to admire the know-how of seasoned sergeants.
But he’s still not much for excuses.
More than once, someone in the military has told him, "Oh, we can’t do that. That will require an act of Congress."
"OK, then," Wolf says. "Congress does act. Get on it."
Restoration research
To the degree that Wolf is known outside the burn-care world, it is due to his research with what is known as "pixie dust." It has gotten him in Newsweek, on CNN and in several other media outlets, and for good reason. The research is almost unbelievable.
Wolf, along with researchers from the University of Pittsburgh, is using tissue from pig bladders to see whether it will spur the body’s stem cells to regrow its own tissue.
Staff Sgt. Shilo Harris, injured by a bomb in Iraq, volunteered to be the first human in the world implanted with the mixture, and in a few months, he started to grow his missing index finger. Although it grew only about half an inch, Harris told Wolf that it came with sensation too.
Because the mixture appears to work with limb regeneration, Wolf wants to see whether it will help similarly in restoring muscle tissue in burn or shrapnel patients. Cancer patients and diabetes patients could also benefit from this type of regenerative research, Wolf said.
"It’s still fairly young in the process, though," he said.
Much of Wolf’s job, outside of seeing patients, is to focus on groundbreaking research. Right now, 32 research projects are ongoing, almost half of them overseen directly by Wolf.
For instance, troops at the hospital were not getting enough calories, and their nutrition suffered as their bodies fought so hard to stay alive. So he is studying what kind of a diet to provide patients and when.
He also knew that many troops were coming to Brooke with too much fluid in them, which was causing renal and respiratory failure. The doctors in the war zone were doing what is standard practice — rapidly pumping fluids into a burn patient using what is known as "the Parkland formula."
That’s all well and good, except that Wolf believed that the fluid intake was causing other problems. Wolf met with a software developer, and they brainstormed a mathematical formula to better regulate fluid intake.
"We focused on fixing a military problem," Wolf said. "But this product will likely be used in adult burn patients nationwide."
All in a day’s work
Every evening, except when he has to work a trauma shift, Wolf spends the 30 minutes driving to his house in far north San Antonio decompressing.
He’s always made sure he lived away from whatever hospital he worked at, turning on music or talk radio to forget where he’s just been.
"I do not bring work home," he said emphatically.
He and his wife of 20 years have a 15-year-old son and 12-year-old daughter. He’s a competitive golfer and a gourmet who’s handy in the kitchen.
Try as he might to keep his job separate from his home life, it intersects in one way: his refusal to watch a tear-jerker film or read a sad book.
"My life is to see shocking, miserable, sad things every day," he said. "I do not want to watch sad on TV. I don’t want to read sad books."
Sometimes, though, he gets a front-row seat to watch, even participate in, a miracle.
This spring, Wolf was examining Michael Lammey, a 25-year-old sailor badly injured in an explosion that killed two men.
Wolf checked out Lammey’s neck because scar tissue prevents him from turning it well, and he asked about the movement of one of his arms. Both will require more surgery.
The conversation moved on to Lammey’s college classes and how well Lammey likes San Antonio, because, he said, even though people give him an extra glance or two, they "are understanding of your situation here."
Before heading out, Wolf patted Lammey’s leg.
"Thanks for coming in," he said. "You’re doing great."
Lammey called back to him.
"Thanks for saving my life."
Ellie