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."
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?"