Dr. R Adams Cowley, the visionary and sometimes abrasive surgeon at the University of Maryland who established a world renowned shock trauma center to treat severely injured people, died yesterday at his Baltimore home. He was 74.
Dr. Cowley, who suffered from heart disease for years, died of apparent coronary failure at 2:17 p.m.
Dr. Cowley was native of Utah who received his medical degree from the University of Maryland in 1944. He propounded the theory that there was a "golden hour" in the ebbing lives of accident victims when they could be saved if specially trained doctors and nurses could exercise their skills in a properly equipped surgical setting.
Statistics proved his point.
The University of Maryland opened its first Shock Trauma Center under Dr. Cowley's leadership in 1962 when the survival rate of accident victims was 40 percent. Today, the survival rate is nearly 90 percent, and Maryland's accident survival rate, a 1986 study reported, is 2 1/2 times higher than the national average.
For years, Dr. Cowley insisted that the traditional hospital emergency room was not the proper place for treating potentially fatal injuries, a line of reasoning that ruffled some feathers in medical circles.
"There is no way for [medical] people to take care of the critically ill in the hospital today," he told a committee of the American College of Surgeons at a conference at Johns Hopkins Hospital in 1956, adding that "the emergency patient really interferes with the hospital's day."
The remark was the kind of comment that occasionally got the Maryland surgeon in hot water with some of his peers, as well as hospital administrators who did not want their institutions bypassed in serious-injury cases.
But it was also part of a plan of action Dr. Cowley doggedly pursued for the next three decades, culminating in a monument to his perseverance, the eight-story, state-of-the-art structure at Redwood and Penn streets that opened in February 1989 in the university's complex of downtown professional schools.
The building, named the R Adams Cowley Shock Trauma Center, is the hub of the state's emergency medical system which, in close cooperation with the state and county police, fire departments, paramedics and volunteer agencies, rushes seriously injured people there from all parts of Maryland by helicopter and ambulance. The system's success has made it a model for systems throughout the world.
The $45 million building is also a reminder of what a singled-minded, dedicated and sometimes abrasive human +V being can achieve.
On the last point, Dr. Cowley freely admitted that he was no diplomat, and he laughed about it.
A visiting reporter once spotted a small sign on the wall of the director of nurses' office at Shock Trauma, which read:
"Yea, though I walk through the valley of the shadow of death I will fear no evil.
"For I'm the meanest son of a bitch in the valley."
Dr. James P. G. Flynn, the current director of the state's shock trauma system, said Dr. Cowley was "a remarkable surgeon" and "a remarkable organizer" who had little patience for bad ideas.
"He certainly did intimidate," Dr. Flynn said. "If you had doubts about what you were doing, you thought twice about going to him with something half-baked."
Despite his demands, Dr. Cowley's admirers -- among them the nurses and physicians who worked for him -- outnumbered his detractors. Even those he offended couldn't argue with the results of his work.
"He has left Maryland with the finest emergency care system in the world," Dr. Ameen Ramzy, a trauma surgeon and the state director of emergency medical services, said last night.
Gov. William Donald Schaefer described Dr. Cowley last night as a medical giant "who touched so many lives and who put so many lives and dreams back together. He will be greatly missed."
R Adams Cowley (the R is his first name, not an initial) had learned the elements of desperation surgery in the operating rooms of Army field hospitals in France and Germany shortly after the end of World War II.
Although the war was over, he found himself tending a continuous stream of battered people who been injured when bombed-out buildings collapsed or forgotten ordnance exploded on abandoned battlefields.
Under these conditions, the young surgeon concluded that speed with a knife was often essential if a life was to be saved. His reputation in the operating rooms of the field hospitals grew, and he was rewarded with a transfer to the Allgemeine Krankenhaus in Vienna, Austria, where some of Europe's top-flight surgeons worked with astonishing quickness.
"These men . . . one swipe of the knife and the belly was open," Dr. Cowley recalled in the 1980 book "Shock-Trauma," written by two former Evening Sun reporters, Jon Franklin and Alan Doelp. "Not like us, going through layers at a time and stopping the bleeding as we go. They'd slap on towels, do it barehanded.