A 71-year-old man lay motionless on a hospital gurney, tubes entering his mouth and arm, a foam brace holding his neck unnaturally taut.
"Can you wiggle your toes?" Dr. Shawn Varney called out yesterday, his face just inches from the unconscious patient. "Can you wiggle your fingers?"
Varney, a 37-year-old emergency physician, is an Air Force major who has come to the Maryland Shock Trauma Center in Baltimore to gain experience treating the sorts of injuries that are encountered during war.
An elderly man with a head injury - the patient suffered a brain hemorrhage when he fell and hit his head at his home in West Baltimore - might seem to have little in common with an injured soldier. But the 18 Air Force doctors and nurses who have recently begun work at Shock Trauma will treat plenty of injuries like this if they are deployed.
Gunshot wounds, broken bones, spinal injuries, and multiple organ damage - all are seen at the front and at Shock Trauma, which annually treats more than 6,000 of the state's most critically injured patients.
Head injuries are seen in both places, too. Elderly men stumble and hit their heads; soldiers are thrown from vehicles or battered in explosions.
"In Kosovo, the majority of injuries were from people being thrown," said Lt. Col. Tyler Putnam, a surgeon who is the commander of the military contingent.
Called C-Stars, the military training program began this summer when the first Air Force doctors and nurses trickled into Baltimore. But it accelerated when the Sept. 11 terrorists attacks set the stage for war in Afghanistan and the possibility of anti-terrorist actions elsewhere.
A core group of 12 doctors and nurses have full-time faculty positions and will remain at Shock Trauma for three years. They will train up to 300 others a year who will complete monthlong rotations through the hospital before being deployed.
With war being waged in Afghanistan, they could be sent to Central Asia, but they also could be sent to the sites of natural disasters or military bases overseas. Or they could be returned to their home bases and told to await orders to go when and where needed.
Yesterday, patients lay in nine of 10 bays crammed with all manner of equipment, including intravenous tubes, ventilators, X-ray machines and monitors that trace heartbeats and breaths with squiggly lines. Virtually all had been hurt in their cars or at home.
Since his arrival, Varney has been immersed in one serious case after another - leg, pelvic and arm fractures, spinal injuries, gunshot wounds "and, every now and then, a knife in the back." He rarely saw such problems at Andrews Air Force base, where he mainly treated such medical problems as heart failure and flu.
Stepping back from his patient yesterday, Varney said the man probably would emerge from his coma but did present some difficult problems. He has high blood pressure and was taking blood thinners for a heart condition - a combination that could predispose him to additional bleeding.
"Hopefully, he'll do O.K., but he does have a few ticks against him," Varney said.
Maj. Debra Malone, a 42-year- old surgeon, said many in her group had to adjust to the intense pace at Shock Trauma. But, she said, everybody seems to thrive on the challenge.
"The orthopedic surgeons are delighted; so are the trauma surgeons and critical-care physicians," said Malone, who was accustomed to life at Shock Trauma because she had completed a two-year fellowship there. "They're ... intellectually stimulated caring for the most injured and critically ill."
Lt. Col. Warren Dorlac, a 39- year-old surgeon on rotation, said there are obvious differences between the way medicine is practiced in a high-tech hospital and in a hastily erected hospital under a tent near the scene of battle.
One striking difference is technology. Yesterday, doctors quickly performed a CT scan that revealed bleeding deep within the patient's brain. Doctors decided to give him blood-thickening medication and wait to see whether he healed without surgery.
Later in the day, another CT scan would be performed to see whether the bleeding had stopped. If not, doctors might resort to surgery.
A field hospital would not have a high-tech scanner. Instead, said Dorlac, surgeons would have to perform exploratory surgery to see what was wrong and, if necessary, correct the problem. Later, the patient would be flown to a more distant hospital, where a CT scan and other procedures could be performed.
Though happy to take advantage of the technological advantages of Shock Trauma, the military doctors are constantly asking each other what they might do under hostile conditions, said Dorlac. "We have to try and teach these guys how they'd do things different should they be in the field."