Trauma Bonds in the TSICU at University Hospitals Level I Trauma Center

UH System Update | March 2025

Gunshot wounds, car crashes, victims of domestic violence – these are the broken bodies that the tight-knit team in the Trauma Surgical Intensive Care Unit hustle to heal at UH Cleveland Medical Center.

Amidst the constant churn of chirping monitors, blinking lights and whirring ventilators in this 20-bed unit, a tremendous team takes an all-hands-on-deck approach to physically and emotionally demanding care in the TSICU.

“If you come into this unit and you’re my patient, your life just changed in the blink of an eye,” says charge nurse Julie Lacock, BSN, RN. “Trauma doesn’t discriminate. People can be 100% fine one day, and here the next. The majority of our patients are a victim of some kind of violence. Nurses give a lot of grace to each other and patients and family members.”

It is a humbling place, where siblings beg their big brother to wake up from a coma, and staff must remain ever vigilant that a victim in a gang-related shooting is protected from the perpetrator who may still be looking for him.

It’s a sobering environment, where a pregnant woman beaten until she miscarried her baby in her third trimester insisted on keeping her dead newborn by her side to cry over. Isolated from other loved ones by her abuser, her nurse became the only person she fully trusted.

It can also be the site of triumphant celebration, when a survivor of a traumatic brain injury from an ATV accident, paralyzed and enduring two decompressive hemi-craniotomies, was discharged to long-term care – and walked back into the unit months later to thank his caregivers.

“We see things in life that nobody should see,” says Nurse Manager Kelly Puletti, MSN, RN. “We see the worst of the worst. My team are all Type-A people who want to be in action. They have this unique ability to remain calm in the most extraordinary situations.”

Nearly half of the patients in the unit are transferred from other hospitals, including the Level III trauma centers at UH community hospitals. As soon as a bed opens, another patient is wheeled in to take it.

“You hit the deck at a sprint, there’s no easing into the day,” says Julie, who is also a U.S. Navy reservist.

This team hails from backgrounds in EMS, Emergency Departments and ICUs. It is comprised of a trauma component, under Medical Director Andrew Loudon, MD, and a surgical team under Medical Director Connor McNamara, MD. Surgical patients include liver and kidney transplants, Whipple procedures and esophagectomies.

They must have a broad range of experience and know how to use a vast variety of equipment. Trained in Mass Transfusion Protocol, they know how to care for patients with chest tubes, external ventricular drains and bolts for intracranial pressures, dialysis and the Belmont rapid transfuser that can push blood in 30 seconds. For liver transplant patients, they know how to work intraoperative continuous venovenous hemodialysis (CVVHD). They also respond with the med box to Code Blue calls across main campus.

Katie Cumberledge, BSN, RN has four years of experience working EMS in rural Ashtabula County, where it can take an hour to reach the nearest hospital. Medics must use their critical-thinking and autonomy to act quickly for their patients, just as they do in the TSICU.

But unlike the field, Katie can see her patients through to discharge or comfort them at their death. One of her greatest honors was caring for an elderly woman who had endured unforgettable abuse. Katie bathed her, applied lotion to her body and fixed her hair before loved ones came to see her at the end of her life.

“I felt honored to shower this patient with the support, love and comfort she needed prior to dying,” says Katie, who on this day is taking care of a man with gunshot wounds and another whose vehicle rolled over eight times before he was ejected. “This patient is a daily reminder for me to always go above and beyond for patients and others, as you never know what someone is going through.”

Anabelle Murphy, BSN, RN, CCRN, finds nursing is a profession of lifelong learning, and TSICU provides endless opportunities for new lessons. Days are often heavy, with sometimes every resource exhausted for a less-than-optimal outcome.

“As nurses, it is important to remember that our average day at work is often the worst day of our patient’s life,” says Anabelle, who also is a primary charge nurse.  “We deal with a lot of patients younger than us, who are experiencing a traumatic event in the hospital for the first time.”

Most nurses have 1:1 or 2:1 assignments. They spend most of their time in their patient rooms. When at the control desk, they can monitor alarms that alert them if a patient dips below a healthy hemodynamic standard. Alarms sound more sharply as they transition from yellow to red.

Stephen Baldwin, BSN, RN, saw Level III trauma in the ED at UH Portage Medical Center, which saw a wide range of trauma as the only hospital in Portage County. He knew he wanted more. 

“I wanted something more focused, where I could know my patient’s pathophysiology, front to back and head to toe, and be an integral part of keeping patients alive,” Stephen says. “We have an opportunity to have a big impact, and we can advocate for our patients, because we know them best.”

Stephen is still haunted by the first patient death he witnessed during his 12-week orientation, a man who crashed his motorcycle into a stationary truck at top speed. A motorcyclist himself, he saw how a patient can tank in minutes, going into V-tach, a rapid unstable heart rate, to asystole, a fatal cardiac arrest.

“It was heartbreaking,” Stephen recalls. “For weeks in my sleep I could hear the wife’s screaming echoing throughout the unit. Life can end in an instant. We’re kind of a barrier.”

Bringing peace to patients and their family members with constant communication and focused clinical care is essential, says Stephen. Since nurses spend the most time with their patients, TSICU does nurse-driven rounds. The night-shift nurse provides a detailed report to their day-shift counterpart, who shares it with the large team that rounds with the attending physician each morning, a process that can take many hours.

Sometimes, the losses are inevitable.

Julie will never forget the humanity shown by a family early in her TSICU days, who all day long witnessed the parade of doctors and nurses placing lines, performing procedures at the bedside and trying to save their loved one who was medically unstable. She never once left his side, to eat, run to the restroom or anything. When the patient crashed at shift change, both day shift and night shift nurses jumped in to try to save him.

They couldn’t. After time of death was called, the staff prepared the patient for family to say their farewell. Julie was finally charting, sitting down for the first time in over 12 hours, when the family approached her to thank her and hug her. She felt she had failed them, but they had seen how hard the team had worked against all odds.

“They were the first example to me that sometimes you will do everything in your power for an entire shift, work tirelessly and still someone will die,” says Julie. “I was humbled to experience having the family members who had just lost a loved one look at me and still thank me for the work I did that day. It was 2230 when I left the hospital that night and it was my first of three shifts in a row. I had to be back in eight hours to do it all again.”

Staff members support each other unconditionally. They decompress in different ways, many by working out, some by playing or coaching sports, others with music, scrapbooking or coffee dates with colleagues. They have their go-to support people, including the adult child life specialist who frequently comes to the unit.

And they acknowledge the unwavering leadership of their boss, without whose support they could not function so smoothly as a team. She is always available to them and jumps in to help when needed.

“I really want to be out there in the trenches with my nurses, and for them to feel supported,” says Kelly, who typically works 60-hour weeks and logs up to 18,000 steps a day. “With the intensity of the unit comes fast relationships being built with patients and families. In a Level I trauma unit, people do not expect their days to end up as tragically as they do. Emotions are high – sadness, anger, fear, all at the cusp of blowing up were it not for the calming force of our team in the TSICU. 

“So, while our jobs consist of medical knowledge and skill level, it is how this team responds to the emotions swirling around them that emphasizes their humanity and their greatness as caregivers.  You can know all you need to about a disease process, the equipment, and caring for medical wounds and surgical incisions, but what you can't teach is their ability to go back to basic human needs.” 

Many of these nurses have long-range goals to be critical care flight nurses, certified nurse practitioners or certified registered nurse anesthetists. And they will carry with them the lessons of this specialized and very special unit.

Before every shift, Brittany Clemens, BSN, RN, CCRN, looks at the beads gifted to her by loved ones of a patient who committed suicide. The young woman had a severe anoxic brain injury, and her friends removed the beads from her hair before she was taken to the OR for organ donation.

To decompress from a heavy day, Brittany often talks to her father, who has been a nurse as long as she’s been alive. He understands the pressures nurses face.

“I always think about how lucky I am to be alive and healthy,” says Brittany, who has a huge group photo on her wall with about 20 co-workers taken at her wedding last year. “Our nursing team is the reason I chose this workplace as my second home. I have trauma-bonded with many of my coworkers. The situations and trauma we have been through with one another is almost surreal. But I wouldn’t have wanted to do it with anyone else.”