Why Are American Drivers So Deadly?

In the summer of 1999, a few years after graduating from medical school, Deborah Kuhls moved from New York to Maryland, where she had been accepted as a surgical fellow at the R Adams Cowley Shock Trauma Center in Baltimore. Founded by a pioneer in emergency medicine, Shock Trauma is one of the busiest critical-care facilities in the country — in an average year, doctors there see approximately 8,000 patients, many of them close to death.

Kuhls considered herself to be up for the challenge. At 31, she was substantially older than the typical resident — she had been a banker before she was a doctor — and steelier too, capable of operating with preternatural calm in even the most frenetic of circumstances. But her first few months at Shock Trauma tested her resolve. The center sees a particularly high proportion of the region’s car- and motorcycle-crash victims, and not everyone can be saved. On bad days, it could seem as if as many patients were being revived as were being shipped down to the basement morgue.

At a residency at the Albert Einstein College of Medicine in the Bronx, Kuhls had been taught how to handle what’s known in the trade as penetrative trauma — stabbings, impalements, gunshots. Now she underwent an education in blunt-force injuries, which are often considerably harder to diagnose: A gunshot wound is its own clear evidence, in the form of a ragged perforation, of where the surgeon must focus his or her attention. But a body battered in a car crash tends to yield fewer clues — the damage can be invisible to the untrained eye.

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