As a Trauma Intensive Care Unit nurse at Harborview Medical Center in Seattle for the past 10 years, Melodie Martin has seen it all — car-accident victims, people with gunshot wounds, hikers who've suffered bad falls.

When patients arrive at the unit, the extent of their injuries often are unclear. Doctors and nurses must work quickly to determine care, and then closely monitor the patient for any sudden changes, which can often happen with trauma patients.

"We work in a really high-stress situation," said Martin, who has been in the profession for 28 years. "To be here you have to work well under pressure. You need to be aware for subtle changes, and you need to be compassionate and caring."

In her 12-hour shifts, Martin typically cares for one to two patients.

All the patients on her floor have suffered severe physical trauma since the hospital is the only level 1 trauma center in four states which includes Washington, Alaska, Montana and Idaho.

The 60-plus nurses on the floor must undergo specialized training in trauma care, said nurse manager Neil Francoeur. Harborview has more than 1,300 nurses, added hospital spokeswoman Susan Gregg-Hanson. "You have to be a strong-willed individual to deal with difficult circumstances and handle the emotional stress," Francoeur said of nurses in the TICU (Trauma Intensive Care Unit). "It takes a special person."

Attending surgeon on the trauma floor, Dr. Hugh Foy, agrees.

"The nurses in the TICU are the best I've ever worked with. When we say 'sick' at Harborview we mean in imminent risk of dying. When we bring in a patient, ... they all just come together like a Swiss watch factory," Foy said. "They work as a team and they are exceedingly efficient."

Martin's interest in nursing was piqued in high school in Tennessee when speakers from nursing schools spoke to her class. Then when she was 17, her father suffered a stroke and later died.

"The nurses were so supportive and kind, I'll always remember that," Martin said.

After completing nursing school, Martin worked as a traveling nurse, contracting with hospitals across the country in need of short-term assistance. One of her stints was a six-month job at Harborview. She enjoyed the Seattle area so much, she returned to work full time in 1992.

In trauma care, teamwork is critical with everyone from housekeeping to the attending physician playing an important role, said Martin, 48.

One case remains vivid in her mind. Doctors and nurses were doing all that they could to keep a patient alive.

During this hectic period, the patient's parents were allowed to come into the room. They touched their daughter's face, kissed her and told her what a wonderful daughter she was.

"The whole room was quiet," Martin recalled. "It was so nice for her family to have that moment to say goodbye. All the while we were in active resuscitation. I still tear up when I think of it."

While she often builds relationships with family members of patients, Martin regrets that as a trauma nurse, she rarely gets to know her patients. So she's always happy when she hears from or gets a visit from a recovered patient.

"It's so good to see them more alert and able to communicate," she said.

Sherri Thompson's daughter, Summer, was one such patient. Last year the 16-year-old was in a car accident that brought her to the unit for a week. Summer was in a coma for seven weeks.

Sherri Thompson of Issaquah said she was grateful for the nurses on the trauma floor. The first night she and her family saw Summer after she got out of the emergency room, her nurse, Kathleen Therien, had washed Summer's hair and braided it.

Later another nurse, Laurie Pananen, showed her a scrapbook of another patient that had gone through a similar accident and had recovered.

"When Summer left the TICU, the nurses didn't get to see her with her eyes open, they saw nothing of Summer," her mother said. "So we went back and got to meet them and talk to them and to let them know that good things happen, especially someone who was in a coma when they left."

Thompson said she appreciated the nurses' ability to translate what the doctor's told her into layman's terms.

Doctors would do their work, but often didn't have the time to answer all her questions. She knew she could count on the nurses for more information.

The trauma nurses are experienced, Foy said. This is particularly helpful at a teaching hospital, he added. Residents often aren't aware of things that a nurse has significant experience in.

"The resident to a large degree is ignorant and that's why they come here to learn," Foy said.

Nurses often take notice of new residents' fears and suggest care appropriate care

"They give very helpful hints because they really know from experience what the patients need," Foy said. "They are absolutely instrumental in the training of residents. And all of it is done quietly and implied, never overt."

Thompson said she's taken on much of the care for her daughter, who is still recovering. Friends and family often tell her she could be a nurse, but Thompson disagrees.

"I could do that for my own daughter. I'm her mother," she said. "But these people come in every day and take care of a complete stranger. To do that for someone else is amazing. It takes a really special person to do that."