S/P Trauma

One aspect of the surgery rotation I have neglected to mention elsewhere is Trauma. On weekends during the 2 month surgery rotation, we med students take 12 hour shifts in the trauma bay. For me, it was a dreadful part of the week.

My first Trauma shift took place on Sunday night after my first week of surgery. That means I went into the hospital at 7pm on Sunday, worked through the night, and then joined my primary surgery team at 5am and worked an entire work day--almost 24 hours total. Those who know me well know that I am far from a night owl. I like to be tucked in bed no later than 10 or 11pm. On surgery I regularly went to bed at 9pm or earlier given the early wake-up calls, sometimes as early as 4:30am.

That first night on trauma was perhaps one of the busiest of my 2 months. Students typically take turns "gowning" for traumas, meaning only one person actually needs to dawn the blue surgical gown, hair cap, mask and gloves. That person's primary objectives are to cut the clothes off the incoming trauma patient, get them warm blankets, and help the team roll the patient during the physical exam.

If you've seen medical shows on TV, you more or less know what the scene looks like. About 10 people are crammed around the patient trying to establish an airway, IV access, draw blood for labs, and assess the extent of the patient's injuries. It's an intimidating situation to say the least, especially for someone new to medical training. It wasn't uncommon to simply get pushed aside because you were taking too long. Nothing personal, it's just that it could be a life or death situation and things need to happen quickly.

After the airway is established and the initial assessments are done, the room clears out. Often the patients were then left alone, waiting for X-ray or the CT scanner to open up , or for a bed in the hospital to become available. Some needed lacerations sutured or bones reset. Needless to say, the trauma bay isn't a very warm and friendly place. Get in, establish diagnosis, get out.

My first patient was a "delta" meaning a more critically injured patient (as opposed to an "echo"). He was a young man out riding his motorcycle on a rainy evening and flipped over his handlebars, leaving him a quadriplegic. It was clear early on that this man had a severe spinal cord injury; he couldn't feel a bad break in his femur and even gentle touch on his arms caused him shooting pains.

The reason I struggled to like trauma began with that first trauma case. Although I cared that this young man was seriously injured and wanted to see an end to his suffering, it's hard to connect with patients in such a high speed environment. Since I never got to "know" patients like I have time to do in most other situations, I struggled to see them as more than a case or a procedure. Of course the point of trauma is to quickly direct patients to where they need to go, either to surgery or to be admitted for observation, not to bond and share warm fuzzies.

This is in stark contrast to how I see myself practicing medicine though. If I find myself in the trauma bay again, I think I will at least have more confidence and a larger skill set to help me function more effectively, but I think the pace and atmosphere are just not for me.