Saturday, March 26, 2016

Trauma - Something to Easter About

Every old school nurse has a graveyard in the back of their mind filled with a little shop of horrors regarding gruesome cases that have percolated over the years..  I try and stay distant from some of the darker memories, but there is something about Easter celebrations that bring to mind old trauma surgery memories. It must be the theme of suffering, death, renewal, or maybe even the full moon that causes memories to surface. Maybe it has something with the days getting longer as more daylight always translates to more trauma. Trauma is fond of long, warm days when more people are out and moving about in their motor vehicles

People that suffer major trauma and manage to cobble together a recovery even though it's often times not something we would think of as recovery are very special and have a spiritual and inspirational quality about them. I don't even like to think of them as "patients" because of what was accomplished by their inner strength. It's tough to predict which  people can make an adjustment to major trauma and reinvent their lives.  Sometimes people that appear to be leading superficial lives come to new meaning after their injury. I've seen people give up drugs, quit gangs, and commit their lives to helping others after being injured. It really can be an amazing Easter-like rebirth when you witness what some people can accomplish after major life-changing trauma.

First things first-I need to unload some of the downright disheartening memories. The things that are the exact opposite of "comfort food." Like comfort food these things stay with you not because they are filling, but  because they burn an image into your mind. Not even a good dose of foolishness attenuates them. In no particular order, the following comes to mind.

The image of bottle after bottle of   O  negative blood  (bag after bag today) being pumped in with the realization that most of the poor soul's   blood volume was now splattered all over the dashboard of their 1960 Chevy Brookwood station wagon or pooling out there  on Lake Shore Drive.

In many ways the injured persons hands and faced defined their humanity. Seeing an older persons face covered in blood with pooling in their wrinkles always got to me. Clots could become impacted in the  wrinkle creases. I remember one stabbing victim that I removed a huge umbilical clot that formed just as a result of pooling blood  during the prep.

 I always felt better after the induction and draping and it was time to go. Dr. Slambow always said "Things can only get better from this point on." Dr. Slmbow could also make a fairly convincing argument that the only problem surgeons should treat was trauma, but of course he was a trauma surgeon. We also had a nephrologist whose mantra was the only reason for the heart's existence was to pump blood to the kidneys, but that's another story.

I remember a young man whose hand was hopelessly mangled in a book binding machine necessitating an amputation. I kept his hand on my Mayo stand soaking in a basin of normal saline with his shiny gold wedding band reflecting the overhead lights. In the back of my mind I maintained the delusion that somehow it could be re-attached. After the young man was transferred to a Gurney and left the room, I reluctantly  put his hand in a specimen bag.

The blood /bone chip slurry left on the operating room floor after a case was something that sticks in your mind. Plain old blood; no problem. Plain old bone chips: no problem, but that gelatinous, gooey combination somehow represents thatprimative primordial goo that all life evolved  from. Maybe I'm getting a bit carried away. That blood bone chip slurry was really tough to clean up and maybe all that extra time spent with it gave time for the realization that someone's loved one met with an unthinkable event.

Elective surgery always includes some pre-operative rituals to blunt the stark brutality that is about to occur. The careful draping, meticulous set-up of instruments, the surgeon calmly and almost leisurely asking the anesthetist, "May we start now?" Trauma surgery is completely different. I recall Dr. Slambow yelling "Go..Go..We don't  have tie to set up or drape and if I cannot stop that bleeding that airway won't mater." It was just a different mindset when it came to trauma.

 I came across this inspiring video of a modern trauma team in action and was deeply touched by the progress that that has been made since I was on call for a case. The orthopedic resident, Jim Bond, came across with a sense of humbleness  and warmth that was lacking back in the good old days. From the way he introduced himself to patient's families simply as "Jim Bond" to the way he mentioned to the  victim's parents that prayers would be needed. We did not have physicians like that.
Old time docs could be very judgmental at times and shift the blame to the victim. "That's what happens to people who choose to ride motorcycles." comes to mind as an old school attitude. It sure was nice to see such a compassionate young doctor.

The other thought I had after viewing the video was how easily it is to be  misled by such gross orthopedic injuries.  The focus is narrowed to working on  mangled extremities while ignoring possible occult intra abdominal or intrathoracic injury. This problem used to sneak up on us all the time. I remember being grateful that we were done and a hidden obscure problem  pops up.

The recovery to a new and completely different type of life for  trauma survivors resonates with Easter themes. I just  loved the scene at the end of the video where the man, sitting in his wheelchair triumphantly pushes on the switch to  open the doors. Life goes on.


  1. How lucky we all are to have people like Dr. Bond and the other medical professionals so willing and so able to step into a nightmare like this and bring some measure of resolution to it. A first-responder in the truest sense.