Wednesday, April 4, 2012

The Drama of Trauma

I just finished my general surgery rotation with the trauma service at HUP, as well as the entire surgery block. I am astounded that we are done with a quarter of the core clinical year! Time flies when you’re having fun… and when you are really, really busy.

Trauma is consistently ranked as one of the best rotations by medical students at Penn. Besides the daily morning report that is chock-full of teaching points and the ability to play an integral part in the trauma resuscitation team, the sheer excitement of trauma is arguably unparalleled by anything else in the hospital.

All of the medical students are assigned to be the “primary surveyor” in the trauma team (see the picture above for the medical students on trauma for last month – I’m the nerdy looking one on the right). That means that when a trauma patient is rolled into the bay, the medical student is the one responsible for doing the exam and yelling out the results over all of the commotion so that the nurse can enter all of the findings into the record. The exam is shortened as ABCDE – A for airway (is the trachea midline? Is the patient moving air?), B for breathing (can you hear breath sounds on both sides?), C for circulation (check pulses, color, warmth), D for disability (what’s the patient’s neurological function?), and E for exposure, which entails exposing all parts of the patient’s body to look for injuries, deformities, abrasions, stab wounds, gunshot wounds, and whatever else might be present. Each patient receives a full exam, a bedside ultrasound exam to check for fluid in the abdominal cavity, a chest x-ray, IV access, monitoring, and then whatever other imaging or interventions is deemed necessary by the trauma team.

As the primary surveyor, what you find is essential to the decision-making in an acute way. For instance, if you don’t hear breath sounds on one side of the patient’s body, that person is getting an immediate needle decompression (ideally within seconds), followed by chest tube decompression. It is exciting as a medical student to be such an important part of the team and have an impact on emergent decisions.

Then there are the stories – the dramatic saves and the heart-wrenching losses – the types of narratives you would expect to see in movies or on Grey’s Anatomy. I will never forget a young Asian man who came in after being thrown from his car in a motor vehicle collision. He was unresponsive with a decreasing blood pressure, so we took him to the operating room immediately. The electrical activity in his heart went away while we were in the OR, and I found myself doing the most vigorous chest compressions I could at 4:30 AM after being up for almost 24 hours. His heart came back, and we proceeded with opening up his abdominal cavity to control his bleeding, but ultimately he passed away due to massive blood loss. He was the first person who I had seen die, and he looked exactly like my younger brother. As distraught as I was, I knew we had tried our best.

Only a few hours later, when I came back for my next shift, I was able to witness our senior surgical resident and a cardiac surgery fellow operate on a young man who’d been shot in the chest. The bullet had wounded his heart, two lobes of the lung, and the chest wall – generally considered a surefire way to die. Yet the surgeons had the swiftness and the skill to repair his injuries and miraculously save him. In one single day, I experienced death of a patient as well as the rescue of a patient back from the brink of death. These were just few of the memorable patients I encountered while on my trauma rotation.

Despite the long hours, the nonstop studying for shelf exams, and my own personal responsibilities at home caring for my 11-month-old son, experiences like these make me grateful for having the privilege of a medical education and the opportunity to work with an amazing team of care providers who are saving lives like this every day.