Trauma-rama

8 07 2012

Last week, I switched from the burn surgery service to the trauma service.  For many reasons, I was really excited about this.  First, I love trauma—I really like the idea of assessing airway, breathing, and circulation in the trauma bay when patients first come in, and I think that the decisions made in the trauma bay (the trauma-equipped rooms in the emergency department) are probably the most critical in affecting whether the patient lives or dies.  I have wanted to be one of those people for almost as long as I can remember.

Unfortunately, the evolving structure of patient care teams has pretty much dashed that dream against the rocks.  ER physicians hardly do anything with trauma patients these days, unless the doc chooses to work in a small, rural hospital.  This was news to me when I first started medical school, when emergency medicine residents came to the school for a “career interest” thing.  Now, the true emergencies are all about the trauma teams. Even if the patient is already in the ED and something happens that makes the ED physician consider trauma, they page the trauma team in for consults.  And trauma teams are made up exclusively of trauma surgeons.  So in order for me to be one of those individuals caring for acutely, critically ill patients in a level 1 trauma center, I’d have to be a surgeon.

Which is so. not. happening.

Crushed childhood ambitions aside, I was excited for the experience on the trauma service.  The service, as expected, is busy.  There are 2 trauma teams that carry between 80 and 100 patients between them.  With so many patients, each getting so little time during rounds, it’s difficult to keep track of who’s who.  The attending moves so quickly between patients on morning rounds that the whole team barely has time to assemble around the bedside before the conversation is over and we’re leaving for another room; in fact, we spend more time traveling between rooms than actually in the rooms with the patients.  It’s a little crazy, and I truly have no idea how (or if) the attending can really manage so many patients at once.

Trauma surgery isn’t just traumas—in fact, in my first week, I haven’t been into the OR for a single trauma surgery.  Our team has scheduled general surgeries every day, so we get our fair share of lap choles and hernia repairs and appendectomies.  I have seen some pretty cool surgeries—and by seen, I mean ‘been in the room for’ because even scrubbed in, I can barely see anything that’s actually going on.  It’s not as hands-on as the burn and plastic surgeries.  In these surgeries, I only do the normal student things: hold retractors, reach in and touch organs when the resident tells me to, pretend I can see things, and help suture the skin closed.  At least when I scrub, I don’t freeze my tush off in the OR.

What I do love about trauma is the trauma part.  I really like being in the room when a trauma is wheeled in.  Granted, I’ve only seen category 2 traumas thus far (the students were not allowed into the trauma room when the more serious, unstable, category 1 was brought in.  Though that might just be because there were 4 students that day and because we were following a cat 1 into the CT scanner).  The truly unfortunate thing is that it seems the real traumas are a lower priority for my chief resident.  So I’ve missed a number of traumas because I was watching a boring surgery, or finishing my notes for the day, or rounding.  Lame, right?

At any rate, that’s trauma.  It’s definitely longer hours than my last surgery service, and much busier, and there’s a lot more time spent standing around without being able to study or learn things from my patients.  But the people are cool; my chief is hilarious, laid back, and good about teaching, the senior resident understands how frustrating it is to be a med student on the trauma service and tries to get us involved as much as possible; and the attending for last week was very student-friendly, great at teaching, and had a good sense of humor (although he did try to tell us last week that taking out an adult’s parathyroid glands caused cretinism, but I let that slide).

And while I don’t like wishing away time, I can’t help but count the days until I finish 3rd year!  18 to go 🙂

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One response

10 07 2012
NICU doc

I just started reading your blog and haven’t gotten through all the previous entries. Great writing, by the way. But didn’t you indicate that you might be interested in Peds? If so, think seriously about Critical Care (Peds or Adult) or Neonatology. ABCs and mini-codes all the time! I love being a neonatologist and the pace and procedural nature of the specialty can be very reminiscent of ED/trauma work. And this is coming from someone who loved her med school surgery rotation but would never have chosen to be a surgeon in a million years.

So, what do you think?

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