My time on trauma was probably the most intense three weeks of medical school so far – even compared to the three weeks leading up to a major block exam, like I’ve written about before. When you hear “trauma,” you think of crazy accidents and dramatic TLC reenactments and emergency surgeries. There is some of that, but the majority of the time is spent in the ICU after someone has been stabilized “status post” getting hit by a Volvo. In other words, critical care.
Critical care turned out to not be my favorite – I simply don’t have the attention span to round for hours every morning discussing IV drips and feeds – but I’ve promised to not complain too much here. For that, I have my mom, known in the comments section here as “Bringer of Life.” (Seriously. Go see for yourselves).
Or I could complain to my grandma if I want sympathy, and to trigger a reflexive care package of brownies and/or cookies. (Grandma: NO. Do not under any circumstances send brownies. Or cookies. Love, Nate.)
Now, the actual traumas? They were indeed like the TLC reenactments. When someone gets plowed over by a train or something and they come to the hospital – a tertiary medical center serving five states – a huge team of people mobilize. The ER team calls the trauma team and everyone rushes into the trauma bay. There are about fifteen nurses there with no immediately obvious role besides telling me that I am standing in the wrong place. Everyone must don Carolina blue plastic disposable gowns, gloves, masks, and face shields.
(Like every day, it’s a GDTBATH, even though our team sucks this year. And go to hell, Duke. Insider jokes, y’all.)
Medical students like me rotating through the service get to play the role of the “trauma junior.” The junior resident (or student) calls out what’s named the secondary survey, a quick head-to-toe physical exam, calling out findings as they go for the scribe in the corner to record.
Playing trauma junior is crazy and weirdly fun: It’s one of the few times as a student when what you do might actually help save someone’s life. Remember all my posts last year about learning individual physical diagnosis skills – heart sounds, lung sounds, abdominal exams… and other exams? The trauma secondary survey is the all of the exams, head to toe, performed in about sixty seconds.
Mostly you are yelling things, and if there is something that would indicate the need for a quick intervention – like a rigid abdomen, or an unstable pelvis – you have to be extra careful to yell it out.
There are two, uh, unusual physical exam findings that you have to specifically mention because they are mega-bad-news emergencies if present. I am not going to elaborate on either except one involves bleeding from your urinary system and the other involves bleeding from your lower GI tract. Guess how you check for those two?
Of course, once the deed (or DRE, for those of you who like arcane acronyms) is done, you have to yell out your findings in anatomically correct proclamations. So “everything is okay” becomes “NO BLOOD AT THE URETHRAL MEATUS” (look it up) and “GOOD RECTAL TONE NO BLOOD.”
Again, I refuse to rehash the details of the butthole exam, but if you’re interested, enjoy The Exam That Shall Not Be Named.
Also, the entire thing is videotaped in case something bad happens. No pressure.
Actually, “you’re going to feel a little pressure.”
Once the patient is stabilized, they go through a CT scan and are eventually taken upstairs to the trauma ICU. When we’re not discussing tube feeds and IV drips on long rounds, the ICU is where the medical student gets to “do stuff.” As I mentioned last week, on trauma I learned the moral “better to ask forgiveness than permission” as we helped out with what qualifies as odd jobs in an intensive care unit: suturing lacerations, placing and yanking out chest tubes and arterial lines, and stapling things. When it was busy, it was fun.
It was not unusual to be sitting around at night when the intern would appear with a staple gun and say, “You wanna staple a guy’s head?”
Yes. Yes I did. Did I know what I was doing? Eh, kinda. But I wasn’t going to pass up the opportunity to hear the beautifully satisfying SHUNK of the staple gun.
Aside: we’ll find out if I was actually allowed to do this when I meet with my portfolio coach in a few weeks.
Anyway. I know this isn’t my most amusing entry, but it’s hard to write humor about a service where you see such extremes of the human condition. I’ve seen people who crashed a motorcycle, flew a hundred feet, and hit a tree going 65 mph survive their seemingly insurmountable injuries. I’ve watched people walk out of the hospital after just one day with nothing more than cracked ribs after being hit by a car traveling seventy miles an hour.
But I’ve also seen people die – both right away and from infection days or weeks after their accident. Once, in the trauma bay, I translated for a Spanish-speaking patient who had been shot clear through his spine. All he wanted to know was why he couldn’t feel his legs. He died two weeks later from infection; his last days were spent feverish, paralyzed, and on a ventilator attached at his neck.
Those stories tend to stick with you. And it’s hard to be funny.
(Stapling, though, is still really effing fun.)