Tuesday, November 13, 2012

NaBloPoMo Day 13 - On Trauma

I work in a small community hospital.  Most of my day to day patients are what could have been seen in a primary care provider's office if only we had enough primary care providers.  They're the coughs and colds and bladder infections.  The fevers, chills, and hangovers.  Then there's the acutely drunk, the acutely high, the acutely should have passed out quietly at home but friends/family/the police freaked out and brought them to the ED for us to deal with.  .

Occasionally I see a real sick person:  heart attack, pneumonia, appendicitis.  And, occasionally we get a trauma.  Inevitably, I will be asked, "don't you miss it?"  I usually answer, "Not really, trauma is easy."  I trained at a Level 1 trauma center, and we saw a LOT of trauma:  blunt force, penetrating, etc.  We saw it all.  People would ask, "gee, your weekends must be busy."  I would answer, "Not really, we once had three GSW's on a Tuesday morning.  Trauma in the inner city doesn't wait for the weekend."

But, there is something about trauma.  It's a high level excitement event.  Life and death decisions need to be made on the fly.  But, not really.  Trauma is so protocolized that it becomes a matter of checking all the right boxes, stabilizing the patient, and sending them to the appropriate location.  Sometimes an immediate procedure needs to be performed, but almost 75% of the time, nothing more than an IV, some fluids, pain meds and an x-ray need to be done.

Do I miss running down the hallway with my gloved hand in a hole on some patient's chest holding back the blood that was just moments ago spurting out of it as we make our way into the OR?  Do I miss seeing a CT scan like the one above and reaching for the phone to tell my attending I'm calling in the OR team, starting antibiotics and reserving a room in the SICU?  I have to be honest, sometimes I do.  Especially when the 5th pedi with fever checks in and joins the growing chorus in the din that is the E.D. 

It's then that my mind drifts to putting in bilateral trauma chest tubes, placing ICP monitors, and packing a wound during salvage surgery then "getting the heck out of Dodge."  Is that the police monitor I hear...? Another combatitive EtOHer coming in...?  Sigh....

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