Saturday, April 19, 2008

Trauma Call Makes The News

Recently I experienced something a bit unsettling about working in a regional trauma center.

I was on trauma call. At my current hospital, the surgeon on call assumes the role of quarterback when a trauma case comes in the door. He (all of the attendings here are male) meets the patient and collects pertinent information from the emergency transport staff as they come through the door, does the initial Airway Breathing Circulation Deficit Exposure (ABCDE) evaluation and orders the requisite next tests and treatments. If two folks come in, he must asses them simultaneously and enlist the help of the ER docs to stabilize the patient(s). This is exciting to watch; in these situations, I just try to keep up with the decision making process. When patient are already stable as was the case this time, the best I could do to help was to collect supplies needed for exam or treatment.

This case was my first interaction with the outcome of a motor vehicle accident (MVA in ER lingo). The specifics of the case are interesting; some of the passengers died at the scene, so it is expected that there were serious injuries involved. There are two elements of this situation I had not expected.

First, (and this is not the unsettling part) the hospital's chaplain provided an amazing service to the patients. He was able to respond to their emotional state. Whether the patient wanted to begin acknowledging the loss of their loved ones or to wait to hear about the situation, he was able to support them. No one else in the ER was able to forge this needed connection - we were all concerned with placing lines, reading films, and preparing for surgery or transfer. What I learned about telling patients that their loved ones had died was to:
  • Be prepared to report accurate account of what is known about the accident and fatalities. Names, ages and relationships are very important to discern. If this requires calling the state patrol, so be it.
  • Patients know something bad has happened. But they may not be ready to hear the words until some of the physical shock has worn off. They may tell you this. When they say they are ready, then see above.
  • If the information is kept from them, it will not be for long. News travels fast in hospitals. The ICU nurses, anesthesia techs and other docs will know snippets of the story. If the doctor caring for the patient does not tell the whole story, this could erode trust needed to best provide care.
This last part brings me to the unsettling part of the MVA trauma experience: news reports. News of this accident undoubtedly makes it into the local newspaper. Full names, hometown and hospital condition are always reported. When I came across the story of the trauma case I participated in, I imagined the patients' personal concerns, complaints, fear, and humor. I also remember digging glass out of a neck laceration in the operating room and then washing the wound with 3 liters of saline. There is always so much more behind the police report oriented news release.

The news reports are so cold. It's the truth underneath the report that is hot: exciting, heart wrenching, fast paced, uplifting - all with little room for error. That part of the story is tucked away in the confines of the physician-patient relationship. It's a privilege to be a part of that.

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