Kristin Prentiss Ott, M.D.

The Truth about Trauma Drama (PAP series 5/6)

“People are People” Part 5 of 6

 


A few years ago, Mickey (my trauma surgeon husband) was featured on a show on TLC called “Emergency Level One.” There’s a reason trauma is so heavily featured in medical shows. It is…DRAMATIC.

People get run over by giant John Deere farm equipment. They fall off roofs, get bucked by horses and jump off bridges. They get burned throwing gas on fires and from chemical explosions at work. Whether someone is severely injured or not – it is a day that person will remember. It will become a story to tell. And my-oh-my are there some stories!

I once saw a man beaten by a crow bar (and at least 5 guys) for showing up at a wedding uninvited. And I took care of a young woman who got shot setting up a game of horseshoes in her backyard. She lived in the country and got hit in the chest by a stray bullet from a neighbor’s target practice at least a quarter-mile away.

(And while we’re talking about mechanisms… There are only two kinds of people who ride motorcycles: people who have been in an accident and people who will be in one. Law or not in your state, please wear a helmet – and protective gear. Or better yet – just sell your bike!)

When a level one (serious) trauma rolls into a trauma bay, one of the first thing that happens is all of the person’s clothes are cut off to expose potential injuries. I once saw a down coat cut off and the trauma bay was filled with floating feathers. People who are truly severely injured don’t fight this at all. Either they can’t talk, or know their life is at risk and clothes seem very unimportant.

People who aren’t imminently dying sometimes ask with urgency to spare their favorite pants, etc. Women frequently call out,

“No! No! NOT my bra!”

A good bra is tough to part with.

After the trauma patient is fully exposed, he/she gets a head-to-toe exam which includes a rectal exam to check for blood. (You can read a story about that here.)

Trauma patients often ask if they’re going to die. Most healthcare providers seem to avoid the question and say, “Don’t worry; we’re going to take good care of you.” But I think the right answer (true or not) is always, “No. Not today.”

It’s interesting to see the range of pain responses. I have seen many patients who arrive screaming, writhing, and demanding ‘something for pain’ whose workups reveal no major injuries. Some screams are more about fear than pain. In contrast, I had to beg a grandmother pacing the room – with both of her arms dangling at funny angles – to accept pain medication. After a fall holding her grandchild, her only concern was getting to the children’s hospital.

The drama of accidents brings families together. I once took care of a patient who was transferred from an outside hospital after an ATV accident. His work-up did not reveal any life-threatening injuries and the plan was to discharge him. Tons of relatives had shown up from over an hour away and wanted us to keep him “just in case.” (In case of what – I’m not sure.) I happened to be in this patient’s room when a cousin came in and said,

“Man, I haven’t seen you in two years!”

That same cousin later asked me for a work excuse. Because it was late. And, you know, he had to see the minimally injured cousin he hadn’t seen in two years.

Because family and friends converge after trauma – drama ensues. It’s not uncommon for a wife and a girlfriend – or two girlfriends – to show up and it becomes evident that they are unaware the other person exists. And there are estranged siblings and unwelcome first degree relatives. I stay out of ALL of that. Thank goodness for social workers.

With shootings, retaliation is common. When I was a resident, I went with an attending to tell a family that their loved one did not survive a gunshot wound. The room was full; the air was tense. Two people dropped to their knees and starting rocking before the truth had even fully been told. And then within seconds of the d-word escaping my lips, a muscular young man grabbed the shirt of one of the people on the floor. He yanked him up and said, “We’re gonna make this right.”

They were out the door before anyone could stop them. There were more gunshots that night, but I have no way of knowing if it was because of those two men.

One of the most difficult situations is multi-traumas. Kids ask repeatedly for their parents and parents inquire repeatedly about their children. Sometimes you are aware of a death at the scene. But this is usually second-hand information and not the kind of thing you want to be the least bit uncertain about – so you give a neutral answer like:

“There are good people taking care of your little one. We’re going to focus on you right now and we’ll let you know more as soon as we can.”

But my stomach twists a bit when I say it and suspect there will be weeping and gnashing of teeth in the near future.

The injuries that are the most disturbing to me after years in the Emergency Department are impaling trauma, severe eye damage, and burns.

  • For whatever reason it is more unsettling for me to see a stick sticking out of a knee than a bone sticking out of a knee.
  • The desire to protect our eyes is strong and my sympathy level is high when eyes are ruptured or protruding.
  • And bad burns are disturbing because they are so incredibly painful and often life-threatening.

I know an attending who had the foresight to use his phone to video a burn patient’s message to his family before he was intubated and put on a ventilator. It was clear from the severity of his injuries that his life was at risk. He died a little while later, but his family got to see and hear his last words of love.

While the world of Trauma is filled with tragedy, it’s not all depressing.

  • Trauma patients sometimes make jokes that crack up the whole room.
  • It can be heart-warming to see the love families have for one another.
  • And positively spirit-lifting to see someone make a full recovery.

Sometimes patients return to the trauma unit months later – walking and talking – to thank the staff. Those are good days. But even the days filled with bad accidents and hard conversations are rewarding.

People are people – whether they are minimally injured or burned beyond recognition – and it is a privilege to care for them.

PS – I am going to take this opportunity to clear up a common area of confusion. My husband is a trauma surgeon and I am an emergency medicine doc. He is a surgeon. I am not. He works mostly in the ICU and OR. I work only in the ER. He comes down to the ER for traumas and determines whether or not they need surgery or to be admitted and handles their care from there. Trauma surgeons and ED docs work alongside one another sometimes, but we have very different jobs! 


EPILOGUE:

This post is the last in a series about some of the parts of medicine that aren’t suitable for dinner-party chatter. Every post ends with what a privilege it is to care for people – because it is. It is a privilege to care for people with a wide range of penchants, pasts, body types, abilities, injuries, and life expectancy. Thank you for reading. 

#peoplearepeople

Cover photo credit: Flikr, Robert Couse-Baker, creative commons license.

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Kristin Prentiss Ott, M.D.

Author of the viral post: 10 Things to Know Before Your Next Visit to the Emergency Department. Board certified emergency medicine physician, wife, mother, aspiring novelist.
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