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A colleague of mine was recently questioning her capabilities having lost yet another patient who had arrived nearly lifeless after being shot.  She was despondent over the nation’s overall complacency about our gun violence epidemic giving her far too many opportunities to fail or succeed as a trauma surgeon. Truthfully, neither quick decisive action nor expert surgical skill was enough to repair that much damage. Not in the hands of any trauma surgeon.

As trauma surgeons we bring everything we have–every ounce of energy and drive, countless years of specialized training, and an ever expanding armamentarium of medical technology to fix broken bodies–to our work but sometimes we simply feel like failures, both unable to save our patients and unable to move the dial on policies that might ameliorate gun violence.

Here are the words of support that I offered to my friend: a compassionate, highly skilled trauma surgeon who without hesitation took a hemorrhaging gun shot wound victim to the OR to try to save his life:

“The grief is understandable. For your patients. For your community. For our society. You have a skill set that makes you brave enough to even try, my friend. As a trauma surgeon when you hear audible hemorrhage you run toward it, just like the police run into the gunfire or the firefighters run into the flames. Each and every patient is lucky to have you and your strength; their families will be grateful for your efforts and empathy no matter the outcome. Don’t be too hard on your self.”

Having been raised in a culture of morbidity & mortality conferences where we scrutinize every decision and every action preceding a death or complication, having a chosen specialty whose goal is to salvage badly damaged bodies, and living in a world where these patients keep appearing in our trauma bays even when we speak up about gun violence, this self-doubt is common among us.

But sometimes we just needed to be reminded we are heroes who have chosen to run toward the audible bleeding so we can get up and go back to work the next day.

Who do you save? The emotional impact of mass casualties.

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A 6 year old boy with abnormal pupils and gasping for breath.

A 26 year old pregnant woman with a gunshot wound to her abdomen.

A 54 year old male with blood pouring from a wound in his thigh.

Now add 43 more patients.

Imagine you are the paramedic at this scene.  Who do you take to the hospital first?  Who do you have to choose to walk past and leave at the scene while you take your patient to the hospital?

Now imagine you are the surgeon.  You walk into an emergency room with blood everywhere – covering faces, limbs, the floors.  There is a cacophony of sound – screams, cries, gasps, whimpers.  Where do you start?  Which room and which patient gets your attention first?  How many patients, calling out to you for help, do you have to pass by?  What operation will you perform and how will you perform it knowing there are nearly 50 other patients needing your attention at that very same moment?  Will you be right?  Will you save everyone you could?

As a trauma surgeon, these are the real types of questions that we are given when training for mass casualty situations.  And although the patient specifics listed above are not from the shooting, these are still the same thoughts that every single healthcare worker and all six trauma surgeons in Orlando right now have had and will continue to have for months to come.

26 operations in 12 hours.  I wish I could adequately describe the inhuman and superhuman effort that this represents from the trauma surgeons at Orlando Health, one of whom has been a friend of mine since high school.  When I first heard the news I immediately contacted him, letting him know I was thinking of him and his team, knowing exactly that this day will never leave him, or any of them.  I have written before describing the multitude of feelings involved when losing a patient… but this is just the tip of the iceberg when discussing a situation of this magnitude.

After the adrenaline surge, after the floors are mopped, the scrubs are changed, and the patients sorted through, they will pick apart this day – every last detail, decision, and action will be analyzed, examined, and questioned – and never forgotten by a single person who touched a patient on June 12th, 2016.

These six trauma surgeons have made a thousand decisions in the past 24 hours – the types of decisions that no one should ever have to make, but are unfortunately faced more and more by those of us in this field.

To the surgeons at Orlando Health – I know you haven’t slept.  I know you haven’t eaten.  I know you haven’t sat down in close to 30 hours.  I know you are mad, I know you are sad.  Stay strong my friends, we are all with you.

My thoughts and prayers go out to the victims, their families, the first responders and healthcare workers in Orlando – #lovewins.

 

 

 

A Surgeon’s Survivor’s Guilt

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My heart tells me I lost them.  My brain tells me I never had them to lose.

One of my mentors has said that all trauma surgeons have their own personal graveyard, filled with patients we couldn’t save, and families’ hearts left broken.  A truer statement has never been said, and this weekend, this trauma surgeon’s graveyard has increased yet again.

The feelings that accompany this increase are always varying and deep.

There is anger.  True wrath.  When the hell are we going to figure this out?  When are we going to stop shooting one another?!  When are we going to learn that drinking and driving can be deadly?!  When are we going to start respecting ourselves, our bodies, and one another?!  When are people going to stop paving a path of destruction for themselves and others that is wide and immeasurable?!

There is sadness.  Sadness over the pain and the fear that my patients surely felt.  Sadness over the waste of life that we witness.  Sadness for the families left behind, in a new world they never anticipated.

And yes, guilt.  Guilt over being able to go home, when our patient couldn’t.  Guilt for leaving the hospital to enjoy my family knowing another family has just been destroyed.

This weekend was a particularly rough one for myself, and the hospital at which I work.  Although to most people around the country, it was just another act of violence, to myself and our community, it was felt deeply.  Every person in our hospital was stung, upset, and shocked.  Everyone knew what happened – I received touches on the arm, knowing hugs, and reassuring smiles.  They knew I did everything humanly possible even when the inhuman was needed, but that knowledge is a poor salve against this type of wound.

So please, if you know someone who works in healthcare – give them a hug, a high five, or even a thank you.  I have said before how we all take you, our patients and communities, home with us at night, but please also know that our lives are never the same either.  Every patient encounter alters us – sometimes subtly, and sometimes drastically.  We are changed, and we never forget.

Stay safe.

Today Nearly 300 of Us Will be Killed or Injured with a Gun

My heart is heavy this week due to gun violence. Today, it is a mass shooting that happened afar. Most days it is something that happened in my own trauma center’s catchment area.

Some people ask why I only speak up about our nation’s epidemic of gun violence when there is yet another mass shooting. After all, as a trauma surgeon I am all too familiar with the daily toll of gun violence one person at a time.

Whether it is the young urban dweller who lacking hope for a good future, in the absence of socioeconomic security and educational opportunities, turns to a life in gangs armed with illegal guns and ends up in a crime fueled shootout…

Or the depressed middle-aged suburbanite who under the oppression of dark feelings related to job loss or divorce or perhaps seemingly no obvious stressor attempts to take their own life with a hand gun…

Or the believer in concealed carry who, in a state of inebriation, engages in what might have otherwise been a simple fisticuffs that instead turns out to be a deadly bar fight…

Or the curious child who, due to the momentary carelessness of an adult who would swear they are an educated legal gun owner compliant with best practices for firearms safety, pulls the trigger with a devastating outcome…

Or the bereaved, yet obviously mentally unstable, individual who acts on his grievances against his mother’s surgeon by gunning him down in the clinic

Or any of the 297 Americans killed or injured daily due to firearms, as trauma surgeons, my colleagues and I bear witness the death and destruction caused by our nation’s obsession with the right to bear arms first hand each and every day.

While it’s a thrill for a trauma surgeon to get a great case—it might be the adrenaline surge of doing an ED thoracotomy on a coding patient with a hole in the heart or the exhilaration of the exploratory laparotomy requiring 4 or 5 lacerated organs to be repaired—but as a human, each and every time I am called upon to care for someone who was shot, no matter what the circumstances, I feel sick to my stomach. My soul grieves for those who I can’t save, for those who will be left permanently disabled, and for everyone—patients, families, and caregivers alike—who will share the post-traumatic stress of having gone through the shooting and its aftermath.

This should not be happening in a civilized society.

To be sure, there are myriad other issues that contribute to gun violence in our country ranging from economic insecurity to mental illness to extremist beliefs to the ubiquitous violence we see in our LED lit world today. And, let’s not be naive; many objects can be weaponized to intentionally or unintentionally injure, maim, and kill others. As we have come to know from the fertilizer used in Oklahoma City to the ball bearings used in the Boston Marathon to the box cutters and airplanes used on 9-11, to the beer bottles, lead pipes, knives, bats, and automotive vehicles that we surgeons see as causes of trauma every day, it’s not just guns that are the problem. But it is foolish to think that these other issues contributing violence in all of its forms trump that of essentially unfettered access objects that, in any form—shotgun, handgun, semi-automatic—have a singular purpose: to injure, to maim, or to kill. The original purchaser’s intent may have been different—perhaps for target practice or for hunting animals or for self-defense borne out of paranoia of threat to personal property that is seemingly rampant in our society—but it’s just too easy, no matter how the gun was acquired and by whom, for guns to be used to cause harm whether by murder, or suicide, or terrorism, or accident.

And so, when there is a mass shooting that attracts the social media outcry of those around me—those known to me from near and far and those unknown to me who simply come across my news feed—I do speak up more vociferously than I do in my everyday life as a trauma surgeon because, in the deepest depths of my heart, I am hoping that this increased attention might galvanize WE THE PEOPLE to find it in our collective consciousness to finally take steps to re-envision what the right to bear arms means in a civilized society. No other country accepts this as an inalienable right; and, as a result they don’t see nearly as many deaths and injuries due to firearms as we do. But we hang on to this 18th century notion as a point of American pride. It’s time for 21st century Americans to figure this out because today nearly 300 more of us will be injured or killed by gun violence.