Trying to feel

Last night while working in the emergency department, there was a 16 year old boy brought in by helicopter who had been in a high-speed motor vehicle collision. He was following commands and had normal blood pressure, but he did have a severe open fracture of his forearm and a near amputation of his right leg just below the knee. He was going in and out of consciousness as we worked on him, waking up with shrieks of pain when we tried to examine or splint his broken arm and leg. We decided to “knock him out” and put him on the ventilator for the remainder of the work-up so that he would not have to experience so much pain. (He was going to have to be intubated later for the operation on his leg anyway.) After obtaining the appropriate diagnostic tests to rule out any occult life-threatening injury, we (the trauma surgery team) began discussing with the orthopedic surgeons whether or not the leg could be salvaged. All who examined the patient concurred that a completion amputation was the best course given how mangled the accident had left the muscles, skin, and bones of his leg.

As we discussed this with his mother (who incidentally was a nurse from our hospital), I could not help but wonder how the patient was going to experience all this. He was going to wake up in a few hours in an ICU and have to be reminded repeatedly until his narcotic doses were lowered that he had a bad accident and lost his leg. And then finally, one of those times it would hit him permanently and profoundly that his life would never be the same. Now we as surgeons, see a below-knee-amputation (BKA) as a reasonable outcome on the scale of badness that can happen to you in a severe accident. We told the patient’s mother how he would be highly functional with a prosthesis, and with a good below knee stump, he would have a normal gait, and be hardly noticeable with pants on. But in the mind of that boy, I can never quite imagine what it’s like to go from a healthy athletic young man, to being suddenly disabled.

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The suddenness and profound effects of trauma always affect me. I think that’s why I’m drawn to the sub-specialty of trauma. It’s a field where your patients often “meet” you after waking up to realize they have had the biggest set-back of their lives. It may not shock you that patients usually resent their surgeon initially. You can be sure that the 16 year old boy becomes angry in the next few days as he goes through the stages of grief…as he blames the surgeons and calls us butchers (in his mind or sometimes out loud.) But in the long run, that bitterness often turns to appreciation. As a trauma surgeon, you not only manage the patient’s injuries, but you serve as his psychological punching bag when he needs one. It’s a strange specialty, but I’m strangely attracted to it. It is hard to put into words, but seeing someone's normal life turn tragic in an unexpected instant causes one to want to help endure that suffering and to feel their pain...but, I never really can empathize with them. I just become acutely aware of how small my problems are as I'm trying to feel what this poor patient is going through.

I still have some time to decide if or what I will sub-specialize in, but after last night, traumatology has moved back to the top of the list for reasons that I can’t express, but are none-the-less real.

Yours in growing empathy,

chad

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The secret to caring for the patient, is caring for the patient.
-Sir William Osler-