The Miracle of Trauma

Jenny Blair, M.D.
August 11, 2002

I am the medical student on the Trauma Surgery service. Sometimes, a pager beeps. It belongs to a resident on my team (a ladder of doctors, with me on the bottom rung). He twists sideways, putting a hand awkwardly to his waist, and peers down at the offending pager. "It's a Full," the resident murmurs to the team, and slips away. I run after him. Doctors nearby, having jumped and twisted in unison, settle back to work after the false alarm. We hurry down flights of stairs and around corners.

I confess to an unseemly relish for these moments. A Full is a Full Trauma, a badly injured human being arriving in the emergency room, who will be cared for by a disciplined crowd of professionals in a special Trauma Bay. That I wish injury on no one is beside the point. If someone has to be hurt, hurt badly, then I want to be there for the solution, even if I'm standing back behind a bold red line on the tiled floor, even if I'm only listening to doctors and nurses call information to each other while they huddle over a human being whose hand or leg I can just glimpse. Someday, it may be me standing at the head, asking the patient or the paramedic what happened. Sometimes a trauma victim has alarming vital signs or X-ray results, or arrives in the Trauma Bay already unconscious. The decision is then made to put in a breathing tube and wheel her away to emergency surgery. It is my unthinkable privilege to accompany her there, to observe as she is eased to a deeper sleep and placed under sacred blue swathes of sterile paper. It was during operations on this service that I began to see why people become surgeons, why they accept the famously brutal and prolonged course of surgical training and its strain on their personal lives.

Surgery, and perhaps trauma surgery in particular, demands something -- a level of attention, an acceptance of reality -- that no other endeavor does. Nothing is more real than an emergency operation. Nothing could be more free of pretense, devoid of distraction, than someone's intestine rolling gently out of an incision, or a knee cut open and the patella -- the kneecap bone -- laid bare. The trauma victim's insides show themselves with a forbidden red shine, and become your entire world. You learn them intimately: how they lie upon one another, where they slump back to when released. You gingerly examine the damaged parts that are removed to a bowl, parts from textbook diagrams that have suddenly gained heft and wetness. The confirmation is breathtaking. The muffled voices, the harsh lighting, the stark isolation of a single piece of the body framed by blue drapes put thoughts of all else to shame. You're hungry, it's late, your legs ache; but none of that matters. The spell is not broken even after the skin is closed with stitches and the blue sheets pulled away; the patient is still anaesthetized, far from our company, and the memory of red organs is more real than the unconscious person on the table.

At the end of a day of trauma surgery, something in me has been enticed out, almost against its will. I go home and try to gather it in again, pulling strands and winding them back up neatly inside my head. I need all of me back home; I need to read novels, to phone my sister, to sketch and jog and cook without recipes. I knew long ago that my own permanent mental dwelling-place -- the place I come home to -- would always lie outside my career, no matter how much I loved it. But I believe there are people who come home to the operating room: people who are not just brilliant surgeons, but for whom everything else is, more or less, just the time between operations. I asked a resident a couple of years ago how she survived month after month of 120-hour weeks at the hospital. She said it was because she loved it. I do not plan to become a surgeon. But now I think I understand.

A few days after the sober rapture of the operation comes the miraculous part of trauma surgery. The patient remains sedated during her post-op stay in the intensive-care unit. Awed, I peep in on her. She lies buried under pipes and hoses, attended by machines, the room empty of sound but for their beeps and the slow rise and fall of her artificial breathing. She seems more a part of their mechanical world than of mine.

But one day, she is brought to a new room on a floor where less critically ill patients stay before going home. We enter her room on rounds, and for the first time, I see unobstructed the face of the owner of the organs I know so well. She is sitting up, breathing alone, scars hidden, following us with her eyes. The attending physician asks how she's feeling. The miracle, small and quiet: She replies.

Copyright 2002, Hartford Courant

Jenny Blair is a third-year student at the Yale School of Medicine. All stories are real, but identities are concealed for confidentiality reasons.