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What is it like to perform emergency surgery on a patient after a traumatic incident?


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Rachel’s Answer

Trauma surgery can be very frightening and chaotic. Injuries can be severe, and there can be terrible distress in treating a dying patient without knowing where all of the injuries are. However, excellent protocols have been created by experienced trauma surgeons to dictate the order of events in the emergency room and the type of operation to correct most injuries. These protocols allow for some level of order amidst all the uncertainty.

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Ryan’s Answer

I can't speak to surgery as I am definitely not a doctor, but as an Emergency Medical Technician, I have treated thousands of patients that have had traumatic injuries.

Especially early in your career, there will be nerves and adrenaline - lots of adrenaline. Easy knowledge will be more difficult to recall as your brain's amygdala (fear response) tries to overpower your frontal cortex (creative thought). Easy tasks will become more difficult as blood shunts away from your fingers and hands to power your core muscles - what you probably know as the "fight or flight" response. Whether you are in the ambulance or the operating room, you must actively repress the adrenaline. Remain calm. Even if you're intimidated, overwhelmed, or disgusted on the inside, you can't show it, and you need to push it to the side. Meditation and visualization exercises are a great way to make you better at calming yourself down and compartmentalizing your emotions.

The treatments themselves are muscle memory, and or gut instinct. You may be surprised at the end of the event by things you did without really thinking about it. In a true emergency, there is little time to reflect on your education, create a pros and cons list, brainstorm, or consult reference material. In these situations, a good plan NOW is better than a perfect plan LATER. Can't remember if the tourniquet goes 2 inches or 3 inches above the amputation? Just put the darn thing on.

The final thing I will say is that all the emotions you compartmentalized and set aside during the incident will return and need to be addressed after the need to focus and perform has passed. You may feel accomplished and proud of what you and your team accomplished, but frankly, more often than not, you won't. You will feel nervous and remorseful that you didn't do more or faster. You will feel depressed that an 8-year old could be shot in a drive-by over "turf". You will feel angry that a child will grow up parentless because of drunk driver (who, by the way, is in the next ER room over - with hardly a scratch on him). You'll feel isolated because you can't explain your emotions to your friends and family because you've seen things that they will never see or understand in their whole lives working in their cushy 9-5 office jobs. You will feel physically and mentally exhausted from the hormones and chemicals coursing through your arteries and veins for, sometimes, hours.

Your training and education will prepare you for everything you need to do to perform during trauma patient care. The most difficult part to explain, experience, and live with comes after. If you pursue a career in medicine, take steps to preserve your own well being. Exercise. Eat right. Sleep well. Get checkups. See a counselor regularly, whether you think you need to or not. Don't be afraid to talk about your feelings. Repressing thoughts, internalizing emotions, and just "pushing through" will eventually lead to burnout.

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