Even though Phoenix is a big city (sixth largest in the U.S.) the surgical community is a relatively small. We all know most of the other general surgeons in the Valley, if not personally, then by reputation or at one degree of separation. We know who is the best at a particular procedure, who responds quickly to calls, who you can trust in a pinch and who you can’t.
One gets closer to surgeons who are in the same immediate circle as you; the ones you see week in and week out in the locker room or the doctors lounge or waiting in the OR to start their own cases. Many of them you may have worked with directly on the same team, especially in trauma. Others you know only by sight and name, but they are still definitely part of the surgical ‘family.’
Wider associations are formed with the nurses who work in your operating room or in the trauma rooms; with the technicians who draw the labs and manage the ventilators, and scrub your cases; with the representatives from the equipment companies and the surgical device manufacturers who seem to be a ubiquitous as scrub techs. They all are included in the wide circle of those whom you know and regard as part of your world.
“Surgeons who are in the same immediate circle as you…you know only by sight and name, but they are still part of the surgical ‘family.’”
When you work trauma long enough, it’s inevitable that someone you know will appear in your trauma unit. The rules for family members are clear: hands off and call your back-up. But friends and acquaintances are not covered by any rules. You do what you have to and try to maintain some objectivity.
It has happened to me a few times. Some were fortunately minor traumas. Recently, though, an acquaintance showed up with a devastating injury after being hit by a car. His head and face were so traumatized that I didn’t recognize him at first. Even when the paramedics gave us his name, I did a double take. Couldn’t be, I thought. That location is nowhere near his home. He wasn’t exactly a friend, but I knew his name and where he lived. I had seen him and his wife at various social functions and knew he had teenage children.
He’d been riding his bicycle when the car hit him. He was an avid cyclist and often had his bike in the back of his truck and would ride after work wherever he happened to be.
He was in bad shape. His brain was severely injured, and his facial bones were so broken that we had to do an emergency tracheostomy to help him breath. He wasn’t responsive to any stimulation, and the CT showed diffuse brain injury that wasn’t fixable with surgery.
I called the neurosurgeon personally and insisted he come in, explaining that this was one of our own. He came and was as thorough and careful as always. It really didn’t matter that this was a member of our wider community. The neurosurgeon I called is always careful and thorough. That’s why I use him. But in this case, it was important to me to be able to say I’d gotten the best people I knew.
We went over his scans and his exam together. I asked the necessary questions and my neurosurgical colleague confirmed my impression that there was nothing we could do to help, nothing to change the inevitable end.
It didn’t help all that much when I talked to his wife and children and outlined as gently as I could the extent of the injury and the grim prognosis. In the end I was left with the same platitudes we use for all these situations. He’s not in pain. He may be able to hear you, so go ahead and talk to him. Everything possible is being done for him. All true, but not very helpful, and even less satisfying somehow when the patient is also someone you know. His wife thanked me and told me she was glad that it was me who was taking care of him; someone who cared about him.
Sometimes this job really sucks.
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Bruce Davis