All Bleeding Stops by Stephen M. Cohn, M.D. explores the effects of trauma with an in-depth look inside trauma centers. Dr. Cohn describes the impact that injuries from car crashes, shootings, stabbings, and other traumatic events have on the patients — and also their family, friends and medical care team. Through sobering narratives, Dr. Cohn paints the true picture of what it means to work in a trauma center.
In the following excerpt, Dr. Cohn describes what differentiates trauma surgeons from other medical personnel. He explains his path to becoming a trauma surgeon and details the characteristics that allow one to succeed in a trauma center.
Types of Surgeons
There are fields of surgery that are primarily elective (planned) surgery in patients who are not dying (think orthopedics, urology, plastics, or ear, nose, and throat) and those where there is more emergency work and the patients are often incredibly sick (like much of general surgery, cardiothoracic, neurosurgery, and vascular surgery). All trauma surgeons are general surgeons by training. General surgeons do a wide variety of types of surgery. They are the origin of most surgical specialties like colorectal, bariatric, breast, surgical oncology, and most folks going into vascular, plastic, and cardiac surgery. (Think of general surgery like the trunk of a large tree, with each surgical subspecialty representing an important branch). Trauma surgeons deal with the most death and dying among general surgeons. It is like anything else; the folks who enjoy the challenge of dealing with a patient who is bleeding to death in front of them for unknown reasons, gravitate to and remain in the trauma field.
The select group of general surgeons in the U.S. who specialize in the care of trauma patients is often confused with emergency room physicians. Trauma surgeons do surgery and take care of patients throughout the hospital, primarily focusing on the critically ill. Emergency room physicians are certainly front-line workers, but they focus on the initial care of all types of patients, exclusively in the ER. Orthopedic surgeons deliver trauma care in some countries, and anesthesiologists often manage the surgical intensive care units (ICU). This is the case in much of Europe. In the U.S., general surgeons who have completed medical school (4 years), a general surgical residency (5 years), and a surgical critical care fellowship (1 year) work as trauma surgeons in trauma centers. Some residencies add one or two years of required surgical research.
The Path to Becoming a Surgeon
Creating a surgeon certainly requires a long and grueling course of training. During my surgical residency, we were in the hospital every other night and usually awake the entire time. (Think 40 hours awake in the hospital and only eight hours at home every 48 hours). The old gray-haired folks from the last generation of surgeons who existed when I was in training used to say, “the problem with being on every other night is you miss half the action.” Meaning that we were missing valuable training experiences if we left the hospital for even a few hours. Our every other night on call gave us only a tiny, painful glimpse at the real world, which was possibly worse.
The Key to a Good Surgeon
People often say: “Your job must be so stressful.” However, surgeons tend to be stress-resistant. It may be that folks who are calm in the face of a calamity gravitate towards surgery, or it may be that those who survive the grueling residency years can withstand the rigors of a “stressful” career. Indeed, our job is to remain placid when all hell breaks loose. It is only by keeping your cool when encountering significant difficulties that we can pull patients out of bad situations.
Relevant reading
All Bleeding Stops
A gripping portrait of trauma surgeons and their place in the controlled chaos of a trauma center, as told by a 40-year veteran of trauma care.
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