CSTARS: First Overnight Call

Updated: Nov 4, 2020

The Trauma Resuscitation Unit, or “TRU,” as it’s known, is probably the number one place you don’t want to find yourself after a night of barhopping or drunk driving in Baltimore. The TRU is kind of like an emergency department, except the only rooms are trauma bays. Each bay comes stocked with everything a team of nurses and doctors would need to keep someone alive or bring them back to life. The bays are set up in a big half circle, and in the middle of the circle are three or four rows of computers set up like mission control, and the call team of doctors sits in the back row.

It was my first night on call when my fellow said “OK, who’s up?”  The six of us he addressed all came from different backgrounds, with different levels of training. The team consisted of two 2nd year residents and one 3rd year ER resident from ER, one 2nd year and one 4th year surgical resident, and me. We each put our name on a piece of paper and hung it up on a wall in the TRU. When the fellow said, “Who’s up next?” he was referring to the order on the piece of paper. It helps to understand that every trauma code I’ve seen or been part of before now I was way in the back in an overcrowded room full of people. Now I was being pointed at, and being told to run the code, almost regardless of my level of training.

Thankfully the theory was more terrifying than the reality. When my first patient arrived, I was fully pumped as the ambulance came through the intercom shouting out vital signs and describing a man found down after being assaulted. I started frantically running through all the different scenarios in my head. What if he wasn’t breathing? What if all his bones were broken? What if his guts were hanging out, and he was screaming in pain? I was so pumped up I started jumping up and down and stretching. What came in was a mid 30’s drunk that got hit in the face and had a small cut above his eye. The nurses started frantically cutting away his clothes and starting IVs with dizzying speed. I zipped through my airway, breathing, and circulation assessment as I had been trained, all of which was, of course, normal. My fellow was standing at the foot of the bed observing all of this. When he realized this guy was nothing more than a drunk that fell down, he lost interest and walked away. After two minutes of frantic movement, everyone dissipated as fast as they had appeared. The guy got a CT scan, was deemed stable, and was discharged later in the night.

The next patient wasn’t much different. It was a little old lady that fell and broke her hip. She had already been stabilized at an outside hospital, and was being transferred to Shock Trauma because we have better orthopedic surgeons. What struck me was that even though she was stable, the nurses and medics still moved with the same speed and urgency as before. It was as if to say that they didn’t trust this so called “outside hospital” which had clearly missed some horrendous femur fracture, so her pants got cut off like everyone’s did.  There was no fracture, only a little old lady wondering why some nice young man had just cut her pants off.

As the night went on it became apparent that my expectations had been set a little high. I was not going to be slicing someone’s abdomen open with my right hand and intubating them with my left anytime soon.  In between the stable transfers and elderly slip and falls, we did get some actual trauma, and some of them were even in shock, as the hospital’s title might suggest. The first night, a guy came in with two bullet holes in his pelvis, screaming how he didn’t want to die, right before he lost his pulse and got CPR while simultaneously being rolled to the operating room. One of the other residents was managing that case when it came in. I watched from the side as the guy started to go down hill. When the other real trauma surgeons in the room realized the guy was crashing the resident was essentially pushed to the side as more experienced masters of the craft took control. I actually found this push to be quite reassuring. I now knew that if shit actually hit the fan I wouldn’t be left alone to deal with it.

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