Trauma and dark times

I want to be a trauma surgeon.

This is a relatively new revelation. It's only a step away, or a one-word amputation, from my previous, "I want to be an orthopaedic trauma surgeon." It's a world away from turning my nose up at the "soft stuff" that stands between an orthopod and their bones. It's the anatomical quagmire of the abdomen. And it's a different ball game entirely to the young medical student I once was, feverently requesting of my best friend to hit me over the head with a (heavy) saucepan if I ever decided to become a surgeon instead of...well...pretty much anything non-surgical.

I want to work in war zones.

It's an unusual thing to say, when there's the safety of the local operating room and adequate trauma in most cities to sustain a handful of trauma surgeons. It's an unusual thing to say because trauma surgery is tough. But in war zones, it's tougher. In the community, your patients could be anyone and yes, it's still emotionally difficult. But in war zones, your patients are your comrades. They're your fellow soldiers. They're the men and women keeping the medical compound safe. The men and women fighting, literally, tooth and nail for what our nation wants to protect.

I want to be ready.

And, how, you might ask, would that happen? I'm a thinker who paints. I paint with acrylic and canvas, and I paint with medicines and retractors. Before putting brush to canvas, an artist sees the landscape before them. I remember when I used to paint often, I used to see the world in paint. I'd see the strokes to make the road look road-like, the colours I'd mix on the palette for the grass, the smudging required to make sure the sky looked like a sky and not like an ocean. And, in that same way, mental rehearsal can prepare us for the difficult situations in the work place.

I deconstruct all the hard times at work.

I'm pretty sure I could recount in fine detail all of the cardiac arrests I've attended in the hospital. I could tell you where the patient was, and probably a few of the people who attended with me. I spend a lot of time after each of these events thinking through what we could have done better. What I could have done better. Did we communicate appropriately? Was all the equipment in the MET trolley? Were our compressions deep enough? And I walk through the situation again and again, fixing little things. When I was in medical school, we had a weekly resuscitation training session, where our Sim-Man would become progressively more ill and it was our job to save him. Sometimes we worked together as a fantastic team, sometimes too many alphas spoiled the team soup. In the workplace, we do this too.

I imagine often how I would react to a trauma.

My biggest fear is not the injuries that might arrive on our doorstep. I hope that my training will prepare me with the medical and surgical skills I will need to give our patient the best chance at fighting on another day. My biggest fear is actually two-fold. The first, that the patient isn't any comrade, but someone I know. Someone from my present or my past, someone who makes my heart sink from it's place snuggled between my lungs to somewhere lost in my small intestines. And my second fear is having to call their loved one, far away, and tell them all that has happened. Good or bad outcome from the surgery, the news of your loved one being in a massive trauma would never be easy. I walk through these scenarios, the gathering of the surgical team, the plan of action prior to the patient's arrival. I imagine saying a few words to the patient before the kindly anaesthetist works their wizardry. "Who do you love?" I ask them, because in my head I feel like that thought is already what they are thinking. And already I feel the weight of that name. "Margaret." I imagine having to stay calm in the face of massive blood loss. And even in my imagination, I don't know how to deal with bad outcomes. In the safety of my imagination, the patients all live. In the safety of my imagination, there's a postcard a year down the track letting me know that the soldier made it home, made it to rehab, and is doing okay now. A friend told me a story of a defence force pilot who, poignantly, was responsible for flying his childhood neighbour home. The two hadn't spoken in years, and only one of them made it home alive. But it was fitting that these buddies came home together.

I could pick a specialty with fewer emotional hazards.

I could choose to do something happier, or less confronting. But I don't know what that would be. I like surgery. I like the hands-on work. I like the puzzle. And trauma surgery is a complex puzzle indeed. Every case is different. And I feel a overwhelming sense to serve in areas of need.

There's a long road ahead.

There's the journey to surgical training. There's trauma fellowship. There's all of life that goes hand in hand with getting old and following dreams.

And while there's no dress rehearsal for life, there is one for theatre.


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