In trauma, the fundamental problem is the misappropriation of forces.
Knives create holes and allow sharing of fluids and air in cavities of the body that depend on strong borders. Bullets create shockwaves that transfer enormous concussive forces to the tissues, in addition to making a tunnel along whatever path it takes. Car accidents have an amazing ability to create forces in opposite directions, extreme torsional forces, and downright incredibly powerful blunt forces. Physical damage from the paper-cut, to accidentally impaling yourself in the garden, to falling off a roof, to playing with fire; trauma is for me an amazing example of how the body is made to survive. And no species is as specialized in inflicting such damage to ourselves and others. It sometimes seems like medicine is in a head to head race with our inner Suicide Squad. This leads to every day at the office of the Medical Provider a new and exciting adventure of, “What shall we see today.”
There is an interesting game we play in the world of trauma, a mental game of being fascinated and eager for things that are by their very nature despicable and horrifying. Honestly, if you happen to find yourself half folded inside out, you better hope the woman there to help you loves to see your insides. Simon Sinek, a brilliant leadership speaker, and author, has made a career out of talking about trust and cooperation in the workplace. He has said in several speeches that it is embarrassing that there is a market for his work. Why would people pay money to hear about cooperation like it’s some far out idea? Trauma, in particular, is in a similar juxtaposition to what we would like to be our normal. Why do we have four-year-old gunshot victims? Why do we have a specialty in nursing for forensic exams of rape victims? The existence of trauma is not a negotiable. The suffering of people is a reality we can not ignore. With all the process and specialization and training, we still let debilitating trauma continue to permanently damage lives. In this case, I'm talking about health care workers.
“There is no reason for a burn victim to go back to work in a year while the nurse who cared for him has to quit a year later; having been burned herself one too many times.”
The pain a patient experiences in their body can be extreme in trauma. And we in healthcare have to jump right in and grab that mangled limb, or that sloughing skin, or that detached piece and carry on like its no different then clearing a table after breakfast. The doctors and nurses ask if "this hurts" while manipulating whatever part they are sure is broken. Doing this makes it clear to everyone that we all agree it hurts. For the provider of Trauma medicine, we don't have a process for someone to come to us and poke our fears, our worry, our nightmares and ask, "Does this hurt?" I inflict pain on people for a living because I know that this process will give them the best chance to heal. How important is it also that we have people in our life to have the courage to inflict pain and explore our emotional wounds that no debris left behind could cause an infection of the heart. The work is hard and no one denies that, but there is no reason for a burn victim to go back to work in a year while the nurse who cared for him has to quite a year later; having been burned herself one too many times.
We are healers. We use science and practice to deliver highly effective and outcome driven medicine. But we are also humans, and we require grace and compassion to maintain our grasp on the human experience of trauma. We need conversation not criticism. We need check in's, not check lists. We need support, not spreadsheets. We need a community, not a comity. We need leaders who unite us, not budgets that bind us.
In Trauma, the fundamental problem is the misappropriation of forces.