Trauma Surgery Service

I switched to the trauma surgery service last week. It's very different from elective surgery. Obviously, it's unpredictable when patients come in. The most common traumatic injuries are motor vehicle and motorcycle accidents, gun shot wounds, stab wounds, and falls. But we also get appendicitis, pancreatitis, aortic aneurysm rupture, etc. Anything that comes into the emergency department with a surgical component ends up on our list. Some of the odder ones include man vs. animal diagnoses: car vs. horse, motorcycle vs. wild boar, falling off a horse, getting kicked by a horse (it's Fresno after all). Many of the injuries are severe and life-altering, and many involve orthopedics or neurosurgery: open book pelvis fractures, spinal cord injury, brain bleeds. Some patients are actively dying; others are admitted for 24 hour observation. Sometimes, we end up being a dumping ground for patients, and it sucks. Our census has no cap and it can get as high as 60 patients (how ridiculous is that? Spending 8 minutes per patient would take a standard 8-hour work day). The turnover is mindboggling; in a single day, we may discharge 20 patients and get 20 new patients. It makes learning very difficult and good patient care a challenge. It's a good lesson in ward management of an incredibly diverse and complicated set of patients.

There's less time in the operating room because everything is so hectic. Emergency surgeries happen when they happen, and people usually forget to contact students. Unfortunately these surgeries can often be the most interesting: stab wounds, bullets, ruptured bowel. Multiple emergencies can happen at once (multiple car crash) and more traumas happen at night. The whole situation is pretty unpredictable.