Playing Surgeon

I, Doc Gurley, spent the last two days playing surgeon. Eleven hours each day, I went into a temporary emergency tent and shivered over hot coffee. There were lectures, then practical skills stations where I did procedures on rubber dummies while pre-eminent surgeons watched and critiqued me until I got it right. Let’s just say that I resuscitated so many dummies, store manikins the world over now worship me as a goddess. I’m known as the Mass Casualty Queen of Rubber. So why would any self-respecting board-certified internist subject themselves to this level of fumbling humiliation? I mean, it’s not like we internists ever get to stand around and critique surgeons on their choice of antibiotics, or even (heaven-help-us), their EKG interpretation skills. Well, here’s why and it’s an issue that applies to every one of us:

If there’s anything we’ve all learned in the last few years, it’s that no community is immune from disasters. There was one point where I was trying to shove a chest tube into a disembodied dummy chest (optional breasts available, individually cellophane-wrapped), my palms sweaty and the tube bouncing off the “flesh” (read: tan) colored skin. That’s when I confessed to my instructor (Chief of Trauma Surgery) that, given the fact that the homeless clinic where I work is right next to San Francisco’s City Hall, my worst nightmare was that, immediately after the next Big Earthquake, I would be at the driving end of a chest tube, and the person on the receiving end of it would be none other than our esteemed mayor, Gavin Newsom. After a very un-surgeon-like guffaw of laughter, my instructor said, “Gavin’s real happy you’re doing this. Just take a look at his face,” (note to readers: rubber dummy is headless) “Heck,” he continued, “if you weren’t doing this, Gavin’d be dead.” He gave me a major-trauma-inducing whack on the back and headed off to watch someone else mangle a manikin.

His point is an excellent one. What we were all gathered to do is something called ATLS (Advanced Trauma Life Support) Certification. ATLS was developed by the American College of Surgeons as training for people like me – people who don’t normally handle trauma, but might face it one day as the only doctor available. It’s been well-studied, and proven to save lives, despite its two-day brevity. ATLS’ positive effects endure for about 4 years for each individual who takes it. ATLS certification is intended for community docs, non-surgeons, and surgeons who don’t see trauma much. If you think about disasters, even a huge suburban community probably has, at most, only one or two trauma-level surgeons living there to help everyone. What if that person gets hurt?

But, you may be asking, isn’t any doc just about as good as any other? Well, I was on a flight once when the pilot announced overhead that they needed a doctor. I had two toddlers with me, and Cheerios glued onto my clothes with spit-up. I got a pretty skeptical look when a flight attendant responded to my call-button. I was reluctantly taken to the back area of the plane, despite many warnings that the situation was already under control, that they really didn’t need anyone. But when I got there, a graying man in an expensive suit, standing over a clammy, passed-out person said, “Oh, thank GOD you’re here. I’m a dermatologist.”

During ATLS, we docs had, after the rubber-resuscitations, real, live paramedics who volunteered their time to get make-up and bandages and fake blood put on them and be pretend patients. We docs each then underwent two “mock” patient scenarios to see if we could apply what we’d learned. It’s amazing how much more your blood pressure and anxiety levels spike when there’s an actual face to the problem, despite the fact that you know it’s pretend. Then we had The Test – a final fake resuscitation/trauma, with a real person pretending to be injured, and numerous complications in their management. There were no giggles at this stage – no slack was given and no allowances made.

So what did I get out of this, besides my little card?

1) An appreciation for the saint-like patience of all things rubber. I think I only heard one exasperated dummy sigh,

2) A tremendous gratitude for the professionals (surgeons, nurses, and paramedics) who put together such a high-quality course, and devoted so much of their time to it,


3) A profound wish that more of this type of training could occur in rural areas. Contact your local representative and find out if they’re getting some Homeland Security money. See if it can be used to train up people in your area. Write a newspaper article. Because if it’s me on the receiving end of a chest tube, I hope I’m not lying there, looking up at a (no-ATLS) sweating dermatologist.

Or, worse yet, no one.

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