I’ve spent all summer rotating on sub-Is (sub-internships, i.e., senior electives where you essentially act as an intern to show residency programs your ability) on trauma and critical care services, both in rural New Hampshire and inner-city St. Louis. And while the demographics are completely different, the skillset of trauma surgeons is relatively universal. Throughout the summer, I’ve picked up a collection of idioms and reflections from attending trauma surgeons who have been gracious to share their mentorship with me as I prepare to follow in their footsteps.
One morning on rounds, one of my attending physicians was mentioning how the surgical consult service (i.e., when other services ask for the surgery team to intervene or to assess a patient) is often sought out for non-surgical concerns. When I asked why he said that this was called the “courage of the non-combatant.” I didn’t know what he meant at first, but with further reflection, my attending described how it is trauma surgeons who only intervene when absolutely necessary, while other services may want to seek out procedures or surgeries more frequently. (This phrase comes from Clovis, in the Talking Out of Tarrington– my attending also reads a lot). I’ve seen this a few times when a consult for right upper quadrant pain and inflammation around a gallbladder pushes other services to have the surgeon perform a cholecystectomy (i.e., take the gallbladder out). Intra-operatively, we see a perfectly healthy gallbladder, surrounded by a patient with poor liver function.
Another attending of mine quotes something similarly: “Don’t just do something, stand there.”
It’s been very interesting to hear how some of the most presumed interventionist physicians– trauma surgeons– are not as eager to operate and do so only when necessary.