Haste Makes Waste
I returned to the classroom last night, for another evening of mandatory continuing education. First a pediatrician talked to us about childhood pulmonary diseases. Then we heard from a surgeon about chest trauma. Finally, at the end of the night, a trio of Boston Police detectives talked about the status of various street gangs.
I enjoyed the gang lecture the most, because the topic was so unusual. The information will probably come in handy at some point. If nothing else, it'll help us to avoid transporting rival gang members in the same ambulance.
Of all the speakers, the trauma surgeon appeared the most comfortable. For some reason, surgeons always make good lecturers. Naturally confident, they appear poised, no matter how large the audience.
The surgeon who spoke to us tonight kept us amused. He opened his talk with a series of videos that demonstrated all sorts of ridiculous injuries. Then he got down to business, describing the proper ways to diagnose chest injuries and perform tracheotomies.
During his talk, he told a story. "These days, we don't waste time opening chests in the emergency department," he said. "Thirty percent of all trauma patients have either HIV or hepatitis. It doesn't make sense to reach into a thoracic cavity and risk getting exposed, especially when hardly any of those patients will survive. If a patient arrives at our hospital within eight minutes of getting shot or stabbed, we'll open him up. Otherwise, we just pronounce them dead."
He paused for a moment to let this information sink in, then continued.
"It wasn't always that way, though. Doctor Hirsch, the great trauma surgeon, told me about an incident he witnessed back in the seventies, shortly after he became an attending physician. Back then, they opened the chest of every shooting and stabbing victim. Whenever a trauma victim arrived, the residents would run to the emergency department, because they all wanted to open the chest. Whoever got there first would have the opportunity to do it.
"One night he gets a call from the hospital operator, who says that a shooting victim has come in by ambulance. He runs to the emergency department, and there he finds a resident with the patient. The patient has been shot, but he doesn't seem to be bleeding. Yet for some reason, there's a giant puddle of blood on the floor. That's when Doctor Hirsch notices that the resident is holding a couple of fingers in his hand. The resident had been in such a hurry to open the chest that, well, you get the idea.
"Anyway, that's why we're not in such a hurry to open chests anymore."