A 10-hour shift with Trauma

This post was written by Courtney Leach, Digital/Social Media Manager.

I sat in the physician’s lounge at 7 a.m. on the nose. The morning news mumbled inaudibly on a distant wall as the subtitles raced across the bottom of the television screen. The adjoining kitchen was buzzing with dishwashing, meal prepping, and talk of weekend plans. A friendly staff member motioned for me to come get something to eat, but I was too nervous to take her up on her invitation.

It is my experience (minimal though it may be), that the dial on the clinical side is set to two speeds: quiet and quick. This, I anticipated, would be the only quiet I had for the next 10 hours.

It was an unseasonably warm Thursday in late February, and I was scheduled to follow Raymond Cava, MD, PPG – Trauma Surgeon, on his typical shift at Parkview Regional Medical Center. I had never met Dr. Cava, nor had I spent any extended time in the Trauma Center, aside from the occasional set of stitches for my own children. I felt a familiar apprehension, recalling the two days I spent with the crew of the Parkview Samaritan, and how the hours spent waiting for a call can feel so unsettling, laced with anticipation.

Just as the morning news was making the shift from top stories to entertainment, Dr. Cava walked in and introduced himself. “We gotta go!” he prompted and I awkwardly saddled myself up with my backpack and camera bag, and scooted off behind him.

“Things go from quiet to busy here very quickly,” he offered. I expected no less. 

First stop was a morning traffic meeting, where a team of key caregivers gathered to address the status of patients currently in the Intensive Care Unit (ICU). Physical therapists, rounding nurses, physicians, physician's assistants and case managers went down the list of critical patients to address the best next steps for everyone in the unit.  

After the team had their updates and orders, we headed over to the Emergency Room, where a man involved in a truck crash who had been extricated from the vehicle was being assessed and attended to. We stopped into his room. We’d just missed him. We went down to the CT scan area just as they were completing his tests. Dr. Cava chatted with the technicians a bit before heading over to the reading room.

Stepping into the space, I had a thought I’ve had many times since I started at Parkview – I might never know the vast scope of services and specialties that wait behind each and every door in this hospital’s hallways. The reading room was a dark space with a handful of desks, each manned by a different Radiologist who meticulously combed over various scans. Milky white images filled up the vibrant screens illuminating the room just enough to see everyone’s faces. Dr. Cava introduced himself to one of the gentleman and together they began going over the truck driver’s results. I tilted my head, squinted, and followed as well as I could. There are some things only meant for the trained eye to see, I suppose.

From what I could understand, this man had been fairly lucky, all things considered. It was the first incident of the day and, as Dr. Cava would tell me a few times in our hours together, a scenario that plays out more than most might realize. “It’s weather and season-dependent, but you know, people are on their phones, using their GPS, or falling asleep. Plus, addiction to pain pills is a huge issue right now. People are out there driving on pain medication and others have no idea. It’s enough to make anyone nervous to be on the road,” he said. “Or I see people getting hit on the side of the road. They’re just so vulnerable there and nobody's looking up enough.” As preventable traumas go, motorists certainly top the list.

Car crashes and falls have filled most of the trauma surgeon’s 12-hour shifts for the past 14 years, which is a bit different than the gunshot wounds and stabbings he saw in his days working in the Chicago hospitals. “The penetrating traumas were exciting to operate on,” he said, “but every surgery is different and interesting.”

When you walk into a room and a trauma is in progress, everyone is talking, everyone is in motion. Everyone knows what their job is and they are completely competent. “We have good people who have learned their team roles, just like a pit crew,” he said. “Plus, there’s a method to evaluating each trauma.” So, while it might seem chaotic to a layperson, the electric energy of an ER room is truly a well-rehearsed production, driven by the patient’s most impactful human functions. What can a person not live without? Is this person breathing? Start there. Is their brain functioning? How’s their heart? And so on. The team also runs through simulations regularly for constant process improvement.

Certain groups of clinicians have very distinguishing characteristics. Surgeons in particular are a fascinating breed to watch. They have a sharp focus and ability to sort through a lot of stimuli and pick up the precise information they need to act. They are hardwired with a dulled reaction to a rush of adrenaline. They are superior analysts, computing what they know to determine what they should do next. They are steady and calculated and unequivocal. Dr. Cava has an intimidating directness when addressing the black and white points of a case, coupled with a forgiving lightness in the interim. His presence commands both respect and accountability. But his smile and wit are as relatable as his comfy Chuck Taylors.

Dr. Cava’s specialty is acute care surgery, which means trauma, emergency general surgery, and surgical critical care. He spends some days at the trauma follow-up clinic, checking up with patients he evaluated in the Emergency Department.

Because the stakes are often so high in the scenarios they’re presented, the trauma team faces a fair share of loss. I was curious how Dr. Cava addresses the sensitive task of communicating with the loved ones of critical patients, or those who did not survive a trauma. “You have to be honest with families. You have to be matter-of-fact but compassionate. A lot of people don’t understand those words until you say them out loud.”

This led to a topic Dr. Cava feels very strongly about, comfort care for end of life. “I think it’s important to be honest when someone is dying. I think it’s important to say, ‘Look, I can’t stop what’s happening to them, but you can go be with them. That is the best option.’ When people see that you have done everything possible, it helps them through the process. Sometimes, comfort care is the best option. As a nation, we just don’t empathize enough.”

Dr. Cava finds solace in knowing he exhausts all his capabilities with every patient, but he finds those cases where a young patient doesn’t survive particularly difficult. “You know, you go home and you hug your kids a little tighter that night,” he said. “But you can’t fall apart. That doesn’t help the next person coming through those doors.”  

It was time to round on Dr. Cava’s cases in the ICU, an area that, for Parkview Regional Medical Center, holds 40-60 patients at any given time. As we worked our way down the hallways, methodically sliding the curtains back and tentatively approaching the bedside, I began to understand the breadth of this specialty. We saw a woman who had been in cardiac arrest just days before, sitting up chatting and ready to go home. We saw a head trauma. We saw pneumonia. We saw hip fractures. From one room to another, Dr. Cava knew exactly where the patient’s progress was the day before. He transitioned effortlessly. Even though he was holding a chart, their status lived somewhere inside him and he merely pulled it from the filing cabinet in his well-trained mind.

This was also one of the first times I was able to witness Dr. Cava’s endearing exchanges with his patients. We entered an older gentleman’s room who had a tracheostomy tube in. As he over exaggerated his mouth in an attempt to communicate with his caregivers, Dr. Cava ordered the tube removed. He then came back to the bedside and invited the patient to talk. An ornery response filled the room. “It’s good to hear your voice!” he exclaimed in response. The mood lifted to one of joyful optimism, just like that.

But the common thread running through our day was the truck driver. Nearly a dozen people were now working to get him settled into his room in the ICU. They bustled about, performing more tests, making him comfortable, administering medications. Dr. Cava stood at the foot of his bed running through a checklist. Asking questions, answering questions, steering a smart ship, already on course.

After Dr. Cava felt satisfied with the progress in this room, we moved on. Another car crash victim was just two doors down, and I stood outside the door as Dr. Cava very candidly reviewed the extent of the young man’s injuries. I leaned against the wall and practiced a moment of mindfulness in the break. Call lights went on. Call lights went silent with resolution. Nurses buzzed from point to point, delivering comfort items, updating other team members. Visitors strolled with heavy feet, and heavy hearts at times, down the corridor. Their eyes were telling a story I might not have noticed without the context. It was a reminder of the hurt so many carry unnoticed.

I shut off the faucet of thoughts filling my notebook as my guide returned to the hallway. Time to go. We went down to the office adjoined to the physician's lounge so he could catch up on his notes. “There are two things we don’t skimp on around here. Coffee and lunch.” As someone who excels in both of these areas, I was ready for the reprieve. I grabbed a cup of caffeine and settled into an unoccupied work station in the office.

What I didn’t know is I was walking into a fraternity. The men and women who came into this room were all part of a unique band of caretakers. To get in, you must possess this shared drive, shared set of struggles, shared steadiness, shared benevolence. I sat with my back to the room as the rhythmic taps of keys paused intermittently for consultations on techniques and talks of patients’ unique stories and challenges.

Dr. Cava spent time catching up with his nurse rounder, LeeAnn. When I asked him about her later, he said, “She keeps everyone in line. She knows how to get things and who to call. She’s great.” In fact, there were a lot of team members Dr. Cava relied on during his shift. Aaron, was a third year medical student shadowing Dr. Cava for a few days. Grant, trauma nurse practitioner, was Dr. Cava’s main point person for the day. Nicole, trauma nurse practitioner, checked in for a consultation on a head trauma.

It all made an efficient machine. The pulleys and levers and gears all turned and information funneled through for optimal care. As someone who spends most of her days far from this machine, it was illuminating to meet all the players that grease and fuel and turn the necessary mechanisms to keep people moving through their recovery. No one could do this job alone. No matter where they trained, how they prepared or how sharp their skills. This is a job for a team.

I seized a quiet moment to ask Dr. Cava about his background. He grew up in the suburbs of Chicago. Once he realized being an astronaut or hockey player weren’t in the cards, he embraced his desire to be a doctor. He attended medical school at Rush Medical in Chicago and did his residency in the Windy City. He completed a fellowship in Atlanta from 1998 to 2000, and followed that with three years as an assistant professor. From Atlanta, he decided he wanted to bring his family closer to his Chicago roots, and made it as far as Fort Wayne.

“Trauma always seemed the most interesting to me,” he said. “Especially coming from Chicago. The time we spend with the patients is profound, but brief. I just try to relate to them on a human level.” While he credits helping people as the most rewarding element of his job, certainly there are difficult days. “I think that having emotional support at home is key.” And hobbies. In his downtime, Dr. Cava enjoys hunting and hiking in northern Michigan, an area he credits with helping him recharge and spend important time with his wife and two children.

But he never stays away too long. There’s a great deal to be proud of back home. Many people don’t realize Parkview is a Level 2 Trauma Center. The only things that distinguish a Level 1 Trauma Center from a Level 2, is having a residency program and publishing a certain number of research papers. So, when it comes to the patients, the amount of care they receive at our facility is exceptional. “The people we have and the services we offer are truly remarkable,” he said.

Dr. Cava and I filled our plates with last night’s chicken dish and salad from the buffet, respectfully. Just over his shoulder, the subtitles marched along. The headlines from this morning being recycled, updated, refashioned. We chatted about unplugging as he scrolled through sunsets and sunrises he captured over Lake Michigan on his phone. It was a rare moment of reflection; slow, quiet and a scarce luxury for a trauma surgeon.

We finished up and went back up to check on the truck driver from this morning. I wondered if his loved ones were on their way. If he would remember, how much he would remember, what story he would tell in all his days to come. He was resting peacefully as the team continued to adjust medications and address his healing. Our visits to this room had been the punctuation marks to a day of check-ins and follow-ups. I would probably always wonder about this man whose beard I saw tucked into a cervical collar. Who I saw on perhaps the worst morning of his life. I would always wonder. I thought about how many people Dr. Cava saw on the worst morning, day, night of their lives and how he carried that weight.

And then … nothing. Which, I was told, never happens. Indeed, for a department that sees several thousand patients per year, it did seem unusual. Even though the weather was reaching up over the 60-degree mark just more than a week after Valentine’s Day. Even though the cars and trucks and motorcycles buzzed one after another down the interstate just a stone’s throw away. Even though we were there, with a team of skilled caregivers and a wide open agenda, nothing happened. No one needed us. It was a rarity. Of course trauma surgeons wear a unique hat in that, while no one wants anyone to get hurt, the hours can pass very slowly when the buzzer doesn’t sound.

There were several physicians and anesthesiologists taking advantage of this unicorn sighting, this unspeakable quiet, by napping in front of the television. And there I sat again with the news. Those frantic subtitles. Upstairs, people were resting, and healing, and finding comfort, while the man who helped put them back together sat waiting for the next trauma to come through the doors. His is a life baited with adrenaline, fit only for those with the heart, the mind and the focus for it. Dr. Cava is all of this – a vessel of certainty and empathy. Just as he said, his work is profound but brief. He is the statue in the storm. And on this day, we were all lucky enough to catch a break in the weather. 

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