John B. Fortune, MD, FACS is the Medical Director of the Vermont Regional Trauma and Burn Center at the UVM Medical Center. He is also a Professor of Surgery at the University of Vermont.

“I am a trauma surgeon ….”

That’s my standard response to that occupational question that all of us probably get asked dozens of times each week.  Since I have been in this line of work for nearly thirty years, I calculate that this phrase has passed my lips about 15,000 times in my lifetime.  And believe it or not, the responses to my answer are all pretty standard and go something like:

“What is trauma?” or

“Oh, what ER do you work in?” or (and this is my favorite)

“You must see some pretty disgusting stuff.”  

Well, now that you have asked, I will start with the technical answers first.  Trauma means personal injury and each year about 40 million Americans get injured seriously enough to seek formal medical care. Almost 140,000 die which, unfortunately, makes trauma the fourth leading cause of death in our country behind heart disease, cancer, and stroke.  The tragedy of this disease (you know, trauma is a disease!) is that it primarily involves younger people.  In fact, it is the leading cause of death for those under the age of 45. Currently, most major injuries are caused by motor vehicle crashes, followed by falls and then by acts of violence.  For those who survive, permanent disability will be seen in about a half a million people per year.  The annual cost of trauma to society is staggering: $260 billion.  And, you know, except for watching a cable TV show here and there, most people are not aware of the toll that trauma extracts from our society, which is why it has sometimes been called “the silent epidemic of America”.  Next time you pick up the paper and read about a car crash in Burlington or Rutland or Stowe, consider how awful the result can be.

So what is the UVM Medical Center doing to provide the best care possible for the trauma patient?  About 30 years ago a few surgeons recognized that the immediate (that means within minutes) treatment of the trauma patient resulted in the best outcome after injury.  The provision of definitive care within the “golden hour” resulted in the development of trauma centers throughout the country.  A trauma center is not a just a building or an emergency department – it is a team of skilled professionals that are available 24 hours a day to provide the highest level of medical care to the patients on a moment’s notice.

A serious injury in Vermont or upstate New York can be tragic, but when the patient arrives at the UVM Medical Center, we are ready!  Surgeons, emergency medicine physicians, trauma nurses, respiratory therapists, radiology technologists, blood bank personnel, and case managers are all waiting.  And in spite of all the people in the room, the initial evaluation and resuscitation of each patient is like a performance of a symphony orchestra.  Everybody plays their part and works as a team – perfectly.  Our operating rooms, CT scanners, and intensive care units are open and available.

When the patient is moved into the hospital, additional specially trained nurses, therapists, pharmacists, dietitians, and other professionals take over.  Our goal is to get the patient back home to their family and friends.  We think that our results are outstanding, as evidenced by the UVM Medical Center’s recent verification as a Level I trauma center by the American College of Surgeons – the only Level I trauma center in Vermont and Northern New York, and one of only 102 in the country.

And finally, it is often implied that we trauma surgeons might enjoy seeing all of the blood and destruction associated with the trauma patients.  Since I am truly an adrenaline junkie, I guess the excitement, fast pace, and the need for immediate decisions might have attracted me into the field, but today, I derive no pleasure in seeing mangled bodies in the trauma resuscitation bay.  You see, with every injury, there are pain and suffering and a sense of immense loss.  Injuries are usually a result of an unexpected event and, in many cases, lives will never be the same.  Can you imagine – a person starts the day enjoying breakfast with his or her family, and then winds up in our trauma center as the result of an accident on the way to work?  Everybody’s life is disrupted!

What I enjoy about my job is working with a team of UVM Medical Center professionals who labor tirelessly to help these trauma victims and their families return to their normal lives.  Nothing is more satisfying than monitoring the improvement of a young man or woman who has suffered life threatening injuries as they progress through the emergency department, OR, ICU and then into the rehabilitation center. And, yes, some of our patients don’t make it.  But our trauma team still is there helping families through the tough process of letting go and saying goodbye.  Now that I think about what we do, there are days when our team is burdened with tears of sorrow and other days when we cry tears of joy, but all of our days are filled with the fulfillment of providing care and assistance to those who need us most to help them through some of the catastrophic consequences of modern life.

So, back to the answer to that occupational question – the full answer is:

“I am a trauma surgeon leading the UVM Medical Center trauma team … and we make a difference.”

John B. Fortune, MD, FACS is the Medical Director of the Vermont Regional Trauma and Burn Center at the UVM Medical Center.  He is also a Professor of Surgery at the University of Vermont.

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