When Dr. Tracy Timmons worked as a trauma surgeon in Baltimore, she didn’t have much time for chatting with patients.
There could be 20 to 30 trauma admissions at Timmons’ hospital in a 24-hour period. Now, as the trauma medical director at PeaceHealth Southwest Medical Center in Vancouver, her trauma team was activated about four times per day, or 1,441 times, in 2019.
In Baltimore, 20 percent of trauma patients were seen for penetrating trauma (such as stab and gunshot wounds), but in Vancouver, that’s only a little more than 3 percent of the trauma patients, Timmons said.
At PeaceHealth, most trauma patients get care for ground-levels falls, falls off ladders and roofs and work-related injuries. The change in pace has been nice for Timmons, who said she can spend more time with patients while they get continued care before being discharged.
“I was way less likely to go sit at the bedside back then,” Timmons said of Baltimore.
Even though Vancouver provides a slower pace, PeaceHealth’s trauma center is ranked as a Level II, the second-highest designation in the U.S. There are five levels of trauma centers in the U.S.: Level I is the highest designation and Level V is the lowest.
Harborview Medical Center in Seattle is the only Level I trauma center in Washington, and PeaceHealth is the only Level II trauma center in Southwest Washington. OHSU Hospital and Legacy Emanuel Medical Center are both Level I trauma centers in Portland, but Timmons said there would be a huge gap in care if it weren’t for PeaceHealth’s Level II Vancouver trauma center.
Trauma surgery evolved as a speciality and gained value in the 1960s and ’70s, Timmons said, as doctors noticed people dying from injuries they could have survived if they had received care more quickly. That led to the concept of “the golden hour,” that prompt medical and surgical treatment after a traumatic injury can prevent death, according to the American College of Surgeons.
If there were no Level II center in Clark County, it would greatly affect patients living north of the metro area. Longview’s PeaceHealth St. John Medical Center provides Level III trauma care, but patients as far north as Centralia have to visit the Vancouver location, Timmons said. Many patients would have to cross the bridge into Portland during emergencies if it weren’t for the Vancouver location.
“The bridge would take people well outside of the golden hour,” Timmons said.
Shocking for everyone
Dr. Benjamin Rogoway, a PeaceHealth trauma surgeon, is nervous every time he sees a patient. That’s because in his profession, overconfidence kills people.
“The moment I stop being nervous, I’m going to screw something up,” Rogoway said. “We know the gravity of what it is we do. If we walk in the door with some really misguided sense of hubris, someone is going to get hurt. I’m nervous about everything. The longer I do this, the more nervous I get — because I know the different things that can happen.”
Rogoway likes the physical reward of his job — which can provide a high from saving a life. He feels like he’s doing something good every day, and he gets plenty of intellectual stimulation, but surgeons in general have a high rate of burnout, according to a 2015 study from the American College of Surgeons.
The study found that 40 percent of responding surgeons screened positively for burnout, and 30 percent screened positively for symptoms of depression. Some studies have shown that those rates are higher for trauma surgeons.
The medical definition of trauma is a “physical injury,” according to the Oxford Dictionary, but it can also be defined as “a deeply distressing or disturbing experience.” After a shocking physical injury, the injured person, their friends and family, and their surgeons can carry around after-shock.
“In this world, nobody prepares to have a huge traumatic event. It’s shocking to everybody,” said Karly Schrieber, trauma program manager at PeaceHealth.
Timmons said the trauma staff, which consists of 10 surgeons and four physician assistants, sometimes rely on dark humor to help them cope. Many trauma surgeons are also, unsurprisingly, adrenaline junkies. Some of them rock climb, or run races to decompress.
“It can be emotionally very challenging, because you carry a lot of sorrow with you,” Rogoway said. “When you deliver an expired baby out of a mother who was in a car accident with the intent of trying to save the mother’s life and you’ve done that a couple times in your career, that can affect you.”
Timmons said trauma surgeons will always beat themselves up over a negative outcome, even if they did everything in their power to prevent it. That’s why it’s important to lean on colleagues or PeaceHealth’s chaplains for conversation. She also said they have to be open about their own feelings with themselves.
When Timmons started her career, she closed herself off and tried to numb the emotions that came with her work. She thought compartmentalizing would be helpful, but it wasn’t. Now Timmons said she allows herself to feel much more. Sometimes, it might be by a patient’s bedside.
“Family members aren’t going to think anything bad of you if you cry with them, and so I do,” she said.