Diary of a Fourth Year Med Student: Orthopedic Trauma Surgery on the West Coast

“Katie, If you go into surgery, you’re going to miss patients.” It was three in the morning in the ED; the resident was feeling the strain of a 24 hour trauma call, and I was loving it. I had spent the past half hour with a lovely, older woman whose foot had gone through the floor of her vehicle in a crash. We chatted about where she had been traveling, and she barely winced as I worked. The resident had picked up on my admiration for this lady, something he had little time to appreciate as he pulled up the chart of the next consult.

This was my last call night at Harborview Medical Center in Seattle. I had driven across the United States for a series of electives on the West Coast, starting with an orthopedic trauma elective with University of Washington. My first and only other rotation was an acting internship at UVM, and I didn’t know what was expected of me in an elective rotation. The residents didn’t quite know either. After the first couple days of hearing: “You don’t need to do that, you’re just on an elective,” I told my seniors to treat me like a sub-intern, and I got what I asked for. The 6-6 intern shift ran over as traumas bumped our OR times later and later. Every 6th day I stayed for a 24-hour call. Our patients were varied and acute, our interventions were tangible and visible, and I was working harder than I had ever worked before.

To be clear, I have never intended to go into orthopedics. I applied for this elective to give me exposure to a field I found fascinating, to get me into one of the best trauma hospitals on the West Coast, and get me darn good at reading X-rays. Take this lady with the shredded ankle. When the ortho service was consulted, I headed over for a history and physical while the resident put in orders for imaging. Once I got the story, the resident dictated while I irrigated the degloved calf, consulted plastics to take a look, and placed a couple of sutures to reapproximate the skin edges before we splinted the ankle in the ED. The next morning the attendings reviewed the imaging and discussed the fracture type and appropriate repairs. I went to the OR as first assist to the fellow, placing external fixation on her shattered ankle to stabilize it. Finally, we presented the fracture in the weekly fracture conference, discussing the imaging, diagnosis, and potential repairs and complications from the injury.

Seattle has the unique advantage of being a big city in an even bigger wilderness, and patients came to us out of that wilderness. I saw patients who were injured dirtbiking in Idaho, ice climbing in Oregon, and fishing in Alaska, as well as the more standard trauma of car crashes and assaults. In the OR I handled tools and techniques I hadn’t dreamed of, and gained a new respect for skin closures under tension. In the ED I learned casting and splinting from the pros, placed femoral traction pins, learned to shoot portable X-rays while setting bones, sutured some gnarly wounds, and got to meet the multifaceted population of the Pacific Northwest.

The exhausted resident had a point — surgeons spend much less time with their patients than other specialties. But it was my patients that I enjoyed most from the Seattle rotation. A professional water skier who wiped out on a new trick. A drug dealer who described his BMW as I took out his stitches. And this tough retiree who didn’t even wince as I washed her exposed flesh. I saw these people at their most scared and vulnerable, panicked about their injury and what it meant for them. I was able to look at their x-rays, close their skin, and realign their bones. Most importantly, I was able to take this information back to the suffering person, talk to them about their injury, and be a part of the process that helped them get better.