Scribbles from 2 days at the trauma conference

DAY 1

Preventing falls? C-PAP or tai chi?
Probably not.

Ice cave collapse
Finding myself in the crevices/between places
Where I do not belong

Radio this morning: Air France jet disappears on route.

Shaken-baby syndrome
Blast injuries
Death—it’s just the tip of the iceberg
Acute stress disorder
Emotional recovery
Exposure therapy
Maslow's hierarchy
Desensitization
Thought stopping
Cognitive restructuring
Safety in the world
All things undone

Feeling hits me
Life is a trigger
Reminds me of my essential loneliness
Inability to connect/to be with/to belong
To become
Reminds me of death
Reminds me of the essential misunderstandings that encase a life/mine

Things unsaid/said wrongly
The problem of re-reading
The problem of hope
The problem of expectations and false maneuvers
Hidden motivations

It’s all memory anyway
Nothing really happens. Or is that.
Dissociation. Speaking.

Hemipelvectomy.

Where do I belong, hanging
Between life and death, favoring
Death, always favoring death because
Death always prevails. Always.
And time is such a useless concept in the face
Of death. How could it matter, if I am going to die
Anyway. There is the odd concept of waste. Waste of time.
Wasted food. Wasted resources. Waste of energy.
But if energy-matter can neither be created
Or destroyed (and how could that be so?)

Then what is waste?
Wasteful/useless
The same? Or different?

Top 10 Trauma Center topics
*hemostatic dressings
*trauma systems designs
*goal-directed resuscitation
*human genome response to injury (why am I not surprised by this?)
*factor VIIA
*artificial fascia
*endovascular surgery
And a couple more I don’t remember

Learnings? Not sure what I learned today.

DAY 2

Can’t explain these sudden dives and tumbles, feeling bad about self
Comes and goes
Best to learn to “live” with it.
Life is short.

Fresh whole blood in Tikrit
Routine, every day volunteers
Sitting in the mess tent with nothing else to do
Injury severity score

But how do they get used to war?
Even as medical providers?
Is it no different than getting used to:
Death in the hospital?
Abortion?
Assisted death?
Trauma care in general?
Palliative care? Ah, palliative care!

Mixtures of fluids is tricky, surprising, potentially fatal.
(so you see, the trick is understanding data on your own terms)
Hypotension is bad for the injured brain.
But who pays the oxygen debt?

98,000 deaths a year from medical errors
Now, everyone is scribbling

Now on to child abuse
(as about 1/3 of the audience gets up and leaves the auditorium)
“The enemy of good is better” James C. Carrico, MD
Why don't they listen to this guy?

Right and left do make a difference
The racemic mix just didn't work as well.
But no one noticed.

Life imitates science.
Watching the young woman on the aisle
Tuck her bare feet under her bottom, comfy.

Antioxidants improve resuscitation outcomes
The age of the blood affects outcomes.
You don’t want old blood.
Gene-banger. What’s that?
This is a young man’s game, methinks.
If the gut works, use it.

Neuropraxia
Transient quadriplegia
Plexopathy
Nerve root injury
Funiculi
Foraminotomy
Transfusion-related acute lung injury
Platelets must be stored at room temperature, higher risk of transmission
No longer using plasma from females
Older blood-more likely to die—third speaker who says this!
Cryoprecipitate
Second impact syndrome

Lunchtime. I hate small talk, choose to take a walk rather than sit at a table with strangers eating hotel food. Am I an arrogant shit? Probably. But, trauma conference—focus is on war and sports injuries—why am I here? Would rather write a blog than talk. Arrogant shit? No doubt.

Trauma surgeons with their PP slides of bloody flesh, distorted faces, missing limbs--these bring pain into vision. But few outside this club can look. I suppose that I can sit with strangers after all, these comrades who can look at carnage, and then eat lunch.

Preventing ventilator-related pneumonia.
The ventilator bundle.
They look much better, after we place the trach.
Really cute speaker, little crush here!

Thinking about when I wanted to die for every misstep, every miscalculation, every misunderstanding. Now I don’t think about wanting to die,
because I know that I will soon enough. No matter what.

So that’s why I do this work? So I won’t think about suicide as an option?