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Trauma Surgery: Ju-Lin Wang
21 Plays23 days ago
Season 4, Episode 6: Dr. Ju-Lin Wang is a trauma surgeon at Cooper University Healthcare in Camden, New Jersey. Listen to Ju-Lin discuss the clinical decision trees used to stabilize trauma patients, partnerships between trauma surgery and the military and the importance of trauma awareness campaigns in our communities.
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Transcript
Introduction and Guest Overview
00:00:09
Speaker
You're listening to The Wound Dresser, a podcast that uncovers the human side of healthcare. I'm your host, John Neary.
00:00:21
Speaker
My guest today is Dr. Ju-Lin Wong. Dr. Wong is an attending trauma surgeon at Cooper University Healthcare in Camden, New Jersey. For more than a decade, Dr. Wong has led multidisciplinary teams to provide life-saving resuscitations and surgical interventions to trauma patients at a level one trauma center.
Initial Trauma Case Procedure
00:00:39
Speaker
Dr. Ju Lin Wong, welcome to the Wound Dresser. Thanks, John. Happy to be here. I'd like to start by considering what I presume is a common scenario ah for you and your work.
00:00:51
Speaker
ah You get a call about a patient in a motor vehicle accident. They have unstable vital signs and they'll be landing on the helipad in 15 minutes. ah Can you kind of walk our listeners through what happens over the the next 15 minutes for for you?
00:01:07
Speaker
Well, you know, the first thing is we get notified that somebody who is ah is coming. um Sometimes we get kind of pre-notification about how the patient's doing, their vital signs or like their condition. Sometimes we don't necessarily get the full point.
00:01:22
Speaker
full story. um it's It's fairly consistent. We get something, but there's sometimes where you're just you're just completely surprised. Or, you know, like like anything in trauma, the situation is always what we consider to be dynamic or kinetic. You know, it's always kind of moving along while the patient's not here, not in our care yet.
Resuscitation and Patient Management
00:01:42
Speaker
So we organize our team. We go off the helipad.
00:01:45
Speaker
um Our helipad's pretty well equipped with the basics that we need to take care of any trauma patient, including getting an airway or if we have to open their chest or do anything. um We normally, if we know that the patient's unstable from a hemodynamic standpoint, for trauma, bleeding is king. That's always almost always the cause of the instability.
00:02:06
Speaker
So we'll bring up some blood from downstairs up to the helipad and we'll bring that up a nice ultrasound. So we have that available to bring up our team. um If we know somebody on is unstable, um instead of kind of a receiving team where you have just a few people, we bring up the entire team and we can run our resuscitations up there if need be. We've done that in the past. We've run resuscitations up from the helipad and brought patients from the helipad directly to the operating room.
00:02:32
Speaker
So that's a possibility for us at Cooper. um Yeah. Can you expand more on kind of that when the patient after the patient arrives, sort of that decision tree you go through to say like, ah you know, in in terms of getting them stabilized?
00:02:46
Speaker
Of course. um So when the patient arrives, they eat they're using care of a flight medic, flight nurse, and they give us a brief rundown of you know what they encountered. Sometimes they're not first at the scene. They're called to the scene to pick up the patient.
00:03:00
Speaker
um So they give us a rundown on what happened before they were there. um after they arrived and then what happened in flight. This usually lasts about 20 or 30 seconds. And then we start working on the patient. um We are a level one ACS verified trauma center. So we follow ATLS guidelines in terms of resuscitation, which is broken down into alphabetic kind of like algorithm, A, B, C, and D, where we assess the airway. And that's a quick, these are all quick assessments.
00:03:29
Speaker
um We're just asking a patient their name, um if they can move any, move their distal extremities. That kind of gives ah gives us ah gives us an idea of the patient's disability. and there the status of their airway, their mental status.
00:03:41
Speaker
Then we go on to listen for breath sounds, B, and then circulation. We try to get IVs in place. Sometimes the flight crew has already put IVs in. And then if those are enough, we just go with those. And this is also kind of when we begin our resuscitation. But, you know, I'm kind of giving it kind of an algorithm, but a lot of these things are kind of happening concurrently at the same time, just to speed up the care of the patient.
Decision-making in Trauma Care
00:04:04
Speaker
Because we're trying to do one of two things. Number one is we're trying to resuscitate the patient. We don't know what exactly is wrong, but we know that most likely it's bleeding. So they're going to get blood through their IV access.
00:04:15
Speaker
um Generally, that's our first line resuscitant. At Cooper, we have whole blood. So if um we so their patients are hypotensive, um there's a high suspicion for bleeding, they get whole blood resuscitation.
00:04:28
Speaker
um And then we go through disability, which is like a quick neuro exam exposure, which is quick exposure. Sometimes this is done the helipad. If the patients are critically ill and transporting downstairs is too much time for them sometimes or most of the time they're they're stable enough. We get them down to the um trauma bay on the first floor.
00:04:45
Speaker
And that's where we kind of begin this, although the initial assessment happens along the way in the helipad. And in the elevator, and we start doing asking questions and things like that. So we have a trauma team that's comprised of a trauma team leader who's usually the trauma attending or the trauma fellow, a surgical resident, an yeah ER resident. Sometimes there's two yeah ER residents, a bedside nurse, um a charting nurse, and um also a nurse.
00:05:13
Speaker
respiratory therapists, an airway team, which is comprised a CRNA or an anesthesiologist who comes down to alert and a radiology technician will come over to do x-rays if we need.
00:05:24
Speaker
um So that's the team. um So once you run through the primary survey, which is the ADs, CDs and E's, we may have started blood. We may have put in a chest tube at this point, depending on what we think the cause hypotension is.
00:05:35
Speaker
um And then we're deciding at this point if the patient needs an airway or not. Sometimes they're not awake and they're not protecting their airway. then the airway will get established probably while all these things are going on, although, you know, by by the book, that's the number one priority. But like I said, most things happen together.
00:05:52
Speaker
When you're learning this in a classroom setting, it's taught in you know, A, B, C, D and E fashion, but the reality of it is everything's kind done at the same time for speed. um And at this point, we generally have an ultrasound in the abdomen, the heart to look for a pericardial infusion.
00:06:06
Speaker
We're looking at abdomen, see if there's free fluid, trying to identify a source of bleeding.
Types of Shock in Trauma Cases
00:06:10
Speaker
And if it's a motor vehicle collision, which is considered people on trauma, then the patient's going to get a chest x-ray to look for hemothorax or pneumothorax if there's not one clinically obvious from listening and breath sounds and a pelvic film to look for pelvic fracture and this would encompass all the basic places that a patient can lose blood the abdomen the chest um the pelvis and then the other things are we observe the long bones extremities like femurs sometimes a bad humorous fracture open fracture can lose blood and um
00:06:39
Speaker
And we usually go from there. um If there's a bad extremity fracture, we suspect that as a source of blood loss, we'll stabilize it. We'll put put it in traction, put some traction on it and put it in the splint to stabilize it.
00:06:51
Speaker
um So go that those are the basics. And at this point, hopefully, the bedside studies that we've done help us establish where the bleeding is. um Sometimes the patients respond to blood transfusion. They're considered a responder.
00:07:05
Speaker
um Then if they stay relatively stable with kind of like normal vital signs, the patients will usually go to CT scanning where we can really figure out what's wrong with them. Sometimes they're a transient responder. They'll respond a little bit and then they'll like become hypotensive again.
00:07:21
Speaker
We'll further a resuscitation and then we may redo some of the adjuncts like a fast exam, which is ultrasound of the abdomen or the chest and the heart or another x-ray.
00:07:32
Speaker
um And we'll go from there and try to figure out where the bleeding is without doing a scan. What we try not to do is we try not to transport ah an unstable patient to scans.
00:07:43
Speaker
because once they go over there, even though the scan itself technically doesn't take very long, setting it up, getting the patient on table, off table, that all takes time. And you're losing leaving the relative safety of the trauma bay for a CT scanner, which is equipped to take care of critically ill patients, but it's not the ideal setting for doing so.
00:07:59
Speaker
So we try not to do that unless we just cannot find a source. um And then in some cases, sometimes the shock is maybe perhaps not hemorrhagic. It's like neurogenic. And then we support the patient with resuscitation and potentially vasopressors and then try to get a CT scan to see if there's like a cervical spine injury or something causing neurogenic shock.
00:08:19
Speaker
um The three most common forms of shock we look for are hemorrhage, hemorrhage, hemorrhage, and then obstructive shock, neurogenic shock, and then distally, you know, Septic shock is way, way at the bottom side. It's just very uncommon, the front end of trauma.
00:08:34
Speaker
And a cardiogenic shock, perhaps if there's a chest wall injury, something, the trauma's affected the heart in some way, um then that that would be probably fourth. So so that that's that's bleeding is king in trauma. So resuscitation kind of goes in line with the diagnostic tools that you're trying to employ to figure out what's wrong with this patient.
00:08:55
Speaker
So yeah, you mentioned on that when you're you're on the helipad, it seems like you do some of those initial assessments and maybe even some advanced resuscitation if needed. But like, so down in the trauma bay, like how, how would invasive do your interventions get? Like, is there kind of like a framework for what should and should not be done in the trauma bay?
00:09:13
Speaker
um So we, try to limit any of the invasive interventions to things that does the patient absolutely need it? Because what goes along with the interventions are the potential benefits of the intervention, but also potential detriments of causing further harm to the patient, right? So our go-to are peripheral IVs. If we can't establish peripheral IVs, we'll place an IO. If the patient's like an extremist and their blood pressure is extremely low, then we'll have someone break and put in a central line, cordis usually at a large bore, shorter central access to do massive transfusion on the patient.
00:09:48
Speaker
You know, so it's it's really a measured kind of a environment, right? So if you suspect tension pneumo, then a chest tube goes in, right? So we we try to ascertain the side of which we think the tension pneumo is, we put a chest tube in.
00:10:01
Speaker
So it really depends, right? Because procedures take time and they can also create complications. So it should only be really done on the front end if they're absolutely necessary. the The same thing goes in line with intubations, right? Intubations cause, you can not get in the airway, which could result in the patient going to cardiac arrest or needing a surgical airway, you could also cause induced hypotension when you try to um do rapid sequence intubations.
00:10:27
Speaker
And so that can cause detriment to the patient too. So, you know, sometimes the patient's awake, they're protecting the airway, may not get the airway right away.
Teamwork and Stress Management in Trauma Surgery
00:10:35
Speaker
You know it may resuscitate them a little bit more before before doing it.
00:10:39
Speaker
You know, so there's not one thing that happens down there that doesn't necessarily carry or benefit, but also carries or risks too. It's just the way the way trauma is. you know I think that's what makes trauma hard.
00:10:50
Speaker
It's ah figuring out what you're going to do without really knowing what's going on. right that that's It makes it different than a lot of other fields of medicine where you see a patient the and and the the timing of everything is so compressed. you know you're You're trying to do all these things within the first five or 10 minutes of the patient arriving. So you can either get them to scan, get them to the OR,
00:11:11
Speaker
get them to somewhere else, the ICU, IR, wherever they need to go to have their next step of care done. You're trying to take care of the things that would would allow them to transport to these places without with minimizing detriment to the patient.
00:11:25
Speaker
And that's what makes it hard. you're You're doing things on people you don't have a diagnosis, not your classical practice in surgery where you see someone in the office, you assess them, you have time to do it, you talk to them, you get scanning, figure out what's wrong with them, and then you plan an operation.
00:11:40
Speaker
that you've done. Sometimes those operations for people are are not standard. You know, like laparotomy is very standard, but what you find inside and what you need to do, that changes patient to patient. never really quite the same each time. I know surgery as a whole is not quite the same each time you do it, but sometimes you're in the abdomen thinking that,
00:11:58
Speaker
they they have like a mesenteric bleed. And then it turns out they actually have, like, if you never had a chance to scan them, they actually have an IVC injury or an aortic injury. you have to shift gears and address that, you know? So it's, it's that's what makes trauma, I think, challenging.
00:12:13
Speaker
And then, yeah, was, I've, a question I've always thought about too, is like in the midst of all these things happening, like concurrently, like, are you thinking about like the potential risk for infection for the patient or you're just doing kind of life sustaining things and like, we'll worry about infection stuff in the back end.
00:12:29
Speaker
Yeah. um You know, we try as much as we can ah if the, to try to make the procedures as controlled as possible. Cause I feel like that does lower the risk of complication, but there are times where the patients like they're, they're like
Military Trauma Program and Personal Motivation
00:12:42
Speaker
probably seconds to a minute away from, you know, their Perry code.
00:12:47
Speaker
And you're doing things to help prevent them from coding because once they cross that threshold, their outcomes are way worse if they go into cardiac arrest, right? If they go in the cardiac arrest before they even arrive to you, that's like a big hit on their there um they're like chance of a meaningful recovery from this trauma. If they code in front of you, that also is a a hit on them, although it's probably a little bit better if they had arrested in the hospital versus in the field. It's just because you're you're nearer to hemorrhage control and nearer to resuscitation, right?
00:13:15
Speaker
So yeah, all the time. But sometimes do we just throw things in because the patients are dying and they just need to go in? Yeah, absolutely. You know, as much as we can, we try to sterilely drape, gown up, do all these things. that Everyone on the team is wearing PPE and stuff, but sterilely gown up, that takes time, you know?
00:13:32
Speaker
So have I thrown a cortisone to somebody who has like no blood pressure and it's it's like, is braiding down and almost going to die? Yeah. So we can give them blood really quickly. Absolutely. I've done that.
00:13:43
Speaker
many, many times, you know, um but if if it's a more controlled thing, I'll try to drape down and stuff to prevent future complications because even though, like I said before, sepsis isn't like a primary cause of death in acutely for trauma patients, if you look at they them surviving the initial resuscitation, go in the OR and then go in the ICU, it is something that affects them later in the ICU.
00:14:08
Speaker
So you want to try to prevent the problems that you're causing earlier from becoming big problems later, right? So it is important to practice that if you can. So then once you have them you know stabilized, you send them to CT, you you get them back, you have a better idea of what's going on and you see them in the OR.
00:14:25
Speaker
um As I understand, you're a general trauma surgeon, correct? So it's- So for trauma, yeah, general general surgery is the basis of training for every trauma surgeon.
00:14:36
Speaker
And then you do a critical care fellowship. Some of the fellowships are just critical care for the year. And then you go on to do trauma later as part of critical care. They're kind of like lumped together.
00:14:46
Speaker
um For me, my training was at Cooper and we took call and operate on trauma and stuff. So I consider myself to have done critical care fellowship, unofficially a trauma fellowship. There's no strict certification from the American Board of Surgery for trauma fellowship. You don't you don't have to operate on trauma.
00:15:04
Speaker
You just have to do critical care, that the pathways through surgical critical care. Okay. So I guess is your is your scope of practice though, once you get to the OR, like are you kind of basically doing, working with any body parts or you leave kind of the bones to like orthopedics people? Like I guess I was just curious about how- Yes.
00:15:23
Speaker
Absolutely. um Our main role is the abdomen, soft tissue, and the chest. We can operate in the neck. um If it's the brain or the spine, that goes to neurosurgeons. um If it's ah bony fractures or bony injuries, that goes to orthopedists. And then kind of everything else is our territory.
00:15:43
Speaker
um You know, like anything in the abdomens, our domain. Like, uh, and I know like some places, the urologists are more involved in renal trauma. We tend to just do that ourselves, you know, comfortable doing that.
00:15:55
Speaker
Um, we also take care of pediatric trauma a level two. i think we're trying to get our level one certification, but, um, We'll operate on kids as well. Sometimes um if the case is a bit more complicated, we need help, we'll call for help from either our colleagues or from a specialty service.
00:16:12
Speaker
But ah generally, you know, our our role in the OR is stabilization control, bleeding control, contamination, guiding their resuscitation in the operating room, give them off table. Perhaps the stage procedure will do the um initial procedure and then we'll get them to ICU, kind of get their physiology restored back so that they're not coagulopathic from all the bleeding that they had before we we're able to get them the operating room.
00:16:36
Speaker
And then we try to get them back the operating room at some point later to kind of complete the other parts of the surgery.
Coping with Trauma Surgery's Emotional Toll
00:16:42
Speaker
So sometimes trauma surgeries are staged. know, there's meaning that they have a single stage for for controlling bleeding contamination. And then there's a ICU stage where they're warming back up, resuscitating, kind of restoring normal physiological parameters. So then we can do the ah other things that need to be done later that aren't as critical initially.
00:17:02
Speaker
And then so um in this whole workflow you've described so far, where where do the critical care ah medicine folks come in? do Do they like, are you collaborating with them as as soon as the patient arrives or they only kind of ah come into play after the ah o OR or where where do you kind of just the the non-surgical critical care ah folks come into play? Yeah.
00:17:23
Speaker
So the majority of times they would come into play after the patient leaves EOR and goes out to ICU. If they're like rounding on the patient on that side of the our is staffed, our trauma ICU, surgical ICU is staffed by trauma surgeons who are critical care trained, as well as occasionally um EM or like medicine critical care attendings.
00:17:42
Speaker
So we'll we'll like brief them on what we found and like our kind of our plan for when they're going to go back to the OR and the kind of things to look for. Occasionally they'll be involved a little bit earlier at at Cooper. um Like for instance, if we need to put the patient on ECMO for any reason, um the ECMO team comprises mostly of the medical critical care teams who are trained to do ECMO. So sometimes they may get involved earlier, right? If there's like a,
00:18:08
Speaker
a bad chest injury or something where the patient really needs like, um, pulmonary support or cardiopulmonary support. We'll get them involved earlier, but classically they're involved more in the, um,
00:18:21
Speaker
initial post-operative phase, kind of like the um ICU portion of the case to get the patients physiologically restored enough to go back to the OR, and which we're involved again. And then after that, back to the ICU and they're kind of involved again if they're the ones taking care of the patient. Sometimes the people taking care of the patients are our critical care team, our surgical critical care team. So...
00:18:42
Speaker
Just communication in this whole workflow must be like so key. You have like so many different people from the time of arrival all the way to like, you know, when when a patient eventually would go to the ICU. So like, how do you like a keep your calm and be like communicate effectively to to make sure that you give best care to the patient?
00:19:02
Speaker
Yeah, that's so important. There's so many moving parts. ah One of my attendings used to tell me that trauma is the ultimate team sport. It really is. um They're like nurses, techs, residents, attendings, different services all involved in taking care of a patient. And I try to think of it this way. We're all trying to do the same thing. We're all trying to get the patient to survive this and live through this trauma, right?
00:19:26
Speaker
So we're all in it together. So there's a lot of direct communication um and multi-level. you know it's just not It's not just the doctors talking to the doctors and nurses talking to the nurses. There's a lot of cross communication.
00:19:38
Speaker
Like this is why I think it's going on. um We're gonna do these things. And um does anyone else have any, sometimes you after there's like a lot of uncertainty going on. Does anyone else have any suggestions or any ideas of what's going on here?
00:19:51
Speaker
And um yeah i I welcome suggestions. I think as a trauma team leader, ah the major Your major asset downstairs is your ability to think clearly, make decisions, and um not let the situation control you. right You have to control the situation. You control it by being calm and steady.
00:20:11
Speaker
And um that helps you make the best decision. And that, I think, kind of wins the day for us. Yeah, yeah. You know, for for a lot of folks who who even, you know, become physicians or work in medicine, there'll they'll be just like ah like a handful of times where where they experience the things you guys experience on a daily basis. Like, I just think of my, you know, DLS class where everybody's kind of trying to like, you know, they talk about how like important communication is and in those those moments, but that's something you guys do on the daily. So, yeah, does it, does it, do you feel like the the stress can kind of,
00:20:45
Speaker
ah you know, add up over time when you have all these cases stacked on top of each other? i think, you know, I think every trauma surgeon, as they do this, there's certain wins that they have and they really do like, it really lifts your spirits and there's losses that you have that it it really like crushes you a little bit, you
Complexities of Trauma Decision-making
00:21:04
Speaker
know? Yeah.
00:21:06
Speaker
I think overall, though, I always have a sense that i'm doing something good for the patients or I'm trying to do what's right for them. Sometimes, they're they're frankly, they're injured so badly, nothing you do really can can alter the outcome, right? But you still try to do everything that you possibly can.
00:21:21
Speaker
um But, you know, like um I think losing children in trauma is tough, right? Yeah. So, you know, if we if we have a loss of a pediatric patient, um then there's usually like a briefing and then there's like um our trauma team will organize events and things like that where we kind of like will debrief and talk about things to help ah bring in behavioral health and everything else to help us with that. Yeah.
00:21:50
Speaker
A lot of the the way we, I personally deal with loss, and this comes from our like division head, Dr. Porter, my boss, is that I talk to my colleagues. Sometimes after a really rough call, we all sit down together in the trauma conference room, and we kind of talk about like the different aspects of care, the things that work.
00:22:09
Speaker
sometimes you talk about that A lot of times you talk about the things that don't work. I think that we're even when things go right, we talk about the things you could have done a little bit better. And um you talk to colleagues of yours that have lived through all these things before.
00:22:21
Speaker
And I think that's really cathartic. That's like a big part of, I think, preventing burnout. We go eat breakfast afterwards and talk. um So I feel very fortunate that I work in a group that you know I get along with the people I work with and we're able to talk honestly about these things.
00:22:35
Speaker
And that's a big part of kind of like moving on from these things. I don't think you really move on. on You always have something in the back of your mind about this. But you know I think that's what allows you to come back and and do more, right? That you get back on the saddle, so to speak.
00:22:51
Speaker
if you If you encounter like a tough loss or like a tough case. do Do you find yourself like in the in the heat of the moment when you you have to act very quickly, like referencing back to those conversations or previous cases where you need to kind of like channel you know some of those previous experiences into what you're doing right in front of you? you know John, it's really hard to just describe the thinking that goes on and the decision-making that goes on when you're when you're in the middle, the heat of battle, you know so to speak. right You're in the middle of like fighting the war, and a lot of your decision-making becomes...
00:23:24
Speaker
you know, honestly, somewhat instinctive. It's based off of the patterns that you recognized before and coupled with like lot de novo thinking, a lot of asymmetric thinking based on how the patient's doing.
00:23:36
Speaker
Like, and you're making decisions constantly back and forth because you're assessing the patient like second to second. I mean, you you can't even count the time because you're just you're just in the moment, right? Kind of going through and the patient's changing before your eyes. They're either responding to the things you're doing or they're not responding. You have to you have to make a decision of when you're going to like kind of stop going that direction and switch shift lanes or switch gears a little bit to kind of go in a different direction.
00:24:01
Speaker
Right. And you're constantly making these fine. Sometimes they're fine adjustments. Sometimes they're like, they're like abrupt adjustments, you know? So that's what I call asymmetric thinking, right? You're like, you're going along an algorithm and then suddenly they're not following the algorithm, which is like a lot of patients, like patients just don't read books.
00:24:18
Speaker
We always have that saying in trauma, you know, they don't read the book, right? So you're constantly kind of altering, tailoring your decision-making based on how the patient's doing. And if you need to get more blood or they need to, you need to like stop everything, resultate go up to the operating room,
00:24:33
Speaker
you know, based off of the things you're seeing as they as a situation unfolds. So it's like just constant thinking and direction change. And and sometimes they follow everything and then they you get them to turn around and you go to scan, you make you make the diagnosis. But a lot of times, really unstable sick patients, they don't. And a lot of, in in you know, the thing with what I've found in medicine is Patients can only react a certain amount of ways to a certain amount of things.
00:25:00
Speaker
So there are a lot of times where two or three different problems can manifest themselves in the same signs or symptoms. So it's it's very hard to tell, you know. It's not like the hypotension from septic shock is like different from the hypotension from hemorrhagic shock, right? There's some nuance to different types of shock, but sometimes they behave the same.
00:25:24
Speaker
And then you also have patients who are older. Sometimes they just, they're on like beta blockades. So they don't have a cardiac response to being in hemorrhagic shock, whereas a younger patient will become tachycardic first. Then as they're dying from the hemorrhagic shock, they become bradycardic. Sometimes older patients, they're taking beta blockers. You don't know this. they They were in a car crash. You can only see that they're probably a little older and they may be on something. So, so you don't know. So their reaction to the shot is slightly different than somebody else. you can't buy the book be like, Oh yeah, well their heart rate's not high and their blood pressure low. So it must be neurogenic shot.
00:25:53
Speaker
It's not always the case.
Military-Civilian Trauma Partnerships
00:25:54
Speaker
I think that's what makes trauma very, very hard. There's a lot of like nuance and, and like, um, asymmetry to how people behave. So it just, it just makes it just that much harder.
00:26:06
Speaker
i know. Um, there's kind of a ah ah deep partnership between the the, you know, the field of trauma surgery and the military. Can you kind of talk about ah the the military trauma program at Cooper and perhaps, you know, the the the role of the military in trauma surgery?
00:26:23
Speaker
Yeah. um You know, I give a lot of credit to Dr. Shavanas, John Shavanas. He has, you know, been a mentor to me. He was ah intending when I was a fellow, like kind of towards the end of my fellowship. But for a large part of it. And um as a junior attending back at Cooper, he was ah a more senior um attending surgeon who, um you know, was backed me up quite a few times when we had difficult trauma situations. You you can't have enough those people in your career.
00:26:52
Speaker
they They play such a large role in your development. um He was an army reservist and basically has occupied every echelon of medical care there's been. He was a nurse at one point, yeah went to medical school, was a resident and um became an attending. And he's an army reservist and he deployed to like ah during operation, during freedom to Iraq and Afghanistan multiple times when you know it was it was like, I mean, they had tons of casualties, you know American casualties.
00:27:26
Speaker
um So he was really instrumental in starting the military program at Cooper. I've always felt passionate about um being a training site for the army because, ah you know, deep down inside, I wanted to join the military, the medical corps and be a trauma surgeon in the army. But, you know, think you have, you know, as a trauma surgeon, you have two competing interests. You you you are working your field.
00:27:55
Speaker
You want to grow yourself as a trauma surgeon and um And you want to also make yourself better and be of service to your country, right? You know, the United States.
00:28:07
Speaker
ah But ah you're also a father and ah and a husband. You have to balance those things too. And in no way am I saying that, you know, it's because of my family that i didn't do it.
00:28:18
Speaker
it's It's just ultimately a decision you make based off of the things that are important in your life. And, you know, I choose my my wife and daughter over that. Um, so, you know I stayed back, but it, the military program is to me like a way I can still serve without, you know, physically being away from them, uh, for long periods of time.
00:28:40
Speaker
So, um you know, we started the program or Dr. Shavana started the program with um just, you know, like guardians from the state department coming over rotating, doing different rotations in anesthesia, the ER with us, are the and the trauma bay with us. Sometimes they go to the ER, sometimes they're in the ICU.
00:28:57
Speaker
And um it grew to incorporating special operations command medics. I remember our first class was three people, a Navy SEAL, um ah a medic on um and the Special Operations Air Regiment, the 160th, I think a Green Beret.
00:29:17
Speaker
And that program has grown under his guidance and under like the guidance of um a um he who was a Green Beret, Corey Terry, he's a preceptor for the that program.
00:29:28
Speaker
And it's grown to a point where now we have a army medical team stationed at Cooper, which comprises of, and I know I may be missing some people, um but two trauma surgeons, a neurosurgeon who was with us, an EM ah attending, a PA, a bunch of like great critical care nurses,
00:29:51
Speaker
um they're And they're stationed at Cooper now. And then now we have um Army general surgeons from Ramsey Air Force Base rotating with us for weeks on end um to kind of help learn, kind of like bridge a gap in their knowledge with trauma. Because, ah you know, the one thing the Army lacks are but they lack a cadre of crop trauma surgeons, you know. So in the event that there's a major war right now, I think without a major conflict,
00:30:17
Speaker
they they have enough coverage, but in the major war, you know, that that's going to be a problem. You know, it's just, it's hard to train and recruit and keep, maintain trauma surgeons. You know, it's not, it's, it's, there's not that many of us around, you know, so it's, the program's grown leaps and bounds from when it started.
00:30:36
Speaker
But, you know, I think at its core is that um besides the people who are like a end up running the program, Dr. Shavanes, you know, has all the all the different people out, military and diplomatic affairs, is that all the people in the hospital, they really feel like... um like a duty to to train all these different people who are rotating through all these different medics and doc doctors and nurses and things like that and incorporate them into the team.
00:31:04
Speaker
I feel like that's our strongest asset besides the clinical experience that they get, you know, but our strongest asset is that their people are engaged and are all in on doing this program.
00:31:16
Speaker
And um that translates into like, you know, them those trainees feeling at home and ah being able to do the things that they need to do to learn and or get skill sustainment so that they're able to take care of our warfighters or our like the diplomats or whatever whoever's like overseas so it's a really great program for us and I have to really credit Dr. Shivanis for building that program up listening you talk about trauma surgery in the military and it seems like there's so much
00:31:49
Speaker
like fellowship, purpose, a sense of duty. um And a lot of times, like being in other parts of healthcare, it seems like those those forces aren't like as vibrant. it It feels like a lot of times people can get bogged down in the electronic medical record, in insurance stuff, in just...
00:32:11
Speaker
even Even just like the the battle, but yeah you know the the the forces that are making healthcare care more commercial and and just a business. But you know I imagine your job, you don't you don't stop to wonder whether something will be covered under insurance in the in the trauma day.
00:32:27
Speaker
I think that's ah that's one of the things people ask me, did you do trauma? i said, well, i don't have to look at someone's insurance card or wallet when they come in. They don't have it. ah They're just sheer, you know, like there's no pre-off. There's no none of those things. They just show up because they they they fit criteria to come to a trauma center and just take care of them. And I'll be honest, John, that's liberating.
00:32:48
Speaker
I don't like the other part of medicine. It's it's no like a secret that, and I know it's important. I'm not saying it's not important. All the documentation, all the like coding and all those things that that other fields may be deeply involved in, which we are later, you know, like after everything's said and done, but the initial part of the care, it doesn't matter. It doesn't matter if you're undocumented immigrant, doesn't matter if you're white, black, Asian, Hispanic, it doesn't matter. You know, you come, you come to us, you'll get taken care of, right? The the team will take care of you just like anybody else.
00:33:23
Speaker
And um I really enjoy that part. and And you're doing things that are extremely important. And I know some people have a difficult time making life and death decisions, but to me, those are the decisions that if you care about taking care of patients, you want to be making, right? As hard as they are sometimes, and as it's difficult it is when you lose them, when you lose patients, those are the things you want to do.
00:33:46
Speaker
And I think our affinity in the military is multifold. I feel like I've met some of the best Americans um in my life. have rolled through our programs um and they're like, they just want to serve their country and they want to do good. I know, you know, you you watch social media, you'll see people who don't know the president is or who doesn't, they don't know like where the capital of this country is. You'll see people committing criminal acts and stuff. That's, you know, really honestly, of a very small part of of this country. People are like oh young people aren't the way they are.
00:34:17
Speaker
You just haven't met the right people. That's what always tell people, you know, like you just haven't met the right people. And I meet them all the time when they come over and rotate. And it's like so refreshing to see people. i just want to help them learn.
00:34:28
Speaker
And so they can be better. and and And in response to your teaching, they want to learn because they don't want to let their country down. They don't want to let their buddies down in the field. You know, it's just, it's tremendous.
Trauma Prevention and Community Outreach
00:34:39
Speaker
And it's, I think it's a part of why I don't feel burned out doing this because the things you do are so meaningful and significant. You shouldn't be, you know, I just get a lot of like satisfaction on what I do. I hope I can do it for a long time.
00:34:53
Speaker
I know physically it's hard to take calls and and go the ah OR for two or three hours. And like like you said, the stress of taking care of these people. But I hope I can do it for a long time. I really deeply do enjoy it.
00:35:04
Speaker
And the teaching, you know, having medical students. I love having students shadow me. I think that's really a tremendous. That's my favorite part of besides trauma care is education. And people are always asking me, oh, why do you have all these students from high school and college and stuff shadowing I was like, you know, sometimes having them helps you understand it and not forget why you did this to begin with.
00:35:24
Speaker
They ask you, why' you become a doctor? You know, otherwise none of my colleagues are going to ask me. They're all physicians themselves. You know, they're not going to ask you that. Right. they they they They know the reasons why they did it. And they don't they don't really we don't ask each other that question. But a high school student or a college student will ask.
00:35:39
Speaker
And um sometimes you answer them honestly, you know, and and that helps you remember why you did it to begin with. So it's like a very nice part of my job that i really do enjoy.
00:35:51
Speaker
ah As you know, I'm sort of a, you know, deeper thinker. That's why I, you know, have these sorts of conversations. I would imagine if I were in your shoes, I would, I would, you know, when I see a trauma patient in front of me, i would say like, like, how the hell did they get here? Like, how did our healthcare system fail? Or did our something, and you know, societal, know,
00:36:13
Speaker
you know safeguards fail to where this person was you know in in some sort of accident that probably could have been prevented? Do you find yourself thinking about that a lot? um Yeah. you know A big part of what we do besides caring for trauma patients is trauma outreach and prevention, actually.
00:36:29
Speaker
um So we have staff that are hired, like a lot of them are like nurses or outreach coordinators who will go out in the community to promote like wearing helmets for like activities or like you know, properly using child seats.
00:36:45
Speaker
um You know, they'll do outreach at high schools. Like my daughter's in high school right now. So our our trauma department sends a um trauma nurse to do outreach for high school students about motor vehicle safety and things like that.
00:36:57
Speaker
so So, you know, it's it's not like we love people having having accidents and things like that. We do actually ah spend a a good part of our budget doing outreach. It's a requirement. But also, like from a humanistic standpoint, you don't you don't want people to get hurt.
00:37:12
Speaker
Like i I push it all the time for my daughter's friends. I'm like hey, you guys ride a bike or go skiing or do any these activities? should wear a helmet. You know, like I know it's not the coolest thing in the world, but I try to emphasize to them the importance of wearing it because, you know, you don't want to sustain a traumatic brain injury. It can radically alter your life in the long term and it can alter in the short term. You know, maybe you'll recover from it, but you'll you'll like lose a year of school and kind of behind your cohort of friends and stuff, you know, or like, you know, you can become,
00:37:43
Speaker
incapacitated and not be able to like live your dreams. right i I tell my daughter all the time, I said, you know getting into these accidents, and it can crush a person's dreams and aspirations. you know You really need to think about protecting yourself at all times you know as as much as you possibly can. right That includes wearing your seatbelt, not you know not like learning how to drive properly, you know, protecting yourself when you're doing activities and stuff, you know, so it's outreach and prevention is a big part of what we do as
Behavioral Health in Trauma Care
00:38:13
Speaker
well.
00:38:13
Speaker
Gun safety, you know, that's another big thing. So. Yeah. I imagine a lot of the people ah who come in ah for your your care, unfortunately, it could be, you know, injuries of despair, like failed suicide attempts, ah um you know, maybe a substance use problem ah led to some sort of accident. um So I'm curious how the field ah is working to reach those people.
00:38:43
Speaker
um So, you know, we have a violence intervention coordinator who was hired by Grant. um Unfortunately, i think we lost that recently, but he would go out and do outreach to the people who were victims of it. It initially started as gunshots, but it became interpersonal violence.
00:38:59
Speaker
um We have a full-time behavioral health coordinator um who or behavioral health, um like a clinical psychologist who does a lot of behavioral health outreach for our patients. She makes rounds and and takes care of those needs for them, you know, and we have like a tremendous social work team to help with that as well.
00:39:20
Speaker
But that is substance abuse. I never realized this until I started fellowship. it's it It runs hand in hand with trauma. A lot of our patients have mental health issues.
00:39:32
Speaker
um and in particular substance abuse as a um kind of a trigger point for their trauma. and Whether it's directly the cause of their trauma, like driving under the influence of drugs or alcohol, or like, you know, being homeless because of, as a result of substance abuse and then kind of like wandering on the streets and being hit by a car or whatever, hit by train.
00:39:52
Speaker
those Those things all happen. So that they go hand in hand, right? And i tell a lot of medical students who are rotating through trauma, I was like, do not, even if you're going to do surgery, as a ah as a career, don't like de-emphasize the importance of doing your psychiatry rotation properly.
00:40:12
Speaker
Because sometimes if you choose to do a field like this, those things go hand in hand. So it becomes something that you need to do. Am I like an expert psychiatrist? No, we have a great psychiatry team at Cooper, you know, that we lean on all the time for a lot of these patients.
00:40:25
Speaker
right but um But like you need to be able to initiate things right to them, like notice things or like ah realize that the patient this even though sometimes patients won't, sometimes they it's very they're very honest about it. They're like, oh, I try to hurt myself or whatever. Sometimes they're very quiet about it. You have to kind of figure it out, you know hash it out. So it's important to still understand the basic tenets of different fields.
00:40:49
Speaker
So there's not one field of medicine that you don't use to some extent, whether it's pediatrics, geriatrics, internal medicine, psychiatry, you know everything. It's with all encompassed within this profession.
Dr. Wong's Personal Insights
00:41:06
Speaker
With that, it's it's time for ah a lightning round, a series of rapid fire questions that tell us more about you. Sure. So what's the most common trauma you encounter in your work?
00:41:18
Speaker
I would say falls. Falls in the elderly are probably the most common. How do you decompress after a hard case? Yeah. you know, talked to my fellows if they're available residents.
00:41:31
Speaker
I talked to my colleagues, uh, the next morning. Um, and I talked to my wife, she, she's a physician as well. So it's really nice to have, have her be a sounding board for me. Any, uh, favorite go-to wellness practice you have at at home or.
00:41:49
Speaker
Um, you know, I, I'm a big, I like sports. I'm not great at them. So I'll try to play basketball. I ski with my wife a lot, um, in the winters. Um, I garden. I'm an avid gardener and I'm an avid cook. I love to cook.
00:42:02
Speaker
So I try to do those things to decompress, you know, spend family time. What's your what's your your best dish that you like to cook? I'd have to say Chinese dumplings.
00:42:13
Speaker
im I'm great at making them. you You have to come over one time for them. They're great. Better than anything out there, to be very honest. um Along that same vein, what's your favorite food and ah on a cold winter day?
00:42:28
Speaker
Probably a hot bowl noodles. Yeah, definitely. Whatever. it doesn't have to be Chinese style. It can be ramen, Japanese. It can be pho, you know, v Vietnamese, whatever. It's just a hot bowl of noodle soup, but it soothes the soul and warms the heart.
00:42:43
Speaker
We obviously ah went to the same alma mater, University of Michigan. Who's your favorite favorite Michigan football player of all time? I grew up watching Anthony Carter, number one, with my dad. It's very nostalgic to talk about him.
00:42:58
Speaker
um So he's probably my favorite. But, you know, Charles Woodson, having gone to that game against Ohio State and being on on campus during that first national championship run, is it's a close first or second.
00:43:09
Speaker
whether what a great Great football school. right I love it. I love going there. It's great. Yeah. I'd probably say my favorite player is Mike Hart. I really like Mike Hart. Absolutely. He's quite a great player.
00:43:23
Speaker
You know, the whole little brother thing. Y'all love that. And lastly, what's one change you'd like to see in trauma surgery? It's so hard to say.
00:43:34
Speaker
um You know, I would say this. I love trauma surgery. i i Part of me says this. If we can make it more minimally invasive somehow, I would love to see that kind of shift.
00:43:47
Speaker
but Like our ability. I know some things will never be that way. i'm totally i totally understand that. But if we can minimize like the amount of pain we inflict on people to to to fix their problems, that would be tremendous.
00:44:01
Speaker
I would love to see that. Dr. Julian Wong, thanks so much for joining The Wound Dresser. Thanks, John. Thanks for having me. Appreciate it
00:44:14
Speaker
it. Thanks for listening to The Wound Dresser. Until next time, I'm your host, John Neary. Be well.