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What Lies Beneath

What Lies Beneath

Quoth the Raven

Johnston, Michelle MBBS

doi: 10.1097/01.EEM.0000827692.78235.6b
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    trauma management, writing
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    Lewis Carroll had his Mad Hatter cryptically ask, “What is the difference between a raven and a writing desk?” The answer to the riddle is, to this day, unknown. But it hasn't stopped generations of people from making fanciful connections between the two, some of which even make a little sense.

    With my best Mad Hatter impersonation (yes, I realize, not much of a stretch), I pose the question, “What is the difference between a writer and a trauma team leader?” At first glance, nothing. Or even better, it would be preferable if there were nothing. We want very different things from our doctors and writers. We want our doctors to have ordered minds, controlled thoughts, and considered, measured, responsible comportment. On the other hand, we need our writers to let it all loose, to mine the depths, to teeter on the cliff of crazy, to eschew all that is methodical. How else does one create great literature?

    Hear me out.

    Leading a trauma team is a unique role, unlike any other position we occupy in emergency medicine. A unique position needs a distinctive way of understanding it to perform the best we can. I have learned many lessons on the rocky path to becoming an author and how they might equally apply to team-leading a multi-trauma.

    Know Your Audience

    There is no point writing in eclectic metaphor if your audience wants crime. Similarly, the most important starting point when giving a lecture or (ahem) penning a column is understanding upon whom you are thrusting your communication. Sure, you could try to unravel from where they have come, their background knowledge, and their interests, but the most important point is answering, “What does my audience need?”

    Anything that does not fulfill that question will wither on the literary vine. The same with communication in a trauma: “What, precisely, do my team members need to know in this moment?” Give them that—not a bit more, not a bit less. This is respecting the audience, ensuring that you are giving them the best information to keep them performing.

    Keep the Narrative Moving

    The most productive technique I find when leading a trauma is the micro-summary. A recap at regular intervals of where this story has already come and where it needs to go next is priceless. This affords the team the ability to predict what needs to happen next. Team members stay engaged; they know what will be required of each of them. Similarly in writing, this gives the reader the chance to engage. Nothing is more satisfying to a reader than when he gets what's about to happen next by his own steam.

    Tailor the language to the tension of the scene. In the punchy, high points of novels, the vernacular needs to be short, use common language, and be unambiguous. Same in traumas. As the leader, you need to be understood. We have a body of evidence about how to communicate in high-stakes situations. Human factors, they're often called. Crisis resource management. Closed loop communication. It's all about ensuring that the words you have spoken have been comprehended accurately by their target.

    Lifeblood of Trauma Management

    By now, though, this bow has been drawn a little too long. The metaphor has run its race. The original point stands—good communication is a skill, like writing literature, and needs to be given respect, consideration, and practice. This, after all, is the key to good team leadership. Sure, you can know everything there is to know about multi-trauma—every piece of evidence, every possible outcome of every possible injury. You can wield an ultrasound probe or sling a REBOA catheter like a carnival whip, but if you can't communicate to your team—the lifeblood of trauma management—outcomes will not be optimal.

    I have flogged this allegory way beyond its DNR status. The comparison is weak, the connection flimsy. Why is a raven like a writing desk?

    You know me by now, though. This was just an excuse, a non sequitur, a Trojan horse. What I really wanted to write about was ravens, specifically Poe's ravens, the eeriest, darkest, most malevolent of birds, rapping, tapping in the dying embers. That ebony bird, that ungainly fowl, sitting lonely on the placid bust. This I sat engaged in guessing, but no syllable expressing, to the fowl whose fiery eyes now burned into my bosom's core. Poe. What a master. I bet he would have loved to watch a trauma team in action.

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    Dr. Johnstonis a board-certified emergency physician, thus the same as you but with a weird accent. She works in a trauma center situated down the unfashionable end of Perth, Western Australia. She is the author of the novel Dustfall, available on her website, http://michellejohnston.com.au/. She also contributes regularly to the blog Life in the Fast Lane athttps://lifeinthefastlane.com. Follow her on Twitter@Eleytheriusand read her past columns athttp://bit.ly/EMN-WhatLiesBeneath.

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