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Hand Trauma Call

A Blessing or a Curse?

Shin, Alexander Y., MD

Techniques in Hand & Upper Extremity Surgery: June 2019 - Volume 23 - Issue 2 - p 53
doi: 10.1097/BTH.0000000000000242

Mayo Clinic, Rochester, MN

Conflicts of Interest and Source of Funding: The author reports no conflicts of interest and no source of funding.

Address correspondence and reprint requests to Alexander Y. Shin, MD, Mayo Clinic, Rochester, MN 55901. E-mail:

Trauma call has been a rite of passage and an integral part of Orthopedic surgery. I distinctly remember my first rotation on General Surgery as a second year medical student at the University of Pennsylvania. Stories from prior medical students ranged from nightmares of busy work to exciting stories of assisting in surgery or bedside procedures were related to each new medical students from those only a year ahead in medical school. As I was informed by my surgery intern on my duties of the evening during a quick dinner in the hospital cafeteria, I wondered how I would survive an “all-nighter” or how I would react and respond with little to no sleep at 3 AM when paged. Fear, apprehension, insecurity ran through my mind followed by the excitement of possibly putting in an IV, arterial line, chest tube, or doing CPR. Every page brought an adrenaline rush, even though it was just to tell the intern that his signature was needed for a run of potassium chloride. While I don’t remember much of my first night on call, I do remember assisting in the operation room at 3 AM, sewing up my first wound and incising my first abscess. Little did I realize then, that trauma call would become an integral and large part of my surgical education and how it would continually shape and mold me as a surgeon.

While trauma call has been a routine part of Orthopedic Surgery training, its role in shaping us as the surgeons we finally become or evolve into is often overlooked. When the hand trauma call schedule comes out, the first thing many of us do is to see if there are any conflicts with family activities, meeting schedules, or personal events. We look to see if there are any potential switches with colleagues or ways to “make the schedule” work in our favor. It is well recognized that trauma call makes planning a schedule very difficult both for professional and personal schedules. An all-night surgery, such as a 3 or 4 finger replantation, is highly disruptive to a full clinic or surgical schedule the following day. At the same time, a “no hitter” call night, makes the blocked next day seem like overkill. The unpredictability of trauma call is difficult to manage and the physical and mental demands of trauma call can be extraordinary.

The concept of balancing one’s life and job-life satisfaction has become diametrically opposed to the unpredictability of trauma call, resulting in hand surgeons seeking positions with a limited call or the ability to refer time consuming complex trauma to other centers. Many young hand surgeons relate their dissatisfaction with the burden of hand trauma call on their professional and personal schedules. Their ideal profession would be strictly elective practice with referred cold trauma and no hand trauma call.

When I reflected on my experiences of hand trauma call, it reminded me of a quote attribute to Horace: “Adversity has the effect of eliciting talents which, in prosperous circumstances, would have lain dormant.” Hand trauma call puts us in the center of adverse situations. It forces us to be uncomfortable and manage complex problems with the resources we have at that given moment. The patients and problems we see on hand trauma call are quite diverse ranging from simple to complex, acute to chronic, and problems that we can and cannot even imagine. Our management of these patients is a culmination of all the education and experiences we have obtained, and can result in incredible outcomes that benefit the patient. The surgeons we ultimately evolve into or become is directly related to the early experiences we have managing hand trauma. Novel surgical techniques are developed, different ways of thinking of injuries and mechanisms are created, ideas for research are born and dogma becomes challenged as we manage these patients. The adversity of trauma call can unveil the talents we all have inside of us that would have otherwise remained dormant if we didn’t partake in trauma call.

Fridrich Nietzsche eloquently said, “That which does not kill us, makes us stronger.” In reflecting over my past 23 years of trauma hand call, it is remarkable what lessons I have learned that have shaped my surgical and diagnostic skills today. In the chaos of a weekend of hand trauma call, it always felt like a curse to my professional schedule, family life, health, and general well-being. However, what I never realized, was how the experience of hand trauma call blessed me in shaping and molding me into the surgeon I have become.

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