Or Blue-green. The exact color of the hospital-issued scrubs are not as relevant as their purpose: to prevent eye strain (as opposed to the all-white scrubs of prior, think of it like ‘snow-blindness’) as well as to provide contrast to blood.
That was what I had in mind as I think of what one may see during a trauma surgery shift—Color theory. With that observation, I could hardly anticipate what one may learn in the span of nearly twelve hours.
I’m in the hospital at an unfamiliar 6:30am start time. Handoff takes place in a conference room, and whatever happened during night shift was delivered succinctly by a large team. I was assigned to a team with a med student on rotation. Their enthusiasm was encouraging: I was going to follow along with the on-call team, reliant on fickle fate and the scheduled set of patients already expected for the OR.
Promptly soon after, I witnessed a Da Vinci robotic procedure and partook in a new custom, writing my name on the board. There are far too many letters, but I squeeze it in and stand at a respectable distance, eyeing the blue drapes. As excited as I was, it was quickly tempered by the undercurrent of purpose. There are reasons why a gastrostomy tube is placed, there are inquiries between the staff regarding causes for cancer in young patients.
There are your steps: Time out, the draping and preparation of the surgical site. Foley placement and gowning. The abdomen had been inflated with air, providing safe distance for trocars and port placements (known as insufflation). Soon after, the machine docked into place, aligning itself with the ports. The coiled camera is turned on and broadcasted on the OR television, it rests atop the blue tray (I preferred the shade to that of the garish teal) and I recognize the wall it’s pointed at. They move the coil, and the camera changes its binocular focus, perceiving with an extremely high resolution. I fidget, and so does the subject on the screen. Oh, that’s me! I correct my posture.
The lights were lowered, and the camera was driven down to the perpetual darkness and then there was light. Angled below the stomach, resting above the greater omentum, there was the liver on the left of the screen, the stomach to the right, and all the way in the back was the diaphragm.
Thumping against the diaphragm was the heart!
I watch a port get placed, and in a unique subversal of the Aliens franchise, the baby Xenomorph- resembling probe bursts into the other side of the peritoneum, ‘mouth’ open with flashing ‘teeth’ meant for grasping. It will be saving lives, this little one.
I study how the tube was placed into the stomach and inflated into place. The hemicircle of sutures holding up the stomach to the abdominal wall was duplicated on the other side. The port holes were sutured, and there was an unspoken silence: the patient’s life looks different now. The surgery ended at the predicted time, but uncertainty regarding his future followed as he was wheeled away to the ICU.
I wasn’t warned of the slight diplopia afterwards, the OR overhead lights make it feel like you’re on an elevator that’s moving too quickly. ‘It subsides,’ I was assured. There were surgery patients who needed visiting. We moved on.
Trauma yellow, an animal attack. The story is caught in pieces in the trauma bay. Jagged cuts through tattoos, like a serrated knife through a canvas, the patient groans in pain, beside themselves as he is examined and asked to count how many fingers the doctor was holding. The reception to this question wasn’t welcoming, many questions seem frivolous when every limb has been injured. Our personal expectations may make us bristle at tone and behavior, this makes awareness of context and the impact of pain and stress responses all the more important.
Next task: an abscess drainage. Spider bite. This is your reminder that Arizona houses several venomous spiders, such as the brown recluse and the black widow. I hold the leg as the mats are placed underneath. (They are also called ‘chucks,’ I suppose because they’ll be chucked in the trash soon enough, being in trauma is a lesson in linguistics and jargon.)
Back to the trauma bay, there was the task at hand, addressing the numerous wounds. After imaging and resting, and attending feedback, the resident directed me to hold on to some part of their arm not covered in bites, so I held their hand, trying not to squeeze it too tight as they injected local anesthetic. I hold it, hoping there were no lesions on their palm, that he wouldn’t swing their arm back in a moment of clarity, driving the needle in a worse trajectory. There was also the delicateness of simply holding a stranger’s hand, hoping in some way it was reassuring.
The scent of blood is of stress and metallicity. It is a stubborn task, washing off dried matted blood, careful to distinguish lesion from coagulation. Two medical students and a resident worked on the limbs, intercut with requests and questions.
There were moments for pause, a cry to stop for just a moment from the pain. We would pause, he would rest, the stress melting from his face as he slumped. He’d tell us to continue followed by an off-shoulder request for more medication. Then there was some soft snoring, sleeping as we worked, waking on occasion to silently garner the current state of our craftsmanship before returning to sleep.
Once that was done, all there was to do was to cover it with xeroform petrolatum and gauze. I’ve lost count how many packages of xeroform and gauze I retrieved and opened.
Trauma red comes in coding, the pulse comes and goes, a line of PPE-clad staff quickly forms to perform compressions. The perception of time as we know it shifts when the heart stops. Another trauma came in while this occurred, a motorcycle accident. Everyone is calm, uninvolved staff remain at a distance, away from the red lines on the trauma bay’s linoleum floors. Cultivated neutrality in their calm, I imagine experience has drawn mental red lines to distance from the revolving doors of mishap and tragedy.
There is so much blood dripping from equipment. Our blue-green scrubs catch some of it, shifting to a dark brown. Someone moved a bright orange spine board painting a dotted line of blood on the ground in the process. It dripped onto floors, clotted against skin, or was tossed into red bins in the trauma bay. Such a bright shade of red, blood.
The blood-shot eye of the trauma yellow patient. Conjunctiva burning red against the dusky iris. This is what I think of more than anything else I’ve seen. I’m searching for a pillow, or some respectable equivalent. He’s cold, aren’t we all?
Eventually there is a lull, and I take advantage of it. Standing in the healing garden, triple digit heat with the sun hidden behind the ancillary building. There is the soothing warmth that the OR cannot provide, it feels sterilizing, and I hold on to the warmth as I go and get something real to eat at 4:30pm.
A laparoscopic exploratory procedure turns into an Ex-lap, the bright OR lights shine through the pink hyper-inflated intestines, ‘pathological,’ and the shadow of the fluid inside the intestine is seen sloshing around when the intestine is moved. SBO—small bowel obstruction. They ran the bowel carefully, the more experienced surgeons scrutinizing every inch.
Out of the OR, we return to the trauma bay. A severely concussed gentleman with the three-minute memory kindly asks for water and ice chips again. He expressed concern for his belongings, I watched as he asked everyone who gravitated near him. The student on rotation is tasked with stitching up the laceration with a running (baseball) stitch as the patient cycled through their questions once more. The resident tells me how the patient was severely concussed, but lucky. It is an unsavory word, but accurate. A beloved friend visited and granted her support, and he asked again. With her patient response, he pauses. “I think I asked this already, given the look on your face.” I’ve seen the way love and support is shown in trying times, especially in emergency departments. I also see the deep importance of helmets. Watching the first set of suture done, the clock on the trauma bay marked the time, and it was my cue to leave.
The shift ended, they always do. There are various lessons that could be learned, some more obvious: compression socks are a good idea, hydrate liberally, and get accustomed to standing.
There are others, they resonate differently. The vulnerability of the trauma bay, the fact that there are so many ways to help others, and the number of people who help to match. Medicine, no matter the specialty, is made up of moments that you will not forget. What an honor it is to witness it. The CT scan, the seemingly unassuming patient encounter, a story in office, the exorbitantly high lab value, those are the sort of things that follow you.
In the same vein, the multitude of moments patients experience in these times—even the routine!— stick with them just as well. One may see three gallbladder removals in a day as ordinary, but that is a part of three medical histories and may have long-term changes to their life-style, nevermind the impact of recovery.
I relearned that sort of impact we students have. Even the brief moments of an MS3 educating a patient on how to use a spirometer could have lasting impacts on the quality of their care. The effort placed in the education of others and caring will never be time wasted. Balancing that medicine is a to-do list, a detective’s case, and also a grounding collection of moments of empathy—it requires reflection and a courteous reminder here and there. Each hour provided an opportunity to learn, clinically and otherwise. And I also learned that on the back of the scrubs, there is a sticker that explicitly states that they’re teal.
Special thanks to the Trauma Surgery team and to Andrew, MS3, for serving as excellent guides.
Fatemah Alzuhairi
Fatemah Alzuhairi is a UACOMP med student from the class of 2028. She graduated from ASU in 2022 with a degree in biomedical sciences and a minor in history. In her spare time, she enjoys planning creative projects, reading, and drinking copious amounts of Earl Grey tea.