A new memoir by a trauma surgeon sheds light on the different ways we can all suffer.
You might expect a book called Trauma: My Life as an Emergency Surgeon
(St. Martin’s Press, $25.99) to deal primarily with physical pain. Certainly author James Cole, a doctor who has worked trauma units across the country and for the military in Afghanistan, has seen every gruesome injury you can imagine: a teenager shot through the chest with a crossbow, a drug addict with flesh-eating bacteria, a toddler stabbed with a screwdriver, and—if you can believe it—much worse.
But Cole’s book covers a whole spectrum of pain beyond the physical, too, with lengthy sections on mental, emotional, moral, and familial suffering. And while he doesn’t label these different categories so explicitly, instead choosing to let his bloody anecdotes trace the outlines of each, there’s such a wide slick of agony here that it’s worth giving some attention to all of them.
“The next year were some of the worst months of my life. I was consumed by the memories of my past military service, and with thoughts and images of the people I had worked with and lived with, and of the military operations we had served on together. My comrades—people I would have died for—were now likely living in tents in some godforsaken country while I was living in a beautiful home far from harm’s way.”
Though Cole spends much of his early surgical life working with the Navy, his superiors eventually place him at an unfortunate professional crossroads: either he can move to a military hospital in Guam or he can serve as a ship’s surgeon, and either way he won’t get to do much trauma surgery—his somewhat morbid love in life.
So instead he resigns his commission and moves to civilian practice, which suits him pretty well until 9/11—when he’s wracked by guilt that he’s letting down his country and his former service friends. Even as he watches the Twin Towers fall on television, his decision to leave the military haunts him; by the time the war in Afghanistan is in full swing, he’s depressed and taking it out on everyone around him. Never has mental anguish looked so acute.
“I was completely dissatisfied by the Psychiatry Department’s response but I also didn’t want to create a war between our professional services. I simply laughed with disgust as I tore the letter in two and tossed it into the shredder. If the author thought that this letter might have somehow regained my confidence and trust in the professional opinions of mental health providers, the author was certainly mistaken.”
Though Cole is often distraught at losing patients in the operating room, he’s usually able to write off any long-term emotional pain about the patients he’s “failed” by assuring himself that he did his best (or, often, that God must have had some reason for taking them).
When it comes to patients failed by psychiatry, however, he can’t contain his fury. In one chapter he contrasts two women, coincidentally under his care at the same time, who are both suffering from mental health problems as well as physical ones. As he cuts back and forth between their stories, the calm, objective language he uses to describe so many surgical procedures slips away, replaced by angry, emotional outbursts about the uselessness of his mental health colleagues.
His rants are a little one-sided, of course, and I’m sure, too, that if a psychiatrist strolled into the O.R. and claimed to understand the ins and outs of trauma surgery the way he repeatedly claims to understand psychiatry, he’d resent it. But while that sudden lack of empathy is striking, it’s worth remembering that emotional pain can often cloud our higher judgement—and clearly working with his mental health colleagues is the part of his job that tortures him the most.
“At times, I have been frustrated by seeing how people who have previously lived long and memorable years, now stricken with irreversible, chronically life-threatening diseases, get sent back and forth to hospitals to receive treatment for end-of-life conditions, with no hope of restoring any decent quality to their final existence. I’m talking about people who should die—people tortured within their own bodies, and those whose minds left them long ago.”
The merits and shortcomings of extraordinary life-saving measures have been debated widely beyond this book, especially as populations in the developed world grow older and older, but Cole’s firsthand experience often makes the issues involved a little starker. Sometimes, as in the case of the patient above, who can neither sit up nor eat, it seems crueller to keep elderly people alive than to let them go quietly.
There often seems to be an element of self-delusion to Cole’s take on the matter, though, because he frequently takes extraordinary measures to save surgical patients who, even if they survive, will lead hugely impoverished lives, with missing limbs, severe brain damage, or physical disfigurement.
To be sure, he sometimes asks himself—as with the drug addict with flesh-eating bacteria—whether he ought to keep carving up his patients’ flesh, given how difficult their lives will subsequently be. But his criterion for answering the question usually seems to be how difficult the surgery is. If a patient can be saved through his heroic and unusual procedures, it’s generally okay if they only survive to live a difficult, unpleasant life; if a patient requires only routine or minimal procedures—a broken hip, a fractured neck bone—he’s far more likely to say they’re better off dead.
Indeed, Cole’s certainty about elderly patients seems like a way for him to deflect any moral qualms he has about the lengths he sometimes goes to save his younger ones. “Maybe I’ve made the wrong choice in the past,” he seems to be thinking, “but I know I’m making the right one now.” Which leaves us with a telling question to ask of our own moral anguish, when it happens: are we suffering because we’re not sure we made the right choice, or are we suffering because we know we didn’t?
“Thinking I had presented the bad news in the best manner possible, I hoped to see some sign that she was at least comforted in some way, but I didn’t see any such signs on her face. Instead, she started crying, telling me that she knew that if her son was going to live he would be spending the rest of his young-adult years in jail. My heart then began to ache, knowing that the words she spoke were the honest truth. Her son had killed her husband, and once he had recovered from his injuries, he would be put behind bars.”
Cole’s story of the Zukovs, from which the above excerpt is taken, is certainly the book’s clearest example of the particular kind of pain that our family members can inflict upon us.
But throughout another familial trauma lurks: Cole’s own wife and children. They’re rarely mentioned more than in passing, and it’s precisely that ghostly presence, even across the decades of Cole’s career, that makes me wonder about the pain he must have caused his own family.
It’s hard to argue, of course, that it’s not a good man who’s devoted his life to helping the injured—military, civilian, and enemy combatant alike. Still, being a good man in public can often mask shortcomings in your private life, and though Cole is always quick to acknowledge the ways in which he’s neglected his family—and to praise them for enduring it—I wonder if the best men shouldn’t strive to be their best in everything they do, instead of neglecting one part of their lives to benefit another.
Overall, Trauma asks a lot of interesting questions and provides a good deal of fodder for meaningful answers. But as you’ve probably noticed from the lengthy excerpts I’ve provided here, what’s often the most painful thing about Trauma is Cole’s prose. Many scenes are told with such monotony it’s like having Ben Stein read you the script from an episode of E.R.
Still, his punctilious detail will no doubt appeal to medicine buffs and fellow military men, and I’m not going to consign it to oblivion just because of poor editing. Just bear in mind that even with the book’s sometimes nauseating descriptions and graphic visual aids, you might need an extra cup of coffee to get through it.
photo: dendroica / flickr