The Scope E-Newsletter January 2011 Surgery Alumnus Recounts First Weekend of Solo Trauma Attending Call

Cynthia Talley, MD, Surgery Residency and Surgical Critical Care Fellowship Alumnus, graduated from the UT Graduate School of Medicine in 2009 and is now an Instructor of Surgery at Vanderbilt University. Upon completion of her first weekend of solo trauma attending call, she wrote a letter of gratitude and thanks to Mitchell Goldman, MD, Surgery Chair and GSM Assistant Dean for Research, and the Department of Surgery for her experience and training. In the letter published in Surgery's Scalpel newsletter, she details how her training played an integral role in the success of her first weekend.

She said in the letter, "Over the course of the weekend, I performed a thoracotomy for massive hemothorax and diaphragm repair. I remembered closing the chest with Dr. [Raymond] Dieter and him poking me with the blunt needle to show me that it is the best needle for closing the chest. I immediately asked for a blunt needle for my closure. The lady was extubated the next day and one of her chest tubes has been removed. She will go home soon.

"Next, I was summoned to an emergent decompressive laparotomy in a nearby OR. I remembered opening an abdomen with Dr. [Dana] Taylor using only a knife and scissors. This man is recovering well in the ICU. The primary attending (an orthopedic surgeon) was very grateful.

"The next night, I had blunt injury to the distal stomach, pancreas and duodenum with bleeding. Oh boy! I told myself on the way to the OR, ‘I know this anatomy well.' I just did this man's reconstruction yesterday: hand-sewn Billroth II with distal feeding jejunostomy, cholecystectomy and external pancreatic drainage. I did it just how Dr. [Keith] Gray had shown me so many times in my chief year. Several attendings came to look over my shoulder and were impressed with my technique, they said. He was immediately extubated and is tolerating his tube feeds.

"Throw in a couple of diaphragm repairs and small bowel resections, I finished the weekend with a 16-year-old male gunshot wound to the superficial femoral artery (SFA), exsanguinating in the trauma bay! Again, I told myself in the elevator ride up to the OR, ‘I've done this many times before, no problem.' I put on my UT loupes and within 30 seconds, I had proximal control at the common femoral. I opened the wound to find a 10 centimeter defect in the SFA and vein that was shredded. I performed a reversed saphenous vein graft (from contralateral limb) with muscle coverage, deep Jackson-Pratt drainage, and four-compartment fasciotomy with palpable pulses post-op (all in two hours.) This young man is extubated and walking on his leg now. His fasciotomies are being closed today. On an unrelated case, Dr. Colleen Brophy, a well-known vascular surgeon here, remarked on my excellent vascular training.

"I just want you to know how grateful I am of the experience I had at UT."

In follow-up to her letter, Dr. Talley said, "I have now seen all these patients back in clinic and they are doing great. The gentleman with the Billroth II reconstruction tracked me down to deliver a hug and a thank-you card. He said that I saved his life. He is now back to eating a regular diet with normal bowel function ready for his Florida vacation. What a great feeling! What a great job we have!"