About five in the afternoon on a weekday trauma shift we got a call from Native Air, a helicopter medical transport service, about a 17-year-old they were bringing us with multiple fractures sustained in an ATV crash. The accident happened way up in the northern part of the state near St. Johns, a ranching community that borders the Navajo reservation. His vital signs were stable, and they had medicated him for pain and would arrive in 10 minutes. The trauma team assembled in the bay closest to the elevator from the helipad. About 9 minutes later the elevator doors opened and the helicopter crew wheeled our patient in on their flight gurney. I took one look at the patient and cursed under my breath. He had a triangular face with a broad forehead and narrow jaw and chin. His chest was wide and deep, barrel-shaped is the term. His limbs were painfully thin with knobby joints and marked curvature of the long bones, those that weren’t already splinted. His eyes were striking—deep blue, and the sclera, the white of the eyes, were the color of a new robin’s egg. All the markers of Osteogenesis Imperfecta. What the hell was he doing on an ATV? Osteogenesis Imperfecta, also known as ‘brittle bone disease,’ is a genetic disorder, a gene mutation that causes defective collagen synthesis. It may vary in severity, but the classic expression causes weak bones that can break under the patient’s own weight. A sneeze can break ribs. A simple stumble can result in a broken hip or ankle. Patients usually end up confined to wheelchairs by their...
Handling Risk

Handling Risk

“For sheer unadulterated ego, no one is a match for fighter pilots. Except maybe surgeons. Surgeons are in a class by themselves.” Tom Wolfe, The Right Stuff The popular perception of surgeons is similar to the popular perception of fighter pilots. Arrogant self-confidence, disdain for thoughtful planning and reflection, quick to take action—‘shoot first, ask questions later,’ reckless courage in the face of danger, all are considered typical of the personality type. Like all stereotypes, there is an element of truth behind the perception. Both surgeons and fighter pilots do jobs that are inherently unnatural. There is nothing ‘natural’ about flying a machine at speeds faster than the sound made by its own engines. There is nothing ‘natural’ about cutting into another human being’s body and rearranging its anatomy. Performing at a high level in these arenas requires a special kind of confidence in one’s own ability and judgment, a confidence that is often mistaken for arrogance. The willingness to take action in the face of uncertainty, to make irrevocable decisions based on incomplete information, is often mistaken for recklessness. Acceptance of personal responsibility for the consequences of those actions may be mistaken for a disdain for cooperative effort. “The ability to tolerate risk and to mitigate it to the extent possible is the mark of a good surgeon.”   I know several former fighter pilots. They’d all make good surgeons. And contrary to the popular perception, they are some of the most conservative and risk averse people I know. I don’t mean politically conservative, although most surgeons and pilots tend to identify with that end of the political...