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Book Review

‘Trauma’ by Dr. James Cole

By Dennis Rosen
Globe Correspondent / October 10, 2011

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The doors to the trauma bay burst open as a bloodied, semiconscious person is wheeled in, the first responders providing a brief synopsis of what they’ve done so far. Orders for oxygen, medications, blood, and monitoring are given rapidly as life-saving measures are implemented in the minutes between arrival and transfer to the operating room.

Familiar to any viewer of “ER,’’ this is the bread and butter of a trauma surgeon’s practice. Saving lives each day through intense and stressful work, they are seen by many to be larger-than-life superheroes.

But trauma surgeons are made, not born. Dr. James Cole has written a fascinating account of his training and practice, both as a civilian and in active military service, shedding light not only on the well-deserved glamour but also on the hardships involved.

And his training, to put it simply, was brutal. In this era of limits on the number of hours medical and surgical residents can spend on the job, it is hard to read about some of the aspects of his training without wondering why anyone in his right mind would put up with it. For example, having to routinely guzzle cold spaghetti rings straight out of the can during residency because he was given no time to break for lunch; or finally getting permission to use the bathroom after 18 hours in the operating room while working on a case that ultimately ran for 24 consecutive hours.

Not that he seems to have minded it too much. Although noting that “the surgical residents were treated like caged mice in some bizarre, real world experiment, which studied torture, sleep deprivation and human behavior,’’ he also writes after a gratifying shift: “I was so grateful to have been on call that night, and I subsequently viewed every long night spent away from home, sequestered in a hospital, not as a duty or punishment, but as a potential opportunity to excel.’’ Reading this, one wonders whether this isn’t an example of the Stockholm syndrome, in which hostages begin to empathize with their captors, even to the point of defending them.

“Trauma’’ is replete with technical - and graphic - details about various surgical techniques and procedures that sometimes go on for several pages. His descriptions accurately convey the relentless pressure and gripping uncertainty resulting from the ups and downs that invariably accompany his heroic efforts to save lives. Gripping and intense, it places the reader shoulder to shoulder with Cole, elbows deep in the blood pooling in a patient’s open belly as he tries to find the source of the bleed and to stop it.

Despite the daily miracles he performs in the lives of his patients, he remains humble, describing medical care not as “an individual activity but rather a group effort.’’ He also relates multiple instances in which he worked tirelessly for patients who he felt had no chance of survival, only to be astonished at the recoveries they had made when months later they come back to visit. One of these, a 4-year-old victim of a drive-by shooting, taught him not to give up no matter how grim the initial odds seemed: “From that day forward, I allowed the concept of miraculous recovery to enter my realm of possible patient outcomes.’’

Powerful, intense, and inspiring, “Trauma’’ offers a rare window not only into the life of a trauma surgeon but also into his soul as he reflects upon experiences few of us can even imagine.

Dennis Rosen, a pediatric pulmonologist, can be reached at dennis.rosen@childrens.harvard.edu.