The following is Part One of an occasional series called “Working,” which will examine the lives of people on the job. It was inspired by Studs Terkel’s 1974 book, “Working: People Talk About What They Do All Day and How They Feel About What They Do.”
The fastest way to stop profuse bleeding is often with your finger, according to Dr. Carina Biggs, South Nassau Communities Hospital’s chief of trauma surgery since Feb. 1. Sutures or plastic loops to repair the damage can come later. The first order of business is simply to stop the bleeding, by any means possible.
The finger makes a useful and versatile plug, Biggs said as she sat in a quiet courtyard at the center of South Nassau, in Oceanside, on a recent overcast but warm Thursday. It was a rare moment of calm for Biggs, 56, whose day can be upended at any moment by a patient who has fallen off a ladder, crashed a car, or been stabbed or shot.
An analog clock is hung high on the wall above South Nassau’s two trauma resuscitation bays, which are just steps from the Emergency Department entrance on the hospital’s first floor.
Tick, tock, tick, tock.
The battle to preserve life plays out at a rapid-fire pace in the trauma bay, where patients are assessed and treated before they are sent upstairs for surgery or other critical care. With each blood droplet that is lost, a patient’s life slips just a little further away.
Biggs, by all accounts, thrives in this pressurized environment. Part of the reason she became a trauma surgeon, she said, is because she is regularly presented with new challenges and riddles to be solved. “You never know what’s coming,” said Biggs, dressed in blue scrubs, with a tartan-patterned surgical cap covering her auburn-blond hair.
Days often blend into nights into mornings. Five times a month, she must work the 14-hour overnight shift, from 5 p.m. to 7 a.m. As an American College of Surgeons-verified Level II Trauma Center, South Nassau must have a trauma surgeon on site 24 hours a day, seven days a week.
Biggs never knows how many surgeries she might perform in a week. Maybe none. Maybe four or five. The most complicated cases involve multiple gunshot wounds to the chest and abdomen. In such cases, patients might have just minutes to live, Biggs said.
A bullet lodged in the body many times stays there for life, she said, because cutting it out could do more damage than leaving it. A seriously injured spleen can be removed, as can a kidney or part of the pancreas.
Long hours and free coffee
Down the block and around the corner from South Nassau is a tiny, inconspicuous house with a redbrick façade, gray siding, an asphalt roof and a meticulously trimmed lawn. It is the out-of-the-way place that trauma surgeons go to catch their breath while pulling long hours at the hospital. Inside is a dimly lit, largely bare living room with a stationary bike to one side, a futon, a coffee table with an oversized chessboard on top and a small TV. Beyond the living room are two offices and a kitchen. Upstairs is a bedroom. Biggs sleeps there from time to time when her schedule, which is often dictated by the cases that unexpectedly arrive, requires it.
“You get used to it,” Biggs said of the long hours. The upside, she said with a laugh, “There’s free coffee in the surgeons’ lounge.”
Trauma surgeons must maintain their health, Biggs said. She makes sure to sleep well the night and day before an overnight shift, and brings her own lunch so she eats only nutritious food. She also cycles and runs to stay fit.
“You have to be in really good shape” to be a trauma surgeon, she said. “Even then, it’s hard, but it’s a choice.”
“Most people,” she noted, “don’t want to do it.”
Biggs, who lives in Brooklyn, has a 10-year-old daughter, Anya, who, she said, “provides me with a lot of happiness. She’s also my best friend.”
“She asks me what I do,” Biggs said. “She loves to come to the hospital.”
Biggs tells her daughter, “When someone is hurt, they need an operation. I do the operation, and I take care of them after the operation as well.”
She also tells her that when she’s grown up, she should do something that she loves that helps people.
Biggs was 4 or 5 when she decided to become a doctor, she said. For the first five years of her life she lived in Germany, where her father was stationed with the U.S. Army. She remembers being in the Bavarian Alps, in the country, and falling onto stones. She cut her forehead and was bleeding heavily. There was little medical care available. It was only 20 years after World War II had ended, and Germany was still recovering. Biggs was rushed to an American Army hospital, where the damage was repaired. After that, she said, her academic energies, from elementary school on up, were directed toward becoming a doctor.
‘A very complicated role’
“Holidays are busy,” Margaret Puya, a registered nurse who is South Nassau’s trauma program manager, said of the number of trauma cases that South Nassau sees. “Nights are busier than days.”
Biggs and Puya meet daily to review the trauma team’s questions, concerns and cases. “The trauma surgeon,” Puya said, “is really the captain of the ship . . . It’s a very complicated role.”
The trauma surgeon must be willing and able to work with doctors from throughout the hospital, from plastic surgeons to neurologists and cardiologists, said Puya, 49, of Long Beach.
“It’s fun,” she said of trauma medicine. “You either love it or you hate it. Luckily, I have a great team that loves it.”
Dr. Daniel Haller, 39, of Woodmere, has been a trauma surgeon at South Nassau for three years. Among the greatest challenges, he said, is treating older adults who are suffering from Alzheimer’s disease or dementia. In such cases, patients are often physically fragile and unable to respond to the simplest questions, including whether they are feeling pain.
Many older adults, Haller said, “have a lot of other medical problems . . . in addition to the new injuries.”
Biggs returns to protocol and procedure, the time-tested rules of engagement, often borrowed from the military, that allow her to quickly and seamlessly assess a patient’s condition and decide his or her fate. “You have to get control of the situation,” she said.
Tick, tock, tick, tock . . .