Interesting. In what way?
The well to do wrong-place-wrong-time trauma patient is a rarity!
Generally, it is young men and women who are intoxicated that get themselves into ridiculous situations by their own volition which end up in a variety of blunt and penetrating trauma. I would like to illustrate with a few examples:
1) Gang banger is drunk and hits on his homie's girl - guns drawn, multiple shots fired, both come in at the same time. They're intoxicated to the point of agitation, won't let us remove their clothes because "yo that's gay" and due to their ridiculous machismo they don't need our help, their bodies will miraculously weather any lead hailstorm despite the very obvious arterial bleeding from their extremity. Have to put the ED on lockdown because you know his friends are going to show up wondering how they're all doing. Stays in the hospital for weeks due to disposition issues, and is cursing at surrounding patients in hall chairs "what the f0ck are you looking at?"
2) Rural captain america, who votes against his own interests, left high school because college likely wasn't a viable option, basically your Hillbilly Elegy variety, hooked on fentanyl/heroin and loves to drive drunk because "I've been doing it since middle school" Rollover MVA involving the opposite side of the road, and takes out a family of four (who all become the aforementioned wrong-place-wrong-time trauma patient). His family all shows up and they're screaming at the trauma team to clean off the minor amounts of dried blood from his face, why aren't we giving him multiple doses of dilaudid to help his pain, and they all individually want to speak with the doctor and raise a commotion when they're told they need to pick a representative since the doctor obviously cannot speak with all of them individually, "this is the worst hospital, we're going to sue"
3) Young woman with a clear personality disorder, on multiple psychiatric medications (always non compliant), hyperalgesic to even the slightest light touch, even the warm blankets "hurt," took maybe a few too many of her xanax bars and "fell down the stairs" but when her fiance shows up she's suspiciously quiet. He's the rural captain america I described above, and you're now worried about abuse since she just wants to go home and he's overly helpful in trying to get you to discharge her. Low and behold the real story is he pushed her, and she's actually pregnant (she didn't know), and while you really feel for her, her pain is tough to manage, she wants to talk to the doctor every 5 minutes due to her 10/10 pain (nurse has to come up and tell you and documents in the chart because the nurse HAS to, they don't have a choice, "it's just protocol")
There are a ton of examples! I do enjoy the initial trauma resuscitation and stabilization of true life-threatening pathology, but the social and disposition issues are enough to make anybody's heart burn!
I was looked into general surgery heavily before choosing emergency medicine, particularly due to trauma since it seemed so interesting, but a large part of trauma management is social, especially post-operatively. I am in a metropolitan area and the difficulties managing Trauma patients, despite multiple adequate resources at our level 1, seem insurmountable due to social, access, and patient issues.
