IAmA I’m George Velmahos, Chief of Trauma and Emergency Surgery at Mass. General Hospital in Boston. AMA.

1.) How much experience does one generally have to have before qualifying to be Chief of a department as you are?

2.) As the Chief, do you tend to stand back and issue directions and offer information to other less experienced doctors more, or are you usually right in there?

3.) What is going through your mind when you see what you see from day to day? Is it clinical detachment from the gore, or do you still find yourself cringing internally when you see a terrible injury, or somewhere in between?

4.) Do you ever cry when you can't save someone?

I find people with your type of intellectual capacity fascinating, and I admire the work that you do. Thank you!

1. Typically 10-20 years of experience to become a Chief at a major hospital.
2. You cannot be an effective general, if you are not in the trenches with your soldiers.
3. As a trauma surgeon, one should be empathetic but at the same time cool and collected to offer effective care. Direct emotional involvement, when a life must be saved, does not benefit anyone.
4. No, I never cry.

I am a L-1 complete paraplegic. I can't find a decent doctor familiar with paraplegia. I've heard of implants that can rewire my nerves to my brain. Do you know anything about this, and/or direct me in the right direction to get my feet back to working? Broke my back in 2002.

There is plenty of expertise in paraplegia in our place. I would suggest that you contact a rehabilitation center (if you are in Massachusetts, you can contact Spaulding Rehabilitation Hospital). Our trauma rehab physician is one of the best but there should be numerous around the nation.

Softball match: MGH vs BWH

Who wins?

Always the patients.

Aside from advances in sanitation, what do you think the single most important (and relatively recent) breakthrough has been for trauma care? A new tool? A technique?

"Damage control surgery". This is the type of surgery which allows to quickly control the major damage, then resuscitate the patient, then come to repair everything in more detail. This concept has helped save many lives, comparing to the old times.

Have you stayed in touch with any of your past patients (or have they stayed in touch with you by sending the occasional thank you note or Christmas letter-sort of update)?

All the time. I stay in touch with many of my patients. It is probably the most rewarding part of the job.

Just wanted to say good job on yours and the rest of the area hospitals efforts after the bombing. Everyone leaving alive that came in alive is one hell of an achievement.

I do have a question though, can you describe the different levels of a trauma center and the requirements for each?

There are four levels for trauma centers, I through IV. A level I Trauma Center (like MGH) cares for the most severely injured patients, discovers new methods of care (research), educates the new generation, and reaches out to the community for injury prevention. There are progressively less responsibilities of lower level trauma centers.

Hey, I am a student at the bottom of the medical ladder in the UK. What was it like to be Chief of Trauma and Emergency Surgery during the period of, and after, the Boston Marathon bombings?

It was wonderful and awful at the same time. Wonderful for the opportunity to save lives. Awful for being part of this senseless act.

What are your thoughts on the future of surgery, specifically, using robots to conduct surgery? Have you used one before?

Robots are good but will never substitute for good judgment by a real human being.

Clarification: What I meant was the use of a robotic apparatus such as this one.

I think robotic surgery has specific applications. It is not and will not become routine. It facilitates certain surgical maneuvers but the robot cannot make pre-, intra-, and post-operative decisions. Making decisions is hard, putting a stich is easy. This is why humans are still necessary on the planet.

What do you do to relax?

Play tennis and try to beat my son in basketball (which is hard and never relaxes me).

Hello Dr. Velmahos, Thanks for doing this AMA. In 1986 I suffered a double compound fracture of my right wrist at the growth plate. I managed to come away with my hand still attached after surgery (the surgeon told my father afterward that he seriously considered amputation but felt bad doing that to a 10 year old), but as you might expect my hand isn't tip top - for example typing is difficult because I really only use my index & middle fingers on my right hand to do so. I often drop things from my right hand as it's just not as strong as my left, etc. My question is, had I suffered the same injury today, based on where medical science is now, what are the odds my hand functions would be improved at all?

I am sorry to hear that. There is a whole new specialty nowadays (Hand Surgery) and they have wonderful outcomes with complex injuries, such as yours. It is hard to know what they would have done differently without knowing what exactly was the injury then. Obviously, medicine progresses and there is little doubt that after 25 years a lot must have changed.

What happened on your worst night of the job?

I can't remember a "worst night". Since my early years, when I fell in love with trauma surgery, all nights were the "best night".

I'm sure many people will ask what the worst thing you've seen is, but I'd like to know what some of the craziest injuries or situations you've dealt with are? The kind that make you scratch your head and say "How does that even happen?"

Bullets, knives, falls from heights, and car crashes create unpredictable injuries. There must be thousands of "crazy" patterns that awed me and challenged me. But this is exactly what we love in our job.

What is your best memory you've had with any patient(s)?

Waking up after a long operation and saying "thank you"!

As a current M3 considering trauma surgery as a career, what advice do you have for applying to general surgery residencies and away rotations during my 4th year?

What else than to choose the best hospitals with the best gen surg programs. If you are interested specifically in trauma, you should obviously choose programs with great trauma groups.

Hey there :) Just wanted to say you guys are amazing. The care and comfort I have gotten when I was there is 10x anywhere else I've been. Thanks for everything :) What is one thing you love about your job, since it can be such a stressful one most of the time?

I love the fact that trauma can turn people's lives in a second (to the worst) and I can turn it back (to the best). Unlike other areas of medicine, in trauma we can really cure people completely and deliver them back to society completely intact.

Hi I am in High school at the moment and want to become a doctor. I am currently in the uk and my dream is to one day work at MGH. Is it possible to do my medical education in the uk and then do my residency at an american hospital. I would one day like to be a trauma/emergency surgeon any reply is appreciated :)

Yes, you can finish medical school in the UK and then compete for a position for surgical residency in the US. It is hard but doable. You will need excellent USMLE grades.

What has your career path been like to get where you are? When did you decide you wanted to be a doctor? Where did you go to college and med school? What were the major milestones in your professional development and how did you achieve them (e.g. how did you get the Chief job? Did you apply, were you recruited/promoted, etc.?).

If there's one thing in U.S. health care that you could change, what would it be?

This is an involved question but here is the summary. I always wanted to become a doctor (and especially a surgeon). Everything else came up as a fairytale.

1-As a trauma surgeon do you receive the patients immediately when they are wheeled into hospital or are they referred to you by emergency medicine physicians. 2-Why trauma surgery when there are so many less stressful fields in medicine? 3-As a practicing physician in the US, have had some lawsuits against you with ridiculous claims? (don't have to answer). 4- ABCED trauma steps done by you or physicians? 5-How important is it to stop the bleeding. and how do you know that the patients airway is clear? 6-How do you maintain objectivity when treating a patients that you know?

thanks

1. Yes, I receive them immediately, unless if they are not very injured, in which case the EM physicians may see them first.
2. Because stress and job satisfaction are not mutually exclusive, if you really love what you do.
3. Yes, always.
4. Airway clearance is concern number #1 and bleeding concern number #2. Everything else follows.
5. This is really hard.

Are the emergency rooms shown on TV shows like ER or Nurse Jackie realistic? Which ones are the best at conveying what your job is like?

I almost never watch my job on TV. I practice it for real.

First of all, great job on all of your work handling the victims of the bomb blasts in Boston.

As someone who's supposedly "used" to the high stress level of an emergency room, would you say that you treated this event in the same mental state? Or do you have that panic in the back of your mind, but kept it under wraps? Please elaborate on your thought processes as you dealt with the swarm of patients that were entering the emergency room.

Thank you!!!

To clarify first: Trauma surgeons are not Emergency Medicine physicians. We are indeed in the ER all the time but these are two different specialties. Regarding the physical state of mind under duress: We are used to (and actually like) these medically stressful conditions. We are trained to think fast and respond fast. Panic is not in the dictionary. Calmness and precision is.