Stephanie Yen - a fourth year medical student at the Keck School of Medicine of USC
When I was accepted at Keck School of Medicine of University of Southern California, I knew nothing about Los Angeles County Hospital even (LAC+USC) though I grew up in LA. I did not realize the privilege of having the opportunity to train here. I distinctly remember the medical school interview tour during which we made a quick stop in the hospital. We stood on the 2nd floor balcony overlooking the ER waiting area as the tour guide, a medical student, told us how much we would be able to learn and to do as a medical student there.
At the end of my first year, I came to appreciate LAC+USC more when I attended a free screening of the documentary film “Code Black” on campus. Before watching the movie, I knew County had a busy Emergency Department (ED), but had no idea about the history of Emergency Medicine and its origin at old LAC+USC hospital with the famous “C-Booth” trauma bay. “C-Booth” embodied the chaos and challenges that come with acute trauma care and the teaching spirit of the hospital where some of the first Emergency Medicine doctors were trained.
Towards the end of my third year, I got to experience LAC+USC’s greatest strengths – acute trauma care. One of my most exciting, tiring, and unforgettable shifts was during Acute Care Surgery (ACS) rotation. It was my second 30-hour call shift (something USC students see as a right of passage) and I was working with the trauma resident.
The day started out very calmly without much going on. We saw a pregnant lady who was in a car accident and had bruising on her abdomen, or “seatbelt sign,” but ended up being fine. Everything was peaceful – we ate dinner, the resident helped us practice suturing, and I eventually went to nap in our call room. I woke up to a text from the resident at 9:47pm saying there was a consult in the ED, so I met up with him and we walked towards the ED to meet with the senior resident, fellow, and attending. The next nine hours went by in a blur, and I can’t say that I remember the exact order of events, but it went something like this.
While we were seeing the first patient, the ED nurses and doctors were talking about a multi-vehicle crash caused by high-speed freeway racing involving twenty people with two deaths confirmed at the scene. Soon enough, a young man with altered mental status, “seatbelt sign,” and peritoneal signs, concerning for intra-abdominal injury came in. We got a quick chest X-ray and rushed him to the OR for an exploratory laparotomy. He had a bowel injury and ended up requiring intestine resection and admission to the ICU.
Then there were two patients in their 20s who were involved in another racing accident. The driver was unscathed, but his passengers were not as lucky. The girl in the passenger seat sustained severe head trauma and was rushed by neurosurgery to the OR for a craniotomy. The boy in the back seat was stable, but had a fracture in his lumbar spine and couldn’t move his feet, which made us concerned about lower body paralysis.
Then came an elderly man who had crashed his car into a tree and wasn’t responding. I was recording vitals for this patient when I heard the residents doing a cardiac massage. I rushed over and saw a man with an abdominal gunshot wound. He was pulseless so we rushed him to surgery and tried to revive him with cardiac massage, defibrillation, and exploratory laparotomy to try to find and stop the source of bleeding. The doctors called his death on the operating table. This was the first time I had seen a patient pass in front of my eyes. We found that the gunshot had pierced his inferior vena cava and abdominal aorta, two large vessels.
After this, we saw another patient from the earlier freeway accident with a “seatbelt sign,” who couldn’t urinate. On imaging, he had free air indicating perforation, so we took him for an exploratory laparotomy and found he had a small bowel transection. We saw one more car accident patient with a lacerated arm and then headed to morning report. I was surprised that it was already morning.
That night will probably be the most memorable and exhausting night of my life. I was pushed to my limit – physically, mentally, and emotionally – and I was only a medical student on the surgery team. I couldn’t imagine how the residents and attendings worked in this setting night in and out. I was amazed by the teamwork, efficiency, and focus of the medical team. It was like a scene from “Code Black,” but with a more smooth and methodical flow. I performed a cardiac massage for the first time. I saw firsthand the dangers of unsafe driving. I saw how LAC+USC resuscitation center is the front-line for acute trauma care. I saw the fragility of human life. I came to appreciate the greatness of LAC+USC even more.
As I start my final year at the Keck School of Medicine of USC, I look forward to learning more from the patients, residents, and attendings at LAC+USC. I am thankful for having had the privilege of training at an institution that cares for all patients regardless of their ability to pay and provides teaching to medical students like me. I am especially thankful for those residents and attendings who take the time to make us part of the team. Even though I’m not going into Emergency Medicine or Surgery, the life and medical lessons that I’ve learned at LAC+USC have shaped my medical education, and I will use my experiences to become the best physician I can be.
Stephanie Yen is a fourth year medical student at the Keck School of Medicine of the University of Southern California and is applying into Pediatrics for residency.
CODE BLACK is a blog series about what really matters in healthcare by medical students and faculty at the Keck School of Medicine of the University of Southern California.