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Not One More: A trauma surgeon's story
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This important episode is a must-share and could save a life this holiday weekend – or at any time of the year. Hartford HealthCare’s Steve Coates talks with Dr. Jonathan Gates, chief of trauma at Hartford Hospital.
Dr. Gates gives us a rare perspective from behind-the-scenes of a Level 1 trauma center. He also shares some of the chaos and seamless coordination he experienced during the Boston Marathon bombings and the Haitian earthquake in 2010.
Closer to home, Dr. Gates and Hartford HealthCare have joined forces with the Connecticut Department of Transportation for “Not One More” – a campaign designed to prevent the trauma that can result from impaired driving due to alcohol and drugs. He sees the devastating effects every day. It’s an undeniable problem that peaks during the July 4th holiday.
He is asking for Connecticut drivers to pledge that they won’t have that one additional drink or smoke that will put them and others at risk. His story is a compelling one.
Please, explore and share the links in this episode’s notes to “Not One More” with the ones you love. There are some impressive videos and resources there that are guaranteed to make us all think twice about “Not One More.”
Videos, TV spots, resources and more:
Will you sign the pledge? Visit NotOneMore.org.
Follow More Life to be notified every time a new episode drops. Just search “Hartford HealthCare” on your favorite podcast platform.
Somebody may not die from a head injury, but it will change their life. Somebody may not die from a loss of limb from a motor vehicle crash, it will change their life. The OR techs, the OR nurses, the people who you know prepare the rooms in the emergency department and in the ORs, they're affected. They're part of the community. And the community is affected when somebody is badly injured or dies from an impaired driving event. None of us want to see that. It's a little bit of injury to us every time we see it.
SPEAKER_00Welcome to More Life. This important episode is a must-hare and could save a life this holiday weekend or at any time of the year. Hartford Healthcare Steve Coates talks with Dr. Jonathan Gates, Chief of Trauma at Hartford Hospital. Dr. Gates gives us the rare perspective from behind the scenes of a level one trauma center. He also shares some of the chaos and seamless coordination he experienced during the Boston bombings and the Haitian earthquake in 2010. Close to home, Dr. Gates and Hartford Healthcare have joined forces with the Connecticut Department of Transportation for not one more. It's a campaign designed to prevent the trauma that can result from impaired driving due to alcohol and drugs. He sees the devastating effects every day. It's an undeniable problem that peaks during the July 4th holiday. He's asking for Connecticut drivers to pledge that they won't have that one additional drink or smoke that could put them and others at risk. His story is a compelling one. Here's Steve Coates.
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SPEAKER_02Gates, I've known you for a while, mostly in administrative fashion, and sometimes forget that you actually have a day job as a trauma surgeon. Fascinated by the choice to become a trauma surgeon, it's it's a very important and sometimes emotional line of work. Talk about your journey to choose this as a profession.
SPEAKER_01So when I started as a general surgery resident in Boston, uh, you know, I knew I wanted to do surgery and it was great. And I really uh kind of agonized over what direction I would take because everything I did I loved. And I didn't want to just be a regular general surgeon. I wanted to have kind of a um uh additional, you know, specialty areas, and that's how I went on to do uh uh vascular surgery. Uh I think some of the times, um, you know, the figure this is in the uh uh mid to late 80s, um, some of the patients we would see, you know, would be badly injured, and you would get a sense in talking with people that, you know, that the outcomes might not have been what you expected. And it was like, well, it's a bad injury, you know what I mean? And that was the response. And I realized at that time that that's opportunity that we could do better. And I think that, you know, as you learn more and more about how the patients are, you know, injured, how we resuscitate them, how they recover, you realize again, there's opportunity to do better at every step of the way. And so I started personally uh as a general surgeon, as a general surgery resident, and uh I thought, okay, I could go off and do a trauma fellowship, but I'm actually going to do it a little differently. And I ended up doing an extra year of general surgery as what we call the surgical coordinator as a junior attending, and then I went off and did cardiac surgery and vascular surgery. And that way I felt I could be the what I would expect to be a good all-around general surgeon who could do trauma in most any part of the body. Obviously, it doesn't include things like spine and and uh and intracranial things, but at least from a general surgery standpoint, I'd be comfortable in the chest, dealing with heart problems, dealing with uh uh general surgery problems, and vascular surgery problems. So my career path then, when I finished doing vascular surgery, was doing both trauma and vascular surgery side by side for really the last 35 years.
SPEAKER_02Was there an event, a moment when you were a kid that that led you, like a pivotal moment that led you to choose this as a profession?
SPEAKER_01Well, you know, I from first of all, kind of getting into surgery. Um I uh, you know, I always like to tinker and uh kind of build things and uh and uh obviously love the intellectual stimulation behind it as well. My dad was a physician who was an unbelievable role model for me uh as a general practitioner. And it's it's kind of interesting, but you know, I can remember dad was a man of a few words, and he would uh, you know, he grew up at a time as a general practitioner, trained in cardiology, but practiced uh general practice. Uh, you know, when they were training uh after medical school, they would often uh you know first assist back then. He delivered, you know, well over 2,000 babies over his career, and that's what a general practitioner did. And he worked in emergency departments, so that's you know, uh uh what they did then. And at a time when you know car crashes were really prevalent, and uh, you know, the National Highway and Traffic and Safety Administration was not as well developed, the vehicle safety was not as well developed. And I know that he had witnessed a lot of you know uh um injury and families that were, you know, uh marked forever uh from injury and injury to their members. And you know, I can remember him telling me growing up, he said, you can do anything you want, but just don't drink and drive. And it made an impact, but I also know why he was saying that too, because uh one thing we haven't talked about, but it makes the Not One War campaign all that much more important, is you know, go but going back historically from a family standpoint, um, my uh grandfather, who I never met, uh, was a Canadian gentleman, and um he they had a family of five kids. He was a minister, had a PhD in theology. This is back in the 30s. And he um, you know, would often bring the family, so you can imagine that the age group of the family was about you know 15 to 5, and uh there were you know five kids in total, and they would go on Sunday mornings to the nursing homes to you know attend to the elderly people. That's what the minister did, and he brought his family along as well. Well, they're up in Canada in 1930 and they get into a car crash uh from uh a drunken, drunk driver, and my dad was injured, had a head injury, and was in a coma for three days, and his older brother at age 14 uh died. And you know, this happened in 1930, and you heard about this, and you know, his grandfather, his father was a fairly well-known minister up in I think in Nova Scotia at the time, and uh there were, you know, newspaper publications about this, and it became known as sort of crash or the accident uh in the family growing up. So here it is, you know, 2022, and there are still members of that extended family over the years that remember that kind of pivotal event for that family.
SPEAKER_02This is probably a difficult question, but is there a typical day for a trauma surgeon? I'm guessing you can't really predict what's going to happen. I mean, obviously you can't predict what's going to happen, but are you doing surgery every day?
SPEAKER_01You know, uh I will tell you that uh as I've gotten a little bit older, I'm not doing surgery every day, but I do uh elective surgery um, you know, with uh, you know, and vascular surgery, and that's kind of an elective practice. And then trauma is not elective, obviously, but you're available and uh and trained to take care of most any injuries that come in. And so I will take call about six times a month. We uh around on the service on the patients who are in the hospital, maybe you know, a week at a time, something like that. And um, and you know, you'll you'll see patients in clinic and follow-up as well, as well as doing you know vascular surgery on those times when you're not on call and things like that. But behind the scenes, too, uh Steve, which is really important to me, is what we do uh as in an educational institution like this. So I, you know, as the program director for the acute care surgery fellowship, we have fellows that are training up to be trauma surgeons and what we call emergency general surgeons and surgical intensivists. So that's sort of that total package. And we're involved in their education, they are out there getting trained in various subspecialties so that again, they when asked to take care of a trauma patient in the future, they're well equipped to do so. And we're involved in um, you know, research to a tremendous amount. And honestly, I look at a uh uh the concept of surgical education and surgical research and surgical quality as a continuum. You can't have one with the other. And I often say that, you know, our ultimate goal is taking really, really good care of the patients. And that circles back to why I went into trauma and trained myself the way I am, because we want to deliver the best care. We have to uh then look at situations that might not have turned out as they had and say, what do we know and where's the gap in our knowledge and how can we fill that gap with surgical research? And we are doing that very actively. There's not a day that goes by when we're not thinking about what we can do better and from a research standpoint, what projects are we doing, what improvements are we making, and what you know, frankly, abstracts at meetings and publications are we getting out there so that not only we as an organization, but outside this organization are are getting better educated in the care of the trauma patient.
SPEAKER_02We're more than nine years now out from the Boston Marathon bombings, and you were working at Brigham and Women's in Boston during that time as a trauma surgeon. Obviously a life-changing event for you. Take us through those days that day and and and the days following.
SPEAKER_01Believe it or not, after 9-11 occurred, um, it really was a wake-up call, I would say, uh, for medical education and surgical training and things like that. And the reason I say that is the time that when 9-11 occurred and between that period of time and when the Boston Marathon bombing had occurred, Brigham and Women's Hospital had trained 78 times as a hospital-wide disaster. So when I say that, we realized then and there that we were well trained and and not that we expected anything like this, couldn't have dreamed it up in our in, you know, in any way, shape, or form, but we were ready. And it was really, really apparent, you know, the uh and I remember the initial day, you know, that day getting a call from the trauma program manager who was actually at the finish line and said there'd been an explosion. And um, so I no notification had gone off or anything like that. And uh so I called uh the orthopedic surgeon on call and said, meet me up in the emergency department, something's going on. So we went up there, we met, we already started to have a few patients in. And uh, as you may know, that you know, the majority of badly injured patients were already in a hospital in Boston within an hour and a half of the event. And um, we ended up having uh 40 patients, uh, nine of whom went to the OR that day immediately, almost immediately. But you know, it was a great um experience because it was a time when you could see how deep a bench we had and how all that teamwork since really even before 9-11, but all that teamwork just came together seamlessly. And it, you know, it's all the activities we did on a daily basis that trained us to be able to do what we did. And it's all those activities we did outside the organization. You know, when I look back uh 2010, I brought a group uh from the Brigham where there were 13 of us down to Haiti within you know a week of the earthquake, and these guys were tremendous. And again, we had a thousand patients uh that were on on the um at the University Hospital in Port-au-Prince in Haiti. But to see these this group of surgeons, anesthesiologists, orthopedic surgeons come together back then in 2010 was tremendously satisfying. And you again you see it seamlessly occur after an event like the Boston Marathon bombing. It was and it it's just a a reflection on humanity and the the greatness of it and the power behind coming together and working together was uh tremendous.
SPEAKER_02We see the chaos or we saw the chaos on TV. It's a bombing, it's it's in Boston, there's chaos at the scene. But as a surgeon, do you have a pretty good indication when there's something like that or whatever the event is, specifically in this case of bombing, do you have an idea of what's coming into the emergency department, into the trauma center? Are you getting intelligence from the scene that that makes the scene less chaotic for you?
SPEAKER_01Well, again, you know, you're right. Um we'd had a good idea. I mean, honestly, um we we are we were well positioned, uh all the hospitals were. So we had worked with Boston EMS for years. So figure I've been in Boston since 1983. So I knew the the people who were driving the buses and the ambulances, you know, the these are well-versed uh paramedics and medics. And honestly, um, so you may not know, but yeah, I had worked with the SWAT teams uh for the state police and the FBI for many years. And they're all involved in this event, obviously, even you know, even when there's no uh um, you know, bombing, they're involved in all of these events. And we knew very quickly, uh, because of the intel we were getting from the field, there was no radiation exposure. There was another bomb down by the Boston Library that we didn't know what that was, or some suspicious package that was uh, I don't remember what it turned out to be, but again, as we're getting more and more information, it was very helpful for us to be able to decide if we're going to have another wave of patients, how to triage what we have, you know, what do we need to do to be ready? And uh, so there was a lot of information going back and forth from the field. And it basically the hospitals were all crime scenes, and the FBI and state police were there. And it it underscores the importance of really teamwork. Uh, we knew what their job was. I had been out on a number of uh, you know, responses with the SWAT teams over the years. We knew what their capabilities were, they knew what our capabilities were. I'll tell you, there's no question they had our back. So we knew we could do what we needed to do in the safety of the hospital, and the hospital was in good condition. And um, you know, I think that's a very, very important message that it's those relationships ahead of time, it's the teamwork ahead of time, it's the practicing ahead of time that makes you able to really step up. And like they say in the Navy, you fight like you train. And if you train hard, you're gonna fight well when the time comes.
SPEAKER_02I've known you for a while and and you have such a calm demeanor, but I wonder, and I wonder for all trauma surgeons, is you do see um trauma that is sometimes self-inflicted, whether it's through impaired driving, gunshot wounds, where there is intent to cause this trauma. Do you ever get angry?
SPEAKER_01You know, Steve, I don't. Um you're right. I mean, when we look at car crashes, you know, there 95% of these are you know, operator error, and uh, you know, there's weather and other things like that. But that's what makes it not an accident, but a crash that is preventable in the majority of times. We obviously see a lot of, you know, when I look at the my career over the years, we see a lot of penetrating wounds, you know, gunshot wounds and stab wounds and assaults and things like that. And to get to get angry would be kind of a potentially non-productive. But when you think about it, it's that you hate to see that. And but you do understand why it occurs. Uh, you know, people are stressed, they're in stressed environments, and it it reinforces the fact that we're very, very, very fortunate to be who we are and in the positions we're in, but we want to give back and um you know, for to those who are less fortunate, and that's a driver for any physician to be able to say, you know, how can we help? And we need to help because you put anybody in some of the positions they're in, and they're gonna we respond in the same fashion. And uh I think that unsettled feeling we have like this doesn't have to occur, this person doesn't have to be shot or stabbed. And what is it in society and how can we affect change so that in the future we won't continue to see this sort of carnage that we see on a daily basis on the streets in the United States?
SPEAKER_02Has there ever been a case, one case that has has been has touched you so deeply that that you've thought about giving this up? It's it's affected you that profoundly?
SPEAKER_01No, I'd never give it up, Steve. I can tell you that. Um it's too important to me. It's um it's it's incredibly satisfying. Um there are you know highs that go along with it, and the lows can be really, really low. I can tell you that. And that's why people can you know think about burnout and all that. But if if we're in it for the right reasons, which are to help others and uh you know, and to be on our game, that's enough driver for me. But again, oh yes, there certainly are periods of time when you think, oh my god, you know, and uh you know, I think about it. Yeah, you bet. Sometimes almost on a daily basis.
SPEAKER_02And on the flip side of that, you're treating patients, performing surgery on patients at the most terrible times in their lives for them and their families. So uh the reverse of that, have you had patients come back to you to thank you? Does do you do you see that often?
SPEAKER_01Oh, yeah. Oh, many a time. Um, no, I had a gentleman years ago who um had a self-inflicted wound, um, had a cardiac arrest. We brought him back and uh did a pneumonectomy on him, uh, which is a removal of a complete lung because of the location of the injury. And uh he did indeed come back. Um had a young son at the time and said, I'm never gonna do that again. And to this day, I have his picture in the office, and uh, you know, I think about that. And he's done well, done extremely well. So very, very satisfying. Sure, we see a lot of that. Sometimes, you know, we have patients who um uh come back and you know have a chat with them. I've had a number that I have that I still follow to this day. Sometimes one some of them are you know cases I did 25 years ago.
SPEAKER_02One thing you're very passionate about is preventing impaired driving. Hartford Hospital is the leader of a statewide initiative funded by a grant from the state DOT engaging the other trauma centers across the state to bring attention to the dangers of impaired driving, whether it's through alcohol use or drugs. This is a unique program because it takes us through the eyes of those first responders, whether they're working in the emergency department or trauma centers, and just the impact that impaired driving not only has on those who are initially impacted by it, but also those who are treating it and what they see every day. Tell us a little bit more about Not One More.
SPEAKER_01I think it's an incredible opportunity that's uh, you know, that's uh afforded us uh through the Department of Transportation in the state of Connecticut. And as I see it, again, we talked about how uh these crashes, these car crashes are preventable in the majority of time. And the Not One More campaign is designed to reduce the incidence of fatal car crashes, but also the non-fatal car crashes as well, which in some ways can be just as devastating. And we tend to focus on the fatal events and per capita, Connecticut is very high for alcohol-related fatal events when you look at the United States as a whole. You know, the gross number is smaller because the the population is only 3.6 million compared to, say, a place like California or Texas. But nonetheless, the per capita uh number is very, very high uh with respect to impaired driving fatalities. And when we look at the fatalities, that's what you know gets us concerned, gets us worried. How can we reduce those? Because these are preventable. But then I factor in, look at the injuries we see, and somebody may not die from a head injury, but it will change their life. Somebody may not die from a loss of limb from a motor vehicle crash, it will change their life. And that's where we want to have this impact, not only in preventing those fatalities, but preventing the morbidity that comes along with bad car crashes that again are preventable in our eyes. And the the whole concept is you know, we don't want people to go out there and not have a good time and not to enjoy themselves together as a team. That's really important, especially after this uh uh COVID, if indeed I I'm uh able to say after, but after four waves of COVID, it's changed the social fabric uh uh uh that most people experience on a daily basis now. So we do need people to interact together. We want them to, we want them to have a good time, but within reason. And to me, uh the solution for COVID and managing the the COVID pandemic was people watching out for each other. In other words, the social distancing, the mask wearing, the vaccination programs are all we're lucky to have that compared to what they had in 1918 with the uh uh influenza epidemic then, when upwards of 60 million people died worldwide. We are lucky to have the understanding we do now have with respect to vaccinations and viral uh replication and things like that. But it's watching out for each other that I think has allowed us to control it relatively well when you think worldwide this is a uh pandemic, the likes of which we haven't seen in our in our lifetime, and hopefully won't see again. But when you think about it, if we watch out for each other with respect to drinking too much, uh having you know being impaired too much to be able to get behind the wheel, it's watching out for each other. Saying, nope, you've had too much, I've taken your keys away, sleep over, get you a hotel, I'll drive you home, get you a ride share, whatever it might be, to make sure that that individual gets home safely. And you know, it's it it it in and of itself, it must be incredibly satisfying to say you've got a friend who's a pair, and you actually get them home safely, and you see them the next day, and they're alive, and they're in shape, and in good condition, they're not injured. You know, it it's a it's a near miss. Uh, and I think that's what we want to address is to alert people that they can be empowered to care for each other, care for family members, and prevent them from getting to the point where they're impaired when they get behind the wheel of a vehicle.
SPEAKER_02And the power of this campaign is is really hearing the stories. If you haven't seen it on our on the TV commercial or on social media, it's really the power of those trauma surgeons, nurses, techs talking about the impact it's having on them and the people they see. To me, that that's the real powerful part of this.
SPEAKER_01I I I can't agree more. And like you pointed out earlier, you know, when you think about it, we as physicians, and you know, you see us at trauma surgeon, DED physicians. But think about the effect on the workforce as well. They're here every day doing their job, doing the best of their capability. The OR techs, the OR nurses, the the people who, you know, prepare the rooms in the emergency department and in the oars, they're affected. They're part of the community. And the community is affected when somebody is badly injured or dies from a uh from an impaired driving event. None of us want to see that. It's uh it's you know, it's a little bit of an injury to us every time we see it. And that's why it's so important to us to get behind this campaign, which again is a statewide campaign. The 12 trauma centers are behind this campaign, the same messages, not one more.
SPEAKER_02Dr. Gates, it was great to get to know you in a non-Zoom, giant Zoom meeting kind of way. Uh, just you and me on the Zoom. Um, so thanks so much.
SPEAKER_01Thank you very much, Steve. Thank you for the opportunity to have a chat. I enjoyed it.
SPEAKER_00Thank you. Steve Coates and Dr. Jonathan Gates. Please find and share the links in this episode's notes to not one more with the ones you love. There are some really impressive videos and resources that are guaranteed to make us all think twice about not one more. Will you sign the pledge? Visit Not OneMore.org. Follow More Life to be notified every time a new episode drops. Just search Hartford Healthcare on your favorite podcast platform. For Hartford Healthcare, I'm Enron DuPierre. Thanks for listening to More Life.
SPEAKER_03I'm ready for my close up. All the faces start to light up. You know I love this feeling. I got more life in my life. If you feel it, then you know. We can go anywhere we want to go. We're gonna love this feeling. We got more life in our life. I can do anything that I want, and I don't look back. Now I got this winning in me. I can be who I wanna be. Now I'm going, I got more life in me. I'm ready for my clothes up. All the faces start to light up. You know I love this feeling. I got more life in my life.