Thursday, August 5, 2010

Q&A with Hasan Alam, MD


In episode six of ABC's "Boston Med," which aired July 29, Hasan Alam, MD, a trauma surgeon, performs emergency surgery on patient Patrick Coleman, who had fallen 15 feet to the ground while fixing a roof.How did you decide to be a doctor? I didn't come from a family with many doctors -- I'm one of five brothers who are architects, engineers and bankers. But I knew early on that I wanted to be physician, though I didn't know I wanted to be surgeon until I went to medical school. Being a surgeon was very attractive because it is a goal-oriented, definitive field. Rather than following patients through their entire lives and helping manage chronic diseases, I wanted to be in field where I could tangibly fix things. In trauma surgery, most of the time, if you do the right thing, your patients can walk out of the hospital and have normal, productive lives.

What is the most challenging part of your job? The most challenging part of the job is making quick decisions about critically injured patients. These life and death decisions often have to be made with an incomplete set of data -- you don't have the luxury of time to gather all the needed information, review it, consult with your colleagues, look at the pros and cons (there are always different ways to approach a problem), and then choose the best approach and discuss it fully with your patient. This luxury isn't afforded to the trauma surgeons; difficult decisions must be made quickly. But that challenge is also rewarding when the surgery goes well. What was it like to be filmed by ABC while working? It was actually much easier than I thought it would be. Early on it was a little awkward –wearing a microphone and having a camera follow you around – but I got to know crew and they were all nice and fairly nonintrusive. After a few days, filming became fairly routine. Why did you agree to participate in the filming? What interested you about the show? I've been filmed before, not for my clinical work, but in relation to my research on trauma surgery and combat casualty care. I think it's a double-edged sword when you get media coverage. You open yourself and are somewhat vulnerable in terms of what spin they might put on things, so you have to have a little bit of faith in the person or the team that's doing it. At the same time, it's a great way to show others what we do, engage the public and let them behind the scenes to see how the system works. I was open to it in that sense. Where did you watch the episode you were featured in? What did you think of it? I watched it with my wife at home. She actually liked it -- I think she was probably relieved that it was fairly noncontroversial. They did a good job. There were good and bad things about how the situation was portrayed, but the bad things weren't really bad per se. It's hard to cover a complicated story in a short period of time. They didn't really focus on how Patrick had to stay in the hospital for months and had a relatively long and complicated path to recovery. There were numerous teams involved, including the surgical residents who did an amazing job from the moment the patient came in the hospital's doors, to the people who helped with his postoperative and rehabilitative care. Other surgeons, multiple specialists, residents, nurses and ICU staff played significant roles. It all comes together in a relatively complex, choreographed dance that pulls a patient like Patrick through the system and gets him healthy again. I'm almost embarrassed about the attention that I received in the show -- it takes a whole team of dedicated individuals to care for someone who is so critically injured. Is there anything else you'd like to add to what was portrayed in the episode? Another aspect of this type of story that doesn't get enough coverage is the people who make it possible to advance the field. Unfortunately, one thing that advances the field of trauma care dramatically is war. Every time there's a war, the field of trauma benefits, as we learn new approaches for things like resuscitation and hemorrhage control, emergency surgeries and rehabilitation techniques. The Office of Naval Research, the Defense Advance Research Project Agency and the U.S Army Medical Research and Material Command don't get enough credit for the enormous support they provide for trauma research. It is due to the ongoing support by such agencies and heroic efforts of countless military physicians that the care of the injured has been revolutionized in the battlefields of Iraq and Afghanistan. Many of these innovations have already been adopted by the civilian trauma community and are saving lives every day, including the life of the patient shown in this episode. Compared to other similar cases you've had, how severe was Patrick's situation? He was not the most severe case, but he was extremely sick. He had lost a large amount of blood and was still actively bleeding from multiple sources, including his liver, pelvis, chest and abdomen. Although he was bleeding at multiple sites and his blood pressure was extremely low, he was still alert and talking to people, which was very deceptive. Based on the fact he fell 15 to 20 feet, which isn't a terrible fall, and because he was alert and conversant, he didn’t look like someone who had lethal internal injuries. In reality, he was minutes away from a complete collapse, and we made the decision to bypass any additional tests in favor of an emergent operation. As soon as we rushed him to the OR -- which only took about 15 minutes from when he was in the ER -- it already was a struggle to keep him alive.

Have you seen Patrick since surgery? Only during the routine follow-ups, and I've gotten some reports on him and know that he's doing okay. But in surgery and more specifically, in trauma surgery, as a general rule, you want the patients back in the society living their normal lives without any need for long-term follow up. Our role is to support them through a tough period, and if they never need us again I consider it a job well done.

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