Tales From the Trauma Unit


It is a typical day at Hadassah Medical Center.

On a road outside Jerusalem, a young woman army officer, who is pregnant with her first child, is involved in a terrible car accident. She seems to be dying at the scene.

The Hadassah paramedics, who arrive at the site almost immediately, perform heroic feats and, miraculously, bring her back to life. Once transporting her to the trauma unit, the physicians find that the revived woman's abdomen is so severely damaged that they must remove much of it.

In the process, the patient loses the baby.

"So we opened the abdomen, took out the bad parts, closed it up with a mesh net and put a skin graft over it," explains Dr. Avraham I. Rivkind, associate professor of surgery and head of the department of general surgery and shock-trauma unit at Hadassah Hospital — the only Level 1 trauma center in the Middle East.

Rivkind discussed this case — which happened six years ago — while in Philadelphia this spring, speaking at "Sparkle Among the Stars," a Hadassah celebration dinner, as well as to meet with the medical staff at area hospitals and academic medical centers.

'Miracle of Miracles'

A few years later, the now-recovered patient visits Rivkind and tells him that she wants to become pregnant again. He immediately explains why that could not happen. Yes, he told her, you may be able to conceive, but you will never be able to carry the child.

But the patient persisted, and the man who describes himself as a great reliever and a simple general surgeon was persuaded to try. He began meeting with his colleagues in obstetrics and gynecology to create a way to make the impossible possible.

"How did you make it happen?" he is asked.

"It was a miracle," he replies.

To create this miracle, a special belt — actually more like a girdle, it was manufactured in Thailand, composed primarily of polyamide and lycra — was developed to hold the woman's abdomen in place. As planned, she became pregnant and had to go to Hadassah Hospital once a week during her pregnancy to be checked and to have an ultrasound. But it worked out.

"I was at the baby's bris!" announces Rivkind, beaming.

And then, she wanted another baby.

"Today, she is the mother of three sons. The second birth was twins," he says. "That's what we do at Hadassah. It is completely out of the box."

In recent talks, Rivkind has been discussing "Coping With Trauma: Decision Making Under Uncertain Circumstances" to audiences in Israel and around the world.

"Trauma care is not a stable process," he explains. "Because of this uncertain environment, we learn and then teach others what to do."

According to Rivkind, when treating trauma it helps to have some knowledge about the patient.

"When an injured person is brought to the emergency department, we want to know more about him," he explains. "We want to know where he comes from, who is his mother and who is his father. We don't know anything about him, and suddenly, we have to treat the patient."

To overcome this knowledge deficit, Hadassah trauma paramedics have cameras with them to record the scene of injury. They can then transfer the pictures to the operating room for the staff to see prior to the patient's arrival.

"It helps us," attests Rivkind.

"Especially in a blunt trauma motor-vehicle accident, where the patient is bleeding from the head," the doctor says. "We would assume that we should look at the brain. Instead, though, we can be more targeted by the picture."



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