Lewis Carroll cryptically asked his Mad Hatter, “What’s the difference between a crow and a desk?” The answer to the riddle is, to this day, unknown. But that hasn’t stopped generations of people from making fanciful connections between the two, some of which even make a bit of sense.
With my best Mad Hatter impersonation (yes, I realize, that’s not much of a stretch), I pose the question, “What’s the difference between a writer and a trauma team leader?” At first glance, nothing. Or better yet, it would be better if there was nothing. We want very different things from our doctors and writers. We want our physicians to have orderly minds, controlled thoughts, and thoughtful, measured, and responsible behavior. On the other hand, we need our writers to drop everything, mine the depths, teeter on the fool’s cliff, avoid anything methodical. Otherwise, how do you create great literature?
Listen to me.
Leading a trauma team is a unique role, unlike any other position we hold in emergency medicine. A unique position needs a distinct way of understanding it to perform at our best. I learned many lessons about the difficult path to becoming an author and how they could also apply to leading a multi-trauma team.
Know your audience
There’s no point writing in an eclectic metaphor if your audience wants crime. Similarly, the most important starting point when you’re giving a talk or (ahem) writing a column is understanding who you’re pushing your communication on. Of course, you can try to understand where they come from, their background knowledge and their interests, but the most important point is to answer: “What does my audience need?”
Anything that does not answer this question will wither on the literary vine. The same goes for communication during trauma: “What exactly do my team members need to know right now?” Give them that, not a little more, not a little less. It’s respecting the audience, making sure you give them the best information to keep them performing.
Keep the narrative moving
The most productive technique I find when directing trauma is the micro-summary. A recap at regular intervals of where this story has already arrived and where it needs to go next is priceless. This allows the team to predict what needs to happen next. Team members stay engaged; they know what will be required of each of them. Likewise in writing, it gives the reader the opportunity to engage. Nothing is more satisfying to a reader than when they figure out what’s to come next through their own steam.
Adapt the language to the tension of the scene. In strong, punchy moments in novels, the vernacular should be short, use common language, and be unambiguous. Same with trauma. As a leader, you need to be understood. We have a body of evidence on how to communicate in high stakes situations. Human factors, they are often called. Crisis resource management. Closed loop communication. This is to ensure that the words you have spoken have been understood by their target.
The cornerstone of trauma management
Right now, though, that arc has been pulled a little too long. The metaphor has had its day. The starting point remains the same: good communication is a skill, like writing literature, and must be respected, considered and practiced. This, after all, is the key to good team leadership. Of course, you can learn all about multiple trauma – every piece of evidence, every possible outcome of every possible injury. You can wield an ultrasound probe or throw a REBOA catheter like a carnival whip, but if you can’t communicate with your team – the lifeblood of trauma management – the results won’t be optimal.
I whipped this allegory way beyond its DNR status. The comparison is weak, the connection fragile. Why is a crow as a desk?
But you know me now. It was just an excuse, a non sequitur, a Trojan horse. What I really wanted to write about were crows, especially Poe’s crows, the most sinister, darkest, most malevolent birds, slapping, kicking the dying embers. This ebony bird, this ungainly hen, seated alone on the placid chest. What I sat guessing, but no syllables expressing, to the fowl whose fiery eyes now burned deep in my chest. Poe. What a master. I bet he would have loved to see a trauma team in action.
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Dr Johnstonis a certified ER doctor, so the same as you but with a weird accent. She works at a trauma center in the old fashioned end of Perth, Western Australia. She is the author of the novel dust fall, available on his website, http://michellejohnston.com.au/. She is also a regular contributor to the Life in the Fast Lane blog athttps://lifeinthefastlane.com. Follow her on Twitter@Eleytheriusand read its past columns athttp://bit.ly/EMN-WhatLiesBeneath.