Hi Reddit, George Velmahos here at Mass. General Hospital to answer your questions on trauma surgery and life as a surgeon working at a level 1 trauma center. I’m hoping to answer questions from 2:00 – 3:00 p.m. EDT unless my pager decides we’re done early. AMA!

Edit: Proof https://twitter.com/MassGeneralNews/status/331460737203576832

Edit: 2:47 pm - Sorry, I must run to the operating room. Many thanks for your questions!

Comments: 1009 • Responses: 21  • Date: 

catofnortherndarknes539 karma

1.) How much experience does one generally have to have before qualifying to be Chief of a department as you are?

2.) As the Chief, do you tend to stand back and issue directions and offer information to other less experienced doctors more, or are you usually right in there?

3.) What is going through your mind when you see what you see from day to day? Is it clinical detachment from the gore, or do you still find yourself cringing internally when you see a terrible injury, or somewhere in between?

4.) Do you ever cry when you can't save someone?

I find people with your type of intellectual capacity fascinating, and I admire the work that you do. Thank you!

GeorgeVMD1125 karma

  1. Typically 10-20 years of experience to become a Chief at a major hospital.
  2. You cannot be an effective general, if you are not in the trenches with your soldiers.
  3. As a trauma surgeon, one should be empathetic but at the same time cool and collected to offer effective care. Direct emotional involvement, when a life must be saved, does not benefit anyone.
  4. No, I never cry.

Handicapreader424 karma

I am a L-1 complete paraplegic. I can't find a decent doctor familiar with paraplegia. I've heard of implants that can rewire my nerves to my brain. Do you know anything about this, and/or direct me in the right direction to get my feet back to working? Broke my back in 2002.

GeorgeVMD528 karma

There is plenty of expertise in paraplegia in our place. I would suggest that you contact a rehabilitation center (if you are in Massachusetts, you can contact Spaulding Rehabilitation Hospital). Our trauma rehab physician is one of the best but there should be numerous around the nation.

hotmetalslugs353 karma

Softball match: MGH vs BWH

Who wins?

GeorgeVMD776 karma

Always the patients.

GleeUnit332 karma

Aside from advances in sanitation, what do you think the single most important (and relatively recent) breakthrough has been for trauma care? A new tool? A technique?

GeorgeVMD715 karma

"Damage control surgery". This is the type of surgery which allows to quickly control the major damage, then resuscitate the patient, then come to repair everything in more detail. This concept has helped save many lives, comparing to the old times.

jisa249 karma

Have you stayed in touch with any of your past patients (or have they stayed in touch with you by sending the occasional thank you note or Christmas letter-sort of update)?

GeorgeVMD546 karma

All the time. I stay in touch with many of my patients. It is probably the most rewarding part of the job.

gqsmooth241 karma

Just wanted to say good job on yours and the rest of the area hospitals efforts after the bombing. Everyone leaving alive that came in alive is one hell of an achievement.

I do have a question though, can you describe the different levels of a trauma center and the requirements for each?

GeorgeVMD258 karma

There are four levels for trauma centers, I through IV. A level I Trauma Center (like MGH) cares for the most severely injured patients, discovers new methods of care (research), educates the new generation, and reaches out to the community for injury prevention. There are progressively less responsibilities of lower level trauma centers.

acalpaca239 karma

Hey, I am a student at the bottom of the medical ladder in the UK. What was it like to be Chief of Trauma and Emergency Surgery during the period of, and after, the Boston Marathon bombings?

GeorgeVMD488 karma

It was wonderful and awful at the same time. Wonderful for the opportunity to save lives. Awful for being part of this senseless act.

Rockdio206 karma

What are your thoughts on the future of surgery, specifically, using robots to conduct surgery? Have you used one before?

GeorgeVMD421 karma

Robots are good but will never substitute for good judgment by a real human being.

Rockdio155 karma

Clarification: What I meant was the use of a robotic apparatus such as this one.

GeorgeVMD396 karma

I think robotic surgery has specific applications. It is not and will not become routine. It facilitates certain surgical maneuvers but the robot cannot make pre-, intra-, and post-operative decisions. Making decisions is hard, putting a stich is easy. This is why humans are still necessary on the planet.

roroofox187 karma

What do you do to relax?

GeorgeVMD596 karma

Play tennis and try to beat my son in basketball (which is hard and never relaxes me).

polaroidgeek149 karma

Hello Dr. Velmahos, Thanks for doing this AMA. In 1986 I suffered a double compound fracture of my right wrist at the growth plate. I managed to come away with my hand still attached after surgery (the surgeon told my father afterward that he seriously considered amputation but felt bad doing that to a 10 year old), but as you might expect my hand isn't tip top - for example typing is difficult because I really only use my index & middle fingers on my right hand to do so. I often drop things from my right hand as it's just not as strong as my left, etc. My question is, had I suffered the same injury today, based on where medical science is now, what are the odds my hand functions would be improved at all?

GeorgeVMD203 karma

I am sorry to hear that. There is a whole new specialty nowadays (Hand Surgery) and they have wonderful outcomes with complex injuries, such as yours. It is hard to know what they would have done differently without knowing what exactly was the injury then. Obviously, medicine progresses and there is little doubt that after 25 years a lot must have changed.

saywhatisobvious144 karma

What happened on your worst night of the job?

GeorgeVMD378 karma

I can't remember a "worst night". Since my early years, when I fell in love with trauma surgery, all nights were the "best night".

MemorableCactus119 karma

I'm sure many people will ask what the worst thing you've seen is, but I'd like to know what some of the craziest injuries or situations you've dealt with are? The kind that make you scratch your head and say "How does that even happen?"

GeorgeVMD208 karma

Bullets, knives, falls from heights, and car crashes create unpredictable injuries. There must be thousands of "crazy" patterns that awed me and challenged me. But this is exactly what we love in our job.

ILCreatore103 karma

What is your best memory you've had with any patient(s)?

GeorgeVMD225 karma

Waking up after a long operation and saying "thank you"!

wmjohnst91 karma

As a current M3 considering trauma surgery as a career, what advice do you have for applying to general surgery residencies and away rotations during my 4th year?

GeorgeVMD116 karma

What else than to choose the best hospitals with the best gen surg programs. If you are interested specifically in trauma, you should obviously choose programs with great trauma groups.

Bosten81 karma

Hey there :) Just wanted to say you guys are amazing. The care and comfort I have gotten when I was there is 10x anywhere else I've been. Thanks for everything :) What is one thing you love about your job, since it can be such a stressful one most of the time?

GeorgeVMD231 karma

I love the fact that trauma can turn people's lives in a second (to the worst) and I can turn it back (to the best). Unlike other areas of medicine, in trauma we can really cure people completely and deliver them back to society completely intact.

gthomson020179 karma

Hi I am in High school at the moment and want to become a doctor. I am currently in the uk and my dream is to one day work at MGH. Is it possible to do my medical education in the uk and then do my residency at an american hospital. I would one day like to be a trauma/emergency surgeon any reply is appreciated :)

GeorgeVMD165 karma

Yes, you can finish medical school in the UK and then compete for a position for surgical residency in the US. It is hard but doable. You will need excellent USMLE grades.

hollaback_girl42 karma

What has your career path been like to get where you are? When did you decide you wanted to be a doctor? Where did you go to college and med school? What were the major milestones in your professional development and how did you achieve them (e.g. how did you get the Chief job? Did you apply, were you recruited/promoted, etc.?).

If there's one thing in U.S. health care that you could change, what would it be?

GeorgeVMD76 karma

This is an involved question but here is the summary. I always wanted to become a doctor (and especially a surgeon). Everything else came up as a fairytale.

samsung144338 karma

1-As a trauma surgeon do you receive the patients immediately when they are wheeled into hospital or are they referred to you by emergency medicine physicians. 2-Why trauma surgery when there are so many less stressful fields in medicine? 3-As a practicing physician in the US, have had some lawsuits against you with ridiculous claims? (don't have to answer). 4- ABCED trauma steps done by you or physicians? 5-How important is it to stop the bleeding. and how do you know that the patients airway is clear? 6-How do you maintain objectivity when treating a patients that you know?


GeorgeVMD74 karma

  1. Yes, I receive them immediately, unless if they are not very injured, in which case the EM physicians may see them first.
  2. Because stress and job satisfaction are not mutually exclusive, if you really love what you do.
  3. Yes, always.
  4. Airway clearance is concern number #1 and bleeding concern number #2. Everything else follows.
  5. This is really hard.

exackerly35 karma

Are the emergency rooms shown on TV shows like ER or Nurse Jackie realistic? Which ones are the best at conveying what your job is like?

GeorgeVMD212 karma

I almost never watch my job on TV. I practice it for real.

indogirl31 karma

First of all, great job on all of your work handling the victims of the bomb blasts in Boston.

As someone who's supposedly "used" to the high stress level of an emergency room, would you say that you treated this event in the same mental state? Or do you have that panic in the back of your mind, but kept it under wraps? Please elaborate on your thought processes as you dealt with the swarm of patients that were entering the emergency room.

Thank you!!!

GeorgeVMD155 karma

To clarify first: Trauma surgeons are not Emergency Medicine physicians. We are indeed in the ER all the time but these are two different specialties. Regarding the physical state of mind under duress: We are used to (and actually like) these medically stressful conditions. We are trained to think fast and respond fast. Panic is not in the dictionary. Calmness and precision is.