Robert Wood Johnson Medicine • Spring 2011 • Population Science

“We are building on the great foundation of trauma at RWJMS. Using a surgical perspective to evaluate patients, our goal is to create a cohesive system,
integrating every level of care involved in trauma and critical care,” says Vicente H. Gracias, MD, professor of surgery, chief, division of trauma/surgical critical
care, and medical director, trauma and surgical critical care at RWJUH.
part of surgery,” she says. “But I found
emergency medicine more user-friendly.
I like talking to people, taking their history,
and thinking about the possible
processes.”
On her first day in the department, Dr.
Gale gets what she had hoped for: not
the melodramatic scenarios of the
recent television series E.R., but rather
the opportunity to help care for patients
whose symptoms do not necessarily add
up to a clear diagnosis.
Today, assigned to the emergent —
or sickest — side of the department,
Dr. Gale meets six patients with six
different problems. She also meets new
colleagues: attending physicians and
community physicians, nurses, technicians,
and others who contribute to
the department’s high standard of
patient care. She begins mastering
the basics: computerized order entry,
the phone system, and the template
for patient histories.
At every step, Dr. Gale reports to
Robert Eisenstein, MD, associate professor
and vice chair, Department of
Emergency Medicine, who helps her
develop an evidence-based plan for
each patient.
Following is a partial log
of Dr. Gale’s first day in the
Emergency Department:
➔ 10:20 A.M.: Dr. Eisenstein
asks Dr. Gale to perform an endotracheal
intubation on an intoxicated
young man with a possible head injury
and altered level of consciousness.
She tries but is unable to perform the
difficult procedure on the patient,
whose neck must remain stabilized.
Dr. Gale asks Dr. Eisenstein for help
and watches as he quickly intubates
the patient, demonstrating how it can
be done successfully under these
challenging circumstances.
➔ 11:10 A.M.: Dr. Gale sees a
woman in her 70s who suffered a serious
fall while visiting her daughter,
who lives locally. Despite her mother’s
reluctance, the daughter brought her
to the hospital. The patient’s face is a
sea of bruises. She is in pain, vague,
depressed, and somewhat disoriented.
The daughter explains that her mother,
who suffers from multiple sclerosis,
has had many falls, adding, “She lives
alone and wants to remain independent.”
Dr. Gale reviews the case with
Dr. Eisenstein and plans what tests to
order. He discusses the importance of
looking for acute injury but also
emphasizes that the patient’s MS raises
the likelihood that she has suffered
earlier injury from recurrent falls. Dr.
Eisenstein agrees with Dr. Gale’s plan
to order a CT scan to rule out brain injury
or broken bones and reminds her,
“Always give the radiologist an idea of
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