Radiolab - Uneasy as ABC

Episode Date: August 23, 2024

February 1976. A flight out of California turned catastrophic when it crashed into a farm in rural Nebraska. What happened that night at the local hospital, and crucially, what went wrong, would inspire a global sea-change in how emergency rooms operate and fundamentally alter the way doctors think in a crisis.Special thanks to Jody and Jay Upright, Heather Talbott, Dr. Ron Simon, Dr. John Sutyak, Dr. Paul Collicott, Irvene Hughe, Maimonides Medical Center, Karl Sukhia and Vanya Zvonar.We have some exciting news! In the “Zoozve” episode, Radiolab named its first-ever quasi-moon, and now it's your turn! Radiolab has teamed up with The International Astronomical Union to launch a global naming contest for one of Earth’s quasi-moons. This is your chance to make your mark on the heavens. Submit your name ideas now through September, or vote on your favorites starting in November: https://radiolab.org/moonEPISODE CREDITS: Reported by -  Avir Mitrawith help from - Maria Paz Gutierrez, Sarah Qari, Becca Bressler, Suzie Lechtenberg, Heather Radke and Ana GonzalezProduced by - Maria Paz Gutierrez, Becca Bressler and Pat Walterswith help from - Ana GonzalezOriginal music and sound design contributed by - Maria Paz Gutierrez and Jeremy Bloomwith mixing help from - Jeremy bloomFact-checking by - Diane Kellyand Edited by  - Becca Bressler and Pat WaltersSign up for our newsletter!! It includes short essays, recommendations, and details about other ways to interact with the show. Sign up (https://radiolab.org/newsletter)!Radiolab is supported by listeners like you. Support Radiolab by becoming a member of The Lab (https://members.radiolab.org/) today.Follow our show on Instagram, Twitter and Facebook @radiolab, and share your thoughts with us by emailing [e-mail] support for Radiolab’s science programming is provided by the Gordon and Betty Moore Foundation, Science Sandbox, a Simons Foundation Initiative, and the John Templeton Foundation. Foundational support for Radiolab was provided by the Alfred P. Sloan Foundation.

Quick warning, this episode features some quite gruesome and gory injuries. If you are sensitive to that sort of thing or listening with someone who is, keep in mind you might want to skip this one. Oh, wait, you're listening. OK. All right. OK. All right.

You're listening to Radiolab. Radiolab. From? WNYC. C. C? C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. C. From... WNYC. See? So, is today a day off? Are you working later? I'm working overnight tonight. Oh, man.

I work at midnight. Oh. Hey, I'm Lulu Miller. I'm Lutif Nasser. This is Radiolab. What are the tides bringing into the ER right now? Oh, man. I mean, it'll be like everyone thinking they're dying, but it's allergies. Okay.

But no, this never happens to me. I'm like, I'm pretty sure this does happen to you. Today, we're here with our ER doctor correspondent, Avere Mitra. And this time, he's got a story for us from the trauma bay. Yeah, so, you know, in the ER, I guess I'm lucky or cursed enough to see all sorts of crazy things.

Let's move on. You know, it's like everything from appendicitis to strokes to broken bones, but sometimes on your account, it's like a trauma. Like something really bad just happens to a person out of nowhere. How's the airway? Like a gunshot wound, drowning, stabbing, car crash, and all of a sudden, their life is in the balance. Ugh.

So as you can imagine, when a trauma happens, your job is to act quickly. You have to think quickly. You have to get very focused very quickly. Yeah. Because my job in that situation is to keep that patient alive and stabilize them, get them to the point where we can send them to the surgeon where they can get fixed up. And at this point, I feel like I can do a pretty good job of that.

But that was definitely not always the case for me. I still remember one of my first trauma cases where it was a guy who just drank too much. You know, this is in New York and he was walking to catch the subway, tripped, fell onto the subway tracks and got hit by a train. Oh my god. Yeah, so like we get the call, ambulance brings this guy in, and his feet are in a bag. Like, his feet are separate from him in a bag.

And he's got a head injury, bring him onto the gurney, and I'm just... Like, I can't get over the fact that there are these feet in a bag, you know? And I'm looking at all the wrong things. Like, I remember looking at his fingernails and just being like, oh, his hands kind of look like mine, you know? And just all these thoughts are racing through my mind. None of them are useful.

And I just froze. Hmm. And I mean, I just have a ton of memories like this, you know, during my training. But the truth is, I've gotten to the point where I'm pretty good at this. Like, I can save a life in a trauma situation. And it's because of this different way of thinking. It's the way that we've all learned in the trauma bay how to think. And it's pretty counterintuitive. When I looked into it, it's sort of all originates from this one kind of insane story.

Interesting. There's a story waiting in that change? There's a story. Okay. It starts with this guy's name's Jim Steiner. This is in February of 1976. Jim's a doctor. He's not just any doctor.

He's kind of a big deal. He's an orthopedic surgeon. He works at this big hospital in Lincoln, Nebraska. Okay. And him and his family, they're heading back from this wedding that they were just at in California. So it's him, his wife Charlene, and he's got four kids, Chris, Kim, Rick, and Randy. I remember it was a really nice day, completely clear, you know, in California that's a really nice time of the year. This is Randy, he was seven at the time. We got to the airport and we just stand around and talk and

watch the planes come and go, you know, little airplanes coming and landing. I wish that I could just have a Polaroid of that moment, because it was the last time we were ever going to have a moment like that. At any rate, um... Eventually, they get on this little six-seater plane. The B-55 Beechcraft Baron. And Jim's up in the cockpit because he's actually an amateur pilot. Whoa!

Yeah. So he's flying them home to Nebraska. My dad did all his checks. He got the weather report, contacted the FAA and gave him a flight plan. We took off and headed east. So they fly through New Mexico, they go through Kansas. And I just spent my time looking at the world below. And as they're coming into Nebraska, all of a sudden, a pretty unexpected cloud cover just appeared and kind of started to engulf the plane.

Oh no. So now it's foggy and Jim really can't see anything. It was getting near 6 o'clock at this point in time, so the sun was going down. And it's just getting darker and darker and the air pressure is changing around him. My dad had started to get a bad feeling and he decided that he was going to to go under the clouds and you know make sure that he's had visual with the ground. He was trying to get to about 500 feet to sort of orient himself but it turns out his altimeter which is telling you how high or low you are is getting thrown off. So he thought he was flying 500 feet about the ground. He was flying about 50 feet above the ground.

Oh no. Yeah, and he was, we were moving at almost 200 miles an hour. God, probably less than 30 seconds later, the plane went right through two large pine trees. And then all of a sudden everything stopped. The plane had crashed into the middle of this huge 100-acre cornfield in the middle of nowhere Nebraska. So Jim gets knocked out.

He had a broken rib. He, you know, he had a hole in his face. His eye was completely swollen shut. And when he comes to, he starts looking around and he looks to his right and Charlene is just not there. Wait, meaning? She's like, she's nowhere to be,. Like, that part of the plane is gone. Oh no.

He looks behind him. He sees that all the kids are alive, but they've got all these different injuries. My whole scalp was ripped back all the way to my skull. And my sister had a big chunk out of her face. And three of them, Randy, Rick, and Kim, are knocked out. They're unconscious.

So Jim just snapped into doctor mode. He pulled his kids out of the plane and set them on the ground. Did a quick assessment of us there. Randy had this huge gash on the back of his leg. So, he went and pulled out a bunch of suitcases to get clothes out of so he could fashion a tourniquet. And once Jim got their wounds under control, he went looking for Charlene. He shouted for her and was looking for her. And he'd walked about 25 feet before he found her.

And she was dead. Oh. She didn't suffer. For whatever that's worth. Oh, my God. Yeah. And as far as the kids go, it was pretty clear, like, if he didn't get them to a hospital, they were gonna die too.

Yeah. So Jim's out there with these kids for eight hours. Eight hours? Eight hours. You gotta remember, this is the 70s, so there's no cell phones, there's no GPS. It's so foggy, he can't even see anything. And it's freezing cold, so he's covering them with clothes

to keep them warm. My dad was getting pretty frustrated because he really couldn't believe that nobody knew we were missing. But eventually as the fog began to lift and the clouds began to lift, all of a sudden this moon came out. And so Jim could see what's around him.

He could see the tree line we came from. He could see the field rolling out from around him. And he decides to go looking for the nearest road. Try and get us some help. Eventually he finds this road that's like less than a mile away. He flags down this car with a couple guys in it. They pick up the kids and they make their way to the closest hospital. A little town called Hebron about five miles down the road.

So finally after being like stranded for hours, they arrive at this hospital. Oh, thank God. Well, you would think so, but the reason I'm actually telling you this story is because of what happened next at that hospital. When we pulled into the parking lot, the guys who were in the car with us jumped out

and ran to the front door of the hospital. And the front door is locked. So they're banging on the door and they see a couple nurses inside. One of the nurses walked up to the front door. And she's like, the hospital is closed. Sorry, we can't let you in because there's no doctor here. But Jim is a doctor. Yeah, exactly.

And Jim is like in disbelief. From his experience, you know, at the hospital in Lincoln General, there was 24-hour access there. They would have had a whole army of people showing up to stabilize us, to get us in there. And so Jim Steiner, he just walks up and smashes his hand into the glass door, leaving this like blood-soaked palm print. And he says something like, the doctor is here.

Open this door. So they unlock the door. My father kind of just burst in. They page a couple doctors and nurses. And in the meantime, Jim just takes charge. He had to get the gurneys out into the parking lot and get us, start getting us loaded on there and then getting us wheeled into the hospital.

The one boy, the oldest boy, he was conscious. He had a broken arm, he was conscious. He had a broken arm and he could talk. Now the other three, they were unconscious. They had dried blood on them, they were cold. This is Helen Bowman, a nurse called in that night. I have seen a lot of nasty cases, but this was the worst. Yeah.

So my dad was doing the initial assessment on us. He was trying to get the nurses to help with taking vitals. Eventually two doctors showed up on the scene. Dr. Pemery and Dr. Bunting showed up. And so Jim's like, okay, great. He got a sense of comfort from them saying, okay, we'll start handling. Since there were two doctors, it would be a little easier to triage and to start working on a treatment plan.

But Jim wasn't exactly letting go of the reins. From his perspective, they were really just running around like chickens with their head cut off. They seemed completely overwhelmed by the situation. It was chaos. It was just total chaos. I mean, Jim wasn't making their jobs easy. He was very agitated.

He started taking, yelling, barking out orders. But that's because these doctors and nurses, they didn't know how to handle all these injuries. One of the nurses had gone out and gotten a suture kit to start stitching up the back of my leg. My dad freaked out. He said, you know, this is going to require surgery to close. You can't just come in here and suture this up.

And it wasn't just that they didn't know how to treat these kids. They didn't know who to treat first. Basically, if it looked bad, that's what they started on. You know, they saw that I had a six-inch section of my scalp pulled back and that my sister had blood all over her face and she had a cut over her eye. So they were focused on them. But all the while, Rick, who wasn't covered in blood, he had the most serious injury. He was drifting in and out of consciousness and sort of like thrashing around and like

Jim knew that this must mean that he had a pretty serious head injury. And knowing what he knew about head and neck injuries and how they work together, he wanted to get head and neck x-rays right away. But after like pushing and pushing and pushing them to do the x-rays. All they did was x-ray the skull. My dad asked him about the x-ray of the neck. The doctor just blew it off. He said, I see no reason to do that.

And at that point, Jim just broke. That's when my dad said, you people don't know what you're doing. You leave us alone. You are no longer caring for my family. You've got to get us to Lincoln. You've got to get us to Lincoln General. So after all this stuff, a helicopter lands in the parking lot of this small hospital. They get the family onto the helicopter, fly them over to Lincoln General. They got us into ambulances and took us to the emergency room at Lincoln General Hospital.

When they get there, like a dozen doctors descend on the family. The beehive got hit and everybody jumped into action and started taking care of us. And I was going to go to surgery. And at this point, you know, Jim is seeing his close coworkers and they're like, Jim, get on the bed. You know, we're putting you under like goodbye, you know, he's finally, let's go the reins and becomes the patient. He did, and, you know, he managed to calm down. We were all in the same room.

Three of the kids were still in comas. I was in a coma for three days. Kim and Rick were in a coma for seven. But eventually, they all woke up and they all survived. Wow. Okay, that's great. Yeah. So, the family returned to their lives.

They tried to move on from this insane tragedy. I was dealing with a lot of stuff. Obviously the death of my mother. My brother Rick had a fairly slow recovery, but even more, my dad was very lonely. He had four kids that he was now raising on his own. He still had an incredible amount of guilt. I mean, I never got to talk to Jim about any of this. He passed away this year, but according to Randy, he just became totally obsessed with what went wrong in the ER in Hebron that day.

He spent a lot of time complaining about it and saying, I don't get this. How could this happen? It's 1976 and we're still dealing with hospitals that have no idea how to handle a mass casualty event and not even a really significant mass casualty event. There were five of us. The thing is, as angry as he was, Jim knew it wasn't actually the fault of the doctors or the nurses there. Yeah, he thought about it and he knew they were competent. He knew they weren't, you know, yokels. You know, it's not the people.

It's just that they weren't trained to deal with emergencies like this, which are completely different from someone coming into the ER with a stomach ache or eye infection. Like the second a trauma comes in, you're already behind the eight ball. You're already behind this flaming blaze. You have to act fast to save their life. And how fast or even what to do in these emergencies, it wasn't really known. Like, at the time, in the mid-70s,

emergency medicine was a new field. There weren't a lot of specialists. Yeah, so the people who staffed emergency departments in rural parts of the country were usually family physicians or general practitioners. This is Dr. Sharon Henry. She's a professor of trauma surgery at Shock Trauma in Baltimore. You know, as long as you had completed medical school and perhaps an internship, you were qualified to work in an emergency department.

And even in the big city hospitals with ER specialists, like a lot of the doctors were really just figuring it out on the fly. Correct. I didn't have any training. I learned what I learned in the ER. It's whatever rolled through the ER doors. So this is Ron Craig. He worked with Jim at Lincoln General. I worked in Lincoln General Hospital's emergency room for three years. And he wasn't just a colleague. He knew Jim. They went to church together. They were friends. So he was one of the people that Jim was talking to about all of this all the time.

One day Jim Steiner was in the doctor's lounge with me and he was complaining rather loudly about the state of affairs in rural hospitals when it comes to trauma. And that was the point where Ron Craig came to it and said, Steiner, why don't you stop bitching about it and do something? I apparently said something to the effect of put your money where your mouth is or put up and shut up. And what Jim did next, with Ron's help, would change the way ERs work across the world.

And kind of rewire my brain in ways that I'm still trying to understand. That's after the break. Stick with us. Lulu. Lotdiff. Radiolab. Okay, so where were we? So where we left off, Jim's been complaining about like how bad the care was in this small emergency room and his buddy Ron's like, okay, let's do something about it.

So the two of them start meeting up. In my dining room. For a couple of hours. Randy Steiner again. Just to talk about it. And they're like, okay, so one of the things that makes trauma so hard is that it can involve all different types of injuries and even just one gunshot, right? It could cause internal bleeding, a broken bone, damage to your lung, your liver, your spine. So which one do you

deal with first and how do you deal with it? Like each of those injuries requires a different specialist doctor. So Jim and Ron start by calling all those different kinds of doctors. Experts. This is Dr. Henry again. Let's go to the thoracic surgeons. Asking them, how do we deal with your part of it? Like take the internal bleeding,

like what's the first thing we do to save someone from that? What did you do to treat that? And I just took notes. Then they go to a heart doctor. The heart's kind of important. And say, okay, if the bullet went through the heart, like what do we do first for that? This is what I did in this case. This worked. That patient lived. This patient died. So what went wrong there? What should we do differently? They called lung doctors, orthopedists, urologists, neurosurgeons, and ask them, like if the bullet went through the part of the body you specialize in,

what's the first thing you would do to save this person's life? We got information from whoever we could get information from. And then Jim and Ron added all up. Spread out our ideas on paper. They're trying to figure out like, okay, do we deal with the bleeding first or the lung puncture, or the stomach injury?

And, you know, they're not just doing this for gunshots. Like, they're doing this for every kind of trauma that you can imagine. So they're thinking about car crashes, like someone stuck in a burning house, a drowning, someone falling out of a window. Figuring out how you respond to all these different injuries and what order you need to respond to them in,

like to save someone's life. You got it. And what emerged was a process that looked like it could kind of work for every different kind of trauma. A plan that- Doctors can apply to almost any situation. So what was the plan? How do you universally approach all potential chaos itself as it impacts the body?

The answer, I'm almost like embarrassed to say it because you're going to be like, and? It's basically something called the ABCs. The ABCs. The ABCs. Yeah, so they got the idea from these cardiac surgeons who had been developing a process for how to save someone, you know, if their heart stopped. OK. And it's basically like a mnemonic, like A, B, C, D, E.

Each of those letters sort of stands for a different step you would take when you first receive a trauma patient. To the ABCs, what you have to do to stabilize this patient while you get further help. Huh. Okay, so what do they stand for? A is for airway, B is for breathing, C is for circulation, D is for disability, and E is for exposure.

Okay, and what does this actually look like? Like, give me an example. Okay, so let's say you have a patient who is just in a car accident and they roll in on the stretcher. So there's blood everywhere. They're screaming. Maybe their leg is broken and twisted back in a weird direction. But according to this game plan that Jim and Ron just wrote, you don't worry about any

of that. All you do is think A. Airway. And basically that means you can just go up to them, look at their mouth and look in there. Is there blood in there? Is there a tooth in there? You know, you need to make sure that there's an open tube

from the world to their lungs. And if not, you need to suction things out or put a breathing tube down. That's all you worry about first. Simply because if you don't breathe, you don't live. After you've done the airway, then you can move to B. Breathing. So B is like a verb.

Now that you have a tube open where oxygen can get from the air to the lungs, now you gotta make sure the lungs are going in and out and breathing. That's where you listen to the lungs. You decide, okay, is there a collapsed lung? If there's a collapsed lung, you poke a listen to the lungs, you decide, okay, is there a collapsed lung? If there's a collapsed lung, you poke a hole in the chest, put a chest tube in, suck the

lung back open. Now that you have like an open tube that's bringing oxygen to your lungs and you have lungs that are working, that are taking oxygen, putting it into the blood. Now let's like stop the blood from pouring out of you. That's step C. Circulation. You think about blood and hearts. So, okay, if someone's bleeding, stop the bleeding. Got it.

So then you stop the bleeding, then D. Disability. Is disability. Which is essentially a bad name for like a quick assessment of is there any brain or spinal damage here? So the doctor's gonna check your pupils to see are they reacting properly. They're going to put a finger in your butt to see if you have like good rectal tone like

is your spinal cord working. Last one is E. Exposure. So you take scissors and we cut off all their clothes and we look at their entire body. And are you mostly looking for cuts and bruises? Anything else? Holes, big injury. I mean, you'd be amazed at all the things you can find. And I should say, these ABCs, they're supposed to happen in that exact order and pretty damn quick. Like 60 seconds per letter at most. You know, you just have to bang through these things. Now, Jim and Ron realized that a lot of these small town docs weren't necessarily gonna know how to do a lot of this stuff.

So in addition to coming up with the ABCs, they also developed like this crash course in trauma life support. They were going to take these doctors from these rural settings and train them on every step of the process. They called it ATLS, Advanced Trauma Life Support, and they held the first class in February of 1978 in a little town called Auburn, Nebraska. Not knowing for sure if it was even going to work. They explained the ABCs and then dove right into practicing how to deal with each one.

Eventually the class would expand to include these lifelike simulations with dummies and fake blood and sometimes even actors playing the injured patients. And the class was profoundly strange for these doctors. Not just because of the simulations, but because of the way it made them think. It was kind of the opposite of what they'd learned in medical school. What do you mean?

Well, think about the doctors you see on television. Like picture an episode of House, you know? A patient comes in, you talk to the patient, you get the whole story, and then you do this long physical exam. Roll over. You check this for these heart sounds, you listen to their stomach.

Any idea what's wrong with her? You ask questions. What is that? Did the patient have any rashes? Yeah, okay, now let's come up with a list of all the things it could be. Could be adrenal gland disorders, blood issues, and a blast. Once you make the diagnosis, then you create a treatment plan.

Starting on a cocktail of STD meds. Jim and Ron are basically like, to hell with all of that. Like, forget about the test, forget about questions. This is the plan. It's called A, B, C, D, E. You just start doing it. Huh. F with the complexities, go. Yeah. Forget nuance, go. Yeah. Huh F the complexities go. Yeah, forget nuance go

Yeah, and because the class was so strange It was so different from what doctors were used to they really weren't sure how it was gonna be received at all But the first group liked it so they were like, okay, let's try this again We rounded up our instructors held the next class in Scotts Bluff, Nebraska They showed up those docs also loved. And throughout the rest of 1978, 79, they kept holding more classes around Nebraska, and they're finding this groundswell of support. All these doctors are like, thank God we have a plan.

Like, something that tells us how to deal with these incredibly stressful situations. And then finally, in 1980, just a few years after Jim and Ron invented ATLS, it went mainstream. Was adopted by the American College of Surgeons. And since then, it's just spread everywhere. Canada. Most parts of Europe. Mexico.

The Middle East. We intended for this to be a program for primary caregivers in small towns. But it obviously grew beyond that. And now today, over one and a half million doctors have been trained in ATLS, and every year, 50,000 more get the training. Wow. And so anyone who's a surgeon or an emergency medicine doc

gets this training, so I got the training. Okay, so, and it works. Yeah. Do we know how well it works? I mean, like outcomes today in trauma are way better than they were in 1976. You know, like you are much more likely to survive today. And that's definitely in part due to ATLS. I mean, how many lives do you think it's saved?

So it is like a hard thing to study, right? Like they no one was studying this when they rolled it out. And now once people know how to do this, you can't exactly make them forget. Like you can't take it back. Yeah, it's like in the water. It's in the water now. But there have been studies, you know,

when they roll this out to a new country that show the survival rates increase from 32% to 67%. Whoa. And basically... Sorry, does it become mandatory? Yes. To become an ER physician, you have to get this training. Okay.

And you need that. I think you need that. Because when a trauma patient comes in, it can be like the ultimate overwhelm. Right. I'm... When you... When there's two... It's almost like looking at the solar eclipse.

Like, I can't look at that. If I try to look at the whole thing, the whole sun, I'm gonna get burned. So I'm only gonna look at a small piece at a time. So I'm gonna look at A, and I'm gonna allow myself to see all the horrors of A. And I'm gonna make a few key decisions and do things, then I'm gonna stop looking at A and open my mind to B. And then there, I get to look at a few things, make a few decisions, then I stop thinking,

I'm on the letter C, let's go, you know? It's almost like putting blinders on, you know? So like, so that, okay, so A, B, C, D, E, like imagine someone comes in with like a gunshot wound or something and they're like bleeding out, and you're like, oh, let me look at the airway. When you're like, clearly the bleeding out is the problem, though. Yeah.

Um, but you can't... But even if you have a sense like that, you don't skip. You don't skip. Wow. Really? Do you ever skip? You're not supposed to skip. Well, it feels so... It feels... As you describe it like that, it feels very robotic.

Very robotic. Mm-hmm. Yeah, following step-by-step instructions. Like a robot. Okay, so I called up this guy, Dr. Ruben Strayer. Hi, I'm Ruben. I'm an emergency doc at the largest hospital in Brooklyn, my Monday's medical center.

Ruben's worked in a lot of different trauma centers over the years, and he thinks that ATLS has gotten a little too rigid. And when we apply a rigid structure in the evaluation of care, sometimes we end up with thoughtless care. Like for instance, often someone might come into the ER after a car accident, but they just happen to have a sprained ankle, and the doctors will run the full ATLS on them. Everyone's getting a finger in their bum.

They're getting their clothes cut off, and a lot of doctors these days will just give people a full-body CAT scan. It's a CT scan that includes the head, the neck, the chest, and the pelvis. Now Ruben would agree that like in serious traumas, you know, like someone's feet are coming in in a bag, yes, the ABCs are crucial. I'm more on board with following an algorithm if the algorithm compels you to act. But even then, you know, there are still some downsides. Like, he's seen how ATLS can kind of put you on autopilot. It puts this distance between the doctor and the patient.

Yes, and I have colleagues that, for example, I think they would be the first to say, I don't really want to get too deeply involved in thinking about this from a patient. I just want to go through the algorithm and move on. And I love my job. Like I love working with patients, but I do experience this going through the ABCs. It's almost like this technical video game.

Okay, I'm intubating, I'm going to put this scope in here. And the first thing I'm going to see is this. I'm going to travel here. I'm going to see this. I'm going to make a left turn. I'm going to expose this. I'm going to put this scope in here and the first thing I'm going to see is this. I'm going to travel here. I'm going to see this. I'm going to make a left turn. I'm going to expose this. I'm going to move my hand like this." So it becomes very technical because you're not seeing them as a person. You're seeing it as like a body part. And when you're treating them, you know, you kind of want to be in that mode. It helps you stay focused.

But it can be really tricky because once you stabilize the situation, you need to become human again. And that's just as hard, honestly. Like, sometimes you'll be talking with another doctor in the room and just talking shop in this almost robotic way, right? And the family is like, did you just say, like, if we don't do this, my brother's gonna die? And it's like, oh, yeah, I did say that. Like I probably shouldn't say it like that.

You know what I mean? So it can be hard sometimes to snap in and out of this way of thinking. Yeah, I mean, it makes me think about, well, just in general, like I feel like a booster for nuance and complexity. And talking about medicine in general, I think we want our doctors to be really thinking about nuance and being human and being attuned.

But then there is a like, except maybe in trauma, when like the clock is running and actual instincts might get in the way. Like I really see its value. I was going to say like, you know, we want our doctors to be human, but maybe in this case when there's like some unimaginable trauma going on, it's nice to dehumanize a little. Yeah, but like to me, the fundamental irony of this story is that the guy who figured out how to roboticize yourself, like that kind of came out of the most human, the most messy, the most emotional situation you could possibly, you know, engineer. There's a kind of a very funny irony there. Yeah. But if you think about it, like, so much of those emotions

and all the messiness of that night really happened because there was no system. Like, I wish Jim, I wish all the doctors there had something like ATLS that night to help them. Yeah. You know, in the way that it helps me. To me, it's like there's this sort of... It's like you can never control the outcome. You know, you just can't. And if you try... I think that's where I messed up as a human,

but also as an early doctor, where it's like if something goes right, like I'm great. If something goes wrong, I'm terrible. But I'm still the same me, and sometimes things go great, sometimes things go terrible, sometimes patients die. But with ATLS, even if the person dies, you can say, the process and the chips will fall where they will and that'll be happy or sad but it's but at least I can sleep at night you know. This episode was reported by Avirmitra with help from Maria Paz Gutierrez, Sara Kari, Becca Bresler, Susie Lektenberg, Heather Radke, and Ana Gonzalez. It was produced by Maria Paz Gutierrez, Becca Bresler, and Pat Walters with help from Ana

Gonzalez. Original music and sound design contributed by Maria Paz Gutierrez and Jeremy Bloom with mixing help from Jeremy Bloom, fact checking by Diane Kelly, and edited by Becca Bressler and Pat Walters. Special thanks to John Sutyak and Brian Zink, and why not, to every ER doctor everywhere. That's it for us. We'll catch you next time. Hi, this is Danielle, and I'm in beautiful Glover, Vermont, and here are the staff credits. Radio Lab was created by Jad Ebomrod and is edited by Soren Wheeler. Lulu Miller and Latif Nasser are our co-hosts.

Dylan Keefe is our Director of Sound Design. Our staff includes Simon Adler, Jeremy Bloom, Becca Bresler, W. Harry Fertuna, David Gable, Maria Paz Gutierrez, Sindhu Nianusambamdam, Matt Guilty, Annie McEwen, Alex Neeson, Valentina Powers, Sara Khari, Sarah Sandbach, Ariane Wack, Pat Walters, and Molly Webster. Our fact checkers are Diane Kelly, Emily Krieger, and Natalie Middleton. Hi, this is Ellie from Cleveland, Ohio. Leadership support for Radiolab science programming is provided by the Gordon and Betty Moore Foundation, Science Sandbox, Assignment Foundation Initiative, and the

John Templeton Foundation. Foundational support for Radiolab was provided by the Alfred P. Sloan Foundation.