END
PAGE
Treat the Whole Patient, Not Just the Trauma BY AMANDA CASTLEMAN
D
avid H. Livingston, MD, is on a mission to extend trauma treatment beyond patients’ hospital discharge. The physician, an NJMS professor emeritus of surgery and former chief of trauma and surgical critical care, has made this issue a pillar of his 2021–22 presidency of the American Association for the Surgery of Trauma (AAST). He’s challenging his peers to build and oversee long-term trauma survivor clinics, since they have expertise and a big-picture perspective to guide much-needed aftercare. “If you’re brought into a trauma center— and you don’t have a lethal brain injury or advanced age or serious underlying medical problems—your chance of walking out is well above 95 percent,” he notes. “It’s one of the unsung stories in America!” Following their admission to the trauma center, Livingston noticed that many of these patients continued to come back for needed care. “It was my unscientific impression that those I saw repeatedly did better. I’d wind up treating their gallbladder disease, their hypertension, sometimes even their mother….I’d say, ‘You need a regular internist!’” Still, they returned, struggling with PTSD, depression, chronic pain and other complications. “Patients who are severely injured often don’t have great long-term outcomes,” he says. “There is an accelerated death rate and its reason is unknown.” Infection and suicide play a role, but other factors need to be addressed. Livingston believes trauma surgeons should be driving this improved and more integrated aftercare. “Maybe they just need more help, instead of telling them to see their internist or a 24
P U L S E • FA L L 2 0 2 2
KEITH B. BRATCHER, JR.
consultant,” he notes. “In an ideal world, a Center for Trauma Survivorship would help coordinate efforts and support primary care providers with expertise.” Livingston has put these ideas into practice at University Hospital’s Eric Munoz Trauma Center. “I took a center that provided astounding inpatient care and hopefully made it better and more complete,” he says. “It’s thanks to the excellent staff!” This team broadened its scope to include caregivers and dependents, since trauma disrupts entire families. “The goal is to provide patient-centric, holistically driven care, and also to serve as a navigator: an advocate, a case manager.” Livingston has plans to extend this type of care. He says, “My presidential address to the AAST will challenge that group’s trauma surgeons from around the country and the globe. We’ve been successful in creating a lot of survivors. But when they walk out, they have the rest of their lives to live. If we’re really dedicated to care of the injured, that care doesn’t stop at discharge.” The only doctor among a family of engineers, Livingston started his medical education at 18 with a six-year program at Rens-
selaer Polytechnic Institute. “I liked science, biology, and people. It seemed like a good idea at the time,” he says. But if he had a do-over, he would trade the accelerated program for a healthier pace with summers off and more intellectual exploration as an undergraduate. During his surgery rotation, everything clicked. “I loved being in the OR,” he says. He followed a residency at New York’s Bellevue, the oldest operating hospital in the U.S., with a critical care fellowship at the University of Louisville, where he saw a vast spectrum of trauma. In 1988, he was hired by Ben Rush, MD, founding chair of NJMS’s Department of Surgery. He has graduated more than 250 surgical residents and 50 trauma fellows and received numerous grants. He has also been inducted into the Alpha Omega Alpha medical honor society and the American College of Surgeons Academy of Master Surgeon Educators. “Two things have been my guiding principles: patient care and education,” he says. “The last phase of my career is trauma survivorship. It’s the next step in trauma care. Aftercare is important. We need to take this on.” ●