A lifetime of saving lives

Living Well | Words: Nick Place | Photos: Meredith O'Shea | Posted on 01 October 2016

The best part of being a trauma surgeon: RoyalAuto's Impact series interviews Mark Fitzgerald, Director of Trauma Services, The Alfred

For The Alfred hospital’s Director of Trauma Services, Professor Mark Fitzgerald, it’s always been personal. In a world that necessarily demands intense, invasive medical procedures, The Alfred’s trauma boss has never lost sight of the individual humans lying helpless in his emergency department’s hectic bays.

As a youth, he remembers going to the funerals of family and friends killed in road accidents. That was back in the bad old days when Victoria routinely posted annual road tolls well in excess of 1000. And then there were the injuries.

We’d go to church and there were always people with hands missing or a leg missing, from road trauma.

“I remember there was the mother of a kid at school,” Fitzgerald tells RoyalAuto. “She would have been about 30, but when she came to pick him up, she never got out of the car because she’d gone through a glass windscreen, before there were seatbelts, and must have been heavily scarred. She always wanted to hide her face.

”Back then, people used to crash into steering columns, and dashes, and have terrible, terrible injuries. On Sundays, we’d go to church and there were always people with hands missing or a leg missing, from road trauma.”

Young Mark witnessed the longer-term effects of road trauma too. A cousin suffered an irreparable head injury in an accident, and he noted how her friends briefly rallied, came to visit, to sit with her, but then gradually drifted back to their lives, leaving their friend damaged and lonely.

Inspired to tackle the toll

“One day I picked up a book called A Simple Guide to Trauma, from a surgeon who worked in Africa, and he wrote a little handbook on how to look after injuries, and it was the only book around on injuries at that time,” Fitzgerald recalls.

“And I got completely absorbed in it. I also had a big interest in military history and obviously military medicine drives injury care or trauma care, so that’s how I got involved. One of the surgeons said they were setting up a college for emergency medicine and I thought I might do that because I like the resuscitation and acute side of things.

”Every year, you were attending the funeral of family, or a friend, or a cousin who had been killed in an accident and you took it for granted, but then all of a sudden you realised that you could actually do things to stop that from happening. It was a formative part of my career and I took it from there.”

He didn’t realise that this would become his life’s work – helping to establish a sophisticated, co-ordinated and remarkable road trauma strategy that has been adopted around the world – but he still lives and breathes it every day, readily admitting that he prefers shifts in Emergency to sitting at his desk, being a manager.

It’s a great job, a great thing to do with your life.

“I work clinically at least Mondays and Fridays and then one weekend in four,” he says. “The clinical work is the stuff that I really like because there is an immediate response, an immediate sense of achievement. It’s very, very rewarding. If I wasn’t doing clinical work I probably wouldn’t be doing all of the other stuff to support it.

“I like coming to work. The best thing is when someone wakes up. You see someone who is really, really sick and you don’t think they’re going to make it and you suddenly walk around the corner one morning and they’re sitting up having a cup of tea. That’s inspiring.

“It’s a great job, a great thing to do with your life. Most patients have very good outcomes and the good thing now, compared to 15 or 20 years ago, is that we have so much experience, we know when things are going well and we also know when we’ve reached the limit in resuscitation and there’s nothing more that we can do for that person. It’s a lot more satisfying. You used to go home feeling a bit sorry about things.”

High-tech allies in battle for survival

Fitzgerald’s career has coincided with some astonishing developments in medical technology that have allowed trauma staff to achieve far greater survival rates for badly injured road trauma victims.

He cites the development of CT scans, allowing doctors to see inside a brain. “That (development) was beyond belief,” he said.

“Unbelievable. People have bleeding into or over the surface of the brain, sometimes clots that need removal. Previously we used to physically remove a bit of the skull and have a look. We were only looking at the surface and didn’t really understand what was going on underneath. CT scans made a huge difference – first to head injuries and then to the rest of the body.”

It was like the burning bush on the road to Damascus. She would have died, people expected her to die, and here she was talking to you.

Then, in his early days as a trauma specialist, came a move towards greater intervention by doctors. “Previously we used to put them on their side and if they were still alive in the morning, then we’d take them to theatre,” he said.

There was a fear of saving lives but leaving patients in a vegetative state. “We were worried that if these people were unconscious and you treated them they may survive and become a non-functioning burden to their family, living a non-independent life. That wasn’t going to happen, but we didn’t realise it at the time,” he said.

In the pre-internet mid-’80s an American medical journal found its way to Ballarat Hospital, where Fitzgerald was emergency senior resident.

“There was an article about how to manage head injuries. Rather than leave them on their side, unconscious, if you put them on a ventilator or breathing machine and looked after their secondary injuries, they could have a good outcome,” he said.

“It seemed like an extraordinary concept. A girl came in from a severe accident near Daylesford and we ran upstairs to theatre, grabbed some anaesthetic agents. It was the days before CT scans and the like. So we intubated her, put her into intensive care and about 10 days later she woke up. It was like the burning bush on the road to Damascus. She would have died, people expected her to die, and here she was talking to you. It was like the cataracts had been removed from your eyes. It was very personal because you might have made an intervention that might give people life. You want to keep doing that.”

‘It is breathtaking’

Fast forward 30 years and Fitzgerald can’t quite believe how evolving technology is saving lives, in cars and in his trauma bays.

“It is breathtaking,” he says. “The roads themselves have been completely re-engineered. There are barriers and rails, approach ramps, traffic limits and speed limits. Quite phenomenal really. Rules about merging, visibility, moving pedestrians. In the car, better visibility, windscreen glass that doesn’t shatter.”

What people probably don’t understand is that Victoria leads the world on preventative technologies.

He points out in-car devices that determine if drivers are sober enough to get behind the wheel, and says more life-saving wonders are on the way.

“Will we have automatic devices so that when the airbags deploy and there’s a sudden deceleration, the emergency services are automatically alerted and have to investigate that crash site?” he asks.

“Bringing technologies forward, we might have heads-up displays and vision sent from an accident scene via paramedic helmets back to the trauma centres, so that it’s all integrated, so that the trauma team, the surgical and medical, nursing trauma teams can see what’s happening, give advice and be even better prepared for the patient. Synthetic bloods, imaging on the helicopter, doing ultrasounds so you can see inside people with little devices before they even arrive. There’s an endless Pandora’s box of interventions and I think they will continually lower the death toll.

“What people probably don’t understand is that Victoria leads the world on preventative technologies and we have run a lot of programs overseas based on what we’ve learnt around here,” Fitzgerald enthuses. “For every single life that we save here, we save approximately 10 lives overseas, so it has a compounding effect because what we learn here, we then propagate so other people can use it.”

Card in the mail

In the year 2000, Fitzgerald was on a tram heading out of the city along St Kilda Road when it stopped suddenly. A small Chinese girl, hit by a car, was lying on the bitumen, a man in a suit directing traffic around her. Fitzgerald got out to find the girl wasn’t breathing. He went to work, got her heart beating and then she was breathing again. An ambulance took her to the Royal Children’s and he later heard that she had recovered and headed home to Sydney.

Last year, Fitzgerald received a card in the mail. It was from a Chinese woman in Sydney, saying she’d just qualified as an engineer and was about to embark on her working life. It was the grown-up little girl, saying thank you, alive only because of his skills in the middle of St Kilda Road 15 years before.

Professor Mark Fitzgerald has kept the card. He likes his job. A lot.