The salvage of life and limb is the purpose of trauma activations and surveys, but it assumes that moral injury is an appropriate sacrifice in pursuit of that goal. Many of my colleagues fear personally experiencing a trauma activation—not due to personal injury, but because they know about the process. Interviews with patients who experienced trauma resuscitations reveal themes similar to our unspoken professional fears. The violation of personal space and dignity and removal of valued objects without explanation or consent are common frustrations.² The same patients are reassured by our competence, yet we must address the times when acuity, standardized protocols and patient values are misaligned. During one of our recent surges, I rushed through discharging a man without serious injuries after a fall, my mind distracted by the burgeoning waiting room. I asked what questions he had and the only one was about his sweatshirt. His wife had died six months earlier and I had destroyed her last remaining possession, one that he kept with him.

These days, I attempt to balance a less morally injurious trauma resuscitation with the need for rapid stabilization and treatment. The other night I stood in the trauma bay, listening to rain patter against the automatic doors, awaiting an ambulance. The doors slid open and above the rain I heard a woman yelling repeatedly in mixed English and Dari, “No, I do not consent,” while paramedics relayed their concern for a spinal injury after she fell down concrete steps. We found an interpreter, took her vitals, and did one of the harder things to do in a trauma bay—we paused. It took time, but we learned how we could perform a trauma survey aligned with her values and she understood the process. Wearing a cut-up trauma sheet as a hijab, she walked out of our emergency department several hours later, intact and not traumatized.

Dr. Lebold is an emergency medicine resident and physician scientist at Stanford University in Stanford, Calif., with a professional focus on the care of critically ill patients. She completed her MD and PhD training at Oregon Health & Science University in Portland, Ore. Her research focuses on earlier prognostication of acute respiratory distress syndrome.

Dr. Eagle is currently a third-year emergency medicine resident physician at Stanford University in Stanford, Calif. She has broad interests across emergency medicine including wilderness, toxicology, and limited resource medicine, and her artwork can be found accompanying various medical literature and research.