Gregg Adams is on a mission to keep you alive.

The following article appears in “One Giant Leap,”  a special advertising supplement of the March 29, 2013 edition of the Silicon Valley Business Journal.  You can view the entire publication online here, or pick-up a copy of the Journal at your local newsstand.

Meet the man who keeps San Jose’s only top level trauma center at the ready for just about anything, how he copes with the loss of a young patient, and what Hollywood gets wrong about emergency medicine.

California Valley Medical Center

In casual dress, a cup of hot tea, and an office over-flowing with books, paperwork and framed credentials on the wall, Valley Medical Center’s Chairman of the Department of Surgery Gregg Adams, M.D. could easily pass as a college professor.

Which, befitting of a man as accomplished as Gregg, he is – an Associate Professor for Surgery at the Stanford University School of Medicine, to be exact.

But his calm exterior belies a passion and intensity for what he does each day – save lives.

The Southern California native came to VMC first in 1990 at a Stanford resident, and full-time in 1999.  For the faint of heart, his job responsibilities would seem daunting; manage over 130 surgeons, maintain VMCs high standards for trauma services and disaster response and – oh yeah – scrub in for between 200 to 400 surgical procedures each year.

VMC Foundation Executive Director Chris Wilder sat down to talk with Gregg about his career, his day-today-day responsibilities, how he manages the stress of life-and-death situations, and what makes VMC such an inspiring place to work.

Chris Wilder: You started out a pediatrician.

Gregg Adams: I did when I was in training at Oregon Health Sciences University. I liked the science.  I really liked the kids.  Parents were really fun to talk with.

My downfall in pediatrics was during my internship, I did a rotation of pediatric surgery, which was six weeks of absolute bliss, and I thought, I think I’ve made the wrong decision, so I changed.

CW: How is it blissful?  I want to get inside the head of a surgeon because I have no idea what it’s like to do what you do. There must be so much pressure.

GA: I think the pressure is in the trying to do it right.  I think to a certain degree it’s like trying to learn to ride a unicycle. There is a significant front end involvement and commitment.  And you begin to learn and you begin to try and you do a lot of failing and adjusting.

CW: I spend a lot of time touring people through VMC, and when I tell them that we have the only top level trauma center in San Jose, they often ask me what’s the difference between that and an emergency department?

GA: A trauma center is more than just one department.   You not only have to have a top-flight emergency department, but you have to have a top-flight surgery department.  You have to have access to MRIs, you have to access to specialists. All of these systems have to talk to one another.  You have to continually better yourself through education.   So it’s not just an emergency department, it is the entire hospital and the infrastructure that’s built around that to support the trauma center.

CW: True or false – the trauma team springs into action only when an ambulance drives into the ambulance bay or a helicopter lands on the roof.

GA: False.  Trauma begins with prevention.  We go out and talk about wearing set-belts, and talk about wearing helmets on motorcycles and bicycles, and talk about the problems with drinking and driving and talk about gang violence.

CW:  There have been times where you have actually been called to the scene of accident.  Can you tell me one of those stories?

GA:  I’ll use the example of a young man who was at a worksite.  He was digging a hole for a foundation that collapsed around him and was buried up to his neck in dirt.  He could obviously not hop into an ambulance because we was completely surrounded by dirt, and they couldn’t just dig him out, because they feared it might destabilized more of the structures around him, endangering everyone around him.

So we figured out a way to slowly remove the dirt, to reinforce the hole, monitoring his vital signs – because when you are crushed by dirt, actually releasing the pressure can be as dangerous as the crush himself.

CW:  That’s fascinating.  And you saved his life?

GA:  Yes we did.

CW:  So that’s a pretty unique situation, but VMC does a lot of work thinking about the potential for bigger disasters and emergencies that might impact hundreds or thousands of people.  You have a big role in that work.  Are we prepared?

GA: We are prepared in the sense that we have thought about all the things that have happened in the past and that we anticipate that can happen here.

CW: Meteor strike we maybe haven’t thought about yet.

GA:  Right.   A hospital that encounters an earthquake, for example, might say we didn’t have enough gauze sponges, so you buy more gauze sponges.  And we didn’t have good communication, so you buy specialized phones.  So now you have that stuff to handle the next earthquake.  And so of course the next thing that happens is a flood.  And you think – oh my gosh – we ran out of sandbags, so you buy more of those. And you realize you didn’t think of a way to keep the lab from flooding, so you move the lab to the 4th floor.  So now you can handle an earthquake and a flood.  So what’s the next thing that happens?

CW:  A plane crash.

GA:  A plane crash. So while you can prepare in general for a disaster, the disaster that you encounter will require a dedicated crew thinking creatively.

CW:  How do you train for that?

GA:  You practice.

CW:  And VMC actually does practices this stuff?

GA:  We do drills twice a year – and go through all the problems that we encounter and try to fix those each time.

CW: That makes me think of every medical drama and movie.  Hollywood does a pretty good idea of showing people what an emergency department looks like.  But what do they get wrong?

GA:   One is that they have an enormous number of exciting things that happen in 60 minutes with time for commercials.  The second thing is that we are not all beautiful.  And the third thing is probably something I should not say with children present

CW:  I didn’t realize children were present, but I catch your drift.   One thing the TV shows do is make the emergency departments feel like controlled chaos.   Does it feel like that in real life?

GA:  You are never confronted with one problem.  You are confronted with 5, 10 or 50 problems.  Someone that was hit by a car may be drunk, may have cracked their spleen, have a head injury, etc. The only information you have may be what their vital signs are, or what laboratory tests tell you.  So, to a certain degree, it’s a little bit of sensory deprivation and learning to make decisions in a data poor environment.

 

CW:  So it would seem to me that would take a bit of the pressure off if the patient doesn’t survive, but it doesn’t.

GA:  No. I think that we are all set up as a system, as human beings, as professionals, as people who have pride in their work – I would love for everyone to survive.  Trauma in particular is a killer of young people.  That takes a toll and you have to learn to manage that as a human being.

CW:  How do you do that?

GA:  Everyone does it differently.  You get a hobby, you get a pet, you hug your kids, you get involved in public service in a different way, you begin to give lectures on wearing your helmet, safe practices, gang avoidance.  They become passions for you because you are tied up in the last patient you treated that didn’t survive.

CW: And you find that passion in so many people who work at VMC.
GA:  Oh absolutely. And it’s one of the reasons why people not only come here to work but stay here to work.  You come here because you want to take care of the most complex, most interesting, and challenging patients you can imagine.  And ultimately you stay here because you are working with some of the best colleagues you find anywhere in the world.  Dedicated.  Smart.  Funny. Compassionate.  Absolutely beautiful human beings.

CW:  We have had the pleasure of working together for many years now.  I’m interested in your thoughts on the VMC Foundation itself.

GA:  The Foundation in particular is the most pure, beautiful expression of support for VMC that I have ever experienced.  It is completely focused in what it sees as necessary not just for VMC, but uses VMC as it’s vehicle to support for the entire community.  And that’s the part I love about it.