A Tribute to Donald D Trunkey by M. Margaret (Peggy) Knudson MD, FACS

To me and to many trauma surgeons around the world, the word “Trunkey” is synonymous  with the word “Trauma”. Most of us completing our residencies in surgery in the 1980s never considered trauma surgery as a career……it was just something you did when you were on call for the emergency room.

When I moved to California after finishing my chief year in surgery at the University of Michigan, my plan was to be a pediatric surgeon. But sometime during my first year of pediatric surgery fellowship at Stanford University, I realized that I didn’t actually like that field and was considering other areas of specialization.

Around that same time, the state of California was beginning to organize trauma systems by county, spurred on by the seminal work of Trunkey, West, and Lim demonstrating the high rate of preventable deaths after injury in areas of the state without trauma systems. (1) I decided to visit the Department of Surgery at the San Francisco General Hospital (SFGH) to scope things out and had the great privilege of meeting with Trunkey in person.

He told me that I belonged in the trauma world and when I asked him how he knew he replied: “I just noticed how your face lit up when you talked about trauma”! And so, I became a trauma surgeon, making frequent trips to San Francisco to learn from the masters at SFGH  while we set up the trauma system in the county of Santa Clara.

Even after Dr. Trunkey moved to the University of Oregon to assume the position of Chair of the Department, he continued to mentor me in both my clinical and my academic endeavors. In 1989, I was offered a position at SFGH under the leadership of Dr. Frank Lewis, only the second woman to be on their faculty after Dr. Muriel Steele. 

Shortly thereafter, Dr. Trunkey and  I, along with  Colonel Don Jenkins (US Air Force, ret.) traveled to Australia where we taught numerous trauma courses from Melbourne to Sydney. Of course, with Trunkey there was always fun mixed in with work. One day, we traveled to the Blue Mountains, the home of many fine Australian wineries.

We stopped at numerous tasting rooms and at every stop Dr. Trunkey would pull out his credit card and join their wine club so that he could have a continuous supply of Australian wine shipped to his home in Portland. But international travel can wreak havoc on your time zones and one morning during a teaching conference in Liverpool (AU) we were both in need of caffeine. We found ourselves in the kitchen of the hospital but no one was there. I decided to brew coffee and must have hit the start button too many times because not only did we fill the first carafe but also the entire floor with coffee! I was mortified of course, but Trunkey just looked at me and responded with his well-known laugh.  I don’t think the kitchen staff ever did figure out who spilled all that coffee!

In 2006, we initiated the Senior Visiting Surgeons Program that allowed non-military surgeons to work as volunteers at the Landstuhl Regional Medical Center (LRMC) in Germany. Landstuhl became the evacuation hospital for all wounded US troops from Afghanistan and Iraq.

Dr. Trunkey (Col, US Army, ret) was a frequent visitor to LRMC, mentoring young military surgeons in the ICU and operating room, caring for the injured, and assuring that LRMC would pass their inspection by the American College of Surgeons/Committee on Trauma Verification Review Committee (VRC)  (a committee he helped to found while he was the COT Chair) to become a level 1 trauma center. (2,3) (See also attached Photos)

I think my very favorite story about Dr. Trunkey occurred in Hawaii. We were both asked to speak at the Hawaiian Trauma Conference and at the conclusion were heading to a traditional Hawaiian luau. We invited Don to my cousin’s home in Oahu and offered to drive him to the party. When the doorbell rang my young twin daughters answered it and then ran to me saying: “Mom there is this really big man out there in a grass skirt”!. Yes, I said, that in a nutshell is Dr. Trunkey.

In many ways, Dr. Trunkey was my professional father. Even my own father (an engineer) knew his name and how important he was to me in my career and to the world of trauma. To me, Trunkey was larger than life and his death (like my own dad’s) leaves a void that will never be filled.

M. Margaret (Peggy) Knudson MD, FACS

Professor of Surgery, University of California San Francisco

Medical Director, Military Health System Strategic Partnership, American College of Surgeons

References

  1. West JG, Trunkey DD, Lim RC: Systems of Trauma Care: A Study of Two Counties. Arch Surg 1979;114:455-460.
  2. Moore EE, Knudson, MM, Schwab CW, Trunkey DD, Johannigman JA, Holcomb JB: Military-civilian collaboration in trauma care and the Senior Visiting Surgeon program. NEJM 2007, Dec 27;357:2723-7.
  3. Knudson MM, Mitchell FL, Johannigman JA: First trauma VRC site visit outside the US: Landstuhl Regional Medical Center (Germany). Bull Am Coll Surg 2007;92:16-19.

Legends for Figures

Figure 1: Dr. Trunkey helping to load an injured soldier onto the bus at Landstuhl for his trip to Ramstein Air Base and the beginning of his journey home.

Figure 2: The COT  Verification Review Committee at Landstuhl Germany. 

Changing hearts and minds by Robert C. Mackersie, M.D., FACS

My first encounter with Don Trunkey was as an impressionable 4th year medical student, doing an externship on the trauma service in the fall of 1977.  I had spent some time at SFGH previously doing computer programming for Frank Lewis and was beginning to understand that these trauma surgeons (Blaisdell, Trunkey, Lewis, Sheldon, et. al.) were not only impressively smart; could work wonders with their hands (and intellect), but seemingly had great fun at the same time. 

Trunkey epitomized it all – with a command of surgery (and medicine); a lightening-quick wit; and an ability to inspire.  And it didn’t stop there.  When I happened to identified a tune Dr. Trunkey was whistling one day on rounds (Rhapsody on a Theme of Paganini), he immediately replied:  “Yeah, and now tell me who Paganini was…”.   Gulp.  

However, I was hooked.  I was fortunate enough to be able to return to UCSF for residency during which Dr. Trunkey was the Chief of Surgery at SFGH.  Already an imposing figure, Trunkey became larger than life.  Striding around in his colored OR hat and white bucks for OR shoes, he was clearly in command of his realm.  Trunkey was a television star (Operation Lifeline, 1978); he was a bon-vivant (rushing back to the hospital OR one time in black tie), he was a wine-maker – I still have a bottle of Trunkey/Deveny/Upshaw Pinot Noir in my cellar – hopefully it doesn’t “taste like socks” (Trunkey’s opinion of one of his early vintages).  

Don Trunkey was internationally famous – in fact he travelled so much, the surgery residents laughingly posted a sign on his office door that read:  “TWA Visiting Professor of Surgery”.   His travel (and writings/lecturing) made him one of the most recognized figures in American surgery – and it wasn’t limited to purely medical settings.  Many years later, when I happened to be with a surgical group visiting Sydney, Australia, we dined at a place named Doyles on the Beach.  There the restaurant maitre’d was heard to remark:  “American surgeons ay?   Do you know a guy named Trunkey?” 

Trunkey wrote prolifically – on many topics including shock, sepsis, intestinal injury and resuscitation.  He used to remind us that crystalloid fluids were toxic and more than once I remember the senior residents being accused (by DDT) of “salt water drowning” by an overly aggressive crystalloid resuscitation of a patient in shock.  Of course we know recognize that Don was absolutely correct and that crystalloid solutions contributed to immune suppression, coagulopathy, and abdominal compartment syndrome among other things.   

His most notable efforts at changing hearts and minds were probably in the area of trauma center and trauma systems development.  With his charisma and energy, he made a superb spokesman.  Two of his most memorable articles were “Systems of trauma care.  A study of two counties” that he wrote with John West from Orange county in 1979, documenting the (staggeringly) high percentage of preventable deaths that could occur in the absence of an organized trauma center/system.  These concepts were further reinforced in a piece he wrote in Scientific American (1983) where he became one of the first to remind us that trauma accounted (and still accounts) for more productive years of life lost than heart disease and cancer combined.  

As a surgical educator, Dr. Trunkey was a blast to work with.  He was always the master of the ‘pimp’ question, yet held forth with such persistent good humor that one never minded being skewered.  He could be very direct – reserving use of the term “clean kill” for only the most egregious transgressions, but while appropriately critical of residents’ management, he was never, ever mean – a characteristic of his – unusual for the day, that I always admired.    He used to give an introductory lecture to 1st year medical students in the middle of which an agitated person would burst into the lecture hall exclaiming:  “Dr. Trunkey, Dr. Trunkey, there’s been a horrible accident – someone has been hit by a bus in front of the hospital!!”  Following this, the “victim” (a perfectly healthy, uninjured volunteer, in full moulage) would be brought to the front of the room and a number of students called up to help with the “resuscitation”.  It was wonderful theater and made for an experience that the students (and ‘assistants’) would never forget. 

He could be irreverent at times also – usually hilariously so.   One Saturday morning, during the old Morbidity and Mortality conference, our surgical Chairman, Dr. Paul Ebert (one of the most accomplished pediatric cardiac surgeons in the country) was in the midst of an unusually long-winded explanation of a complicated heart operation.  After going on for many minutes (to the increasing confusion and puzzlement of those listening), Trunkey finally blurted out:  “Oh hell, Paul, just give the kid a new set of gills & throw him back in the water”.  The place erupted in unconstrained laughter, (and even Dr. Ebert may have had a faint smile on his face).

I will remember Don Trunkey as one of the two individuals who most sparked my interested in surgery in general, and trauma surgery specifically.  He did the same for many of his residents and fellows who now occupy important positions in academic & community trauma across the country.   Trunkey was one of a kind – extraordinarily bright, articulate, committed, forceful, and charismatic, but with unwavering good humor and grace, and a clear devotion to and love of what he did.  They don’t make ‘em like this anymore.   Our community has lost one of our icons – a mentor, friend, and role model.  We will remember and honor him best by continuing to work towards the goals that he espoused and try to similarly spark the interest of the next generation of general/trauma surgeons who will carry forward the legacy.  

Respect and kindness for patients by Tammy Sloan-Minckler OHSU/MRH

I worked in Med Control/Medical Resource Hospital for OHSU Trauma. Your Father was my favorite Trauma Doc at the “U”.  Not only was I part of OHSU Trauma, my so was a four time kidney transplant patient and three time cancer survivor.  Including CNS lymphoma.  Dr. Trunkey always took time upon arriving in the ED before the arrival of his trauma patient, to stop in and ask about my son, Rory.  He always said he was available to help me with questions or concerns to help him reach the best person in the given field of need.   I adored him for his kindness to us. 

With each Trauma Activation, when Dr Trunkey led the team, I always knew this patient had the best chance and would be treated with the utmost respect, regardless of the patients outcome.  One of my earliest memories of Dr Trunkey, he and his residents arrived to the trauma bay for a gravely injured young man.  After he led the assessment and gave his initial opinion he allowed the team to work their amazing talents.  When the situation was hopeless for the patient, he would simply say “okay, thank you everyone, but stop now.” And a very respectful quiet would come over the ED.   You could see in him respect for every patient, every time.  So, sending my utmost respects to each and every family touched by Dr. Trunkey.  Forever a giant in the world of medicine, military, and humanity.”

My deepest condolences to your family.  This is a loss beyond measure.  I have lost both my parents and my son, Rory passed in 2012 from heart failure.   I understand where your hearts are now.  Please know how admired, respected, and appreciated Dr. Trunkey will always be.