integrity – Don Trunkey

Beyond Friendship by Charles Schwab, MD

It has taken time to write about Don. When he started to decline mentally, it seemed incomprehensible that this great man would come to a disease that would strip away his mind. For it was his intellect that defined Don’s professional life and delivered the influence he had on the world. My father, decades ago, suffered the stages of dementia and Dad’s four-year decline was intensely painful. To know how Don’s remaining years might proceed crushed my heart.

It is difficult to put into words a description of Don Trunkey. For Don Trunkey was in a category all his own—a man of utmost integrity, a person who had all the gifts that could guide, advise and lead during the good times, and especially when paths had not been travelled and answers remained hidden. Dr. Trunkey was the consummate professional: ethical behavior beyond reproach, altruistic to the core, constant intellectual development, committed to his convictions, with superb emotional intelligence and an inability to compromise his values. He was serious and strong, not arrogant, rather humble, and he constantly displayed a sense of enjoyment and fun about life and for the people he served and loved. He was “called” to the profession of medicine and sought to improve the health of others by perpetually elevating the care of the injured. He was a visionary, counselor, leader, physician, surgeon, righteous citizen, patriot, confidante to many and the most impactful trauma surgeon of our time.

I don’t how, why or exactly when Don and I became good friends. Regardless, for some thirty years we were the best of friends. We rarely talked business even though we traveled together a great deal, vacationed with our wives and, if time sped on without talking, with no regard for time zone or , continent, a phone call came about. Our Sun Fun group with Tommy Thompson, Lew Flint and Kim Maul kept the five couples together. Always a gathering in mid-winter, on a Caribbean island and a few rules: no business allowed, great music and entertainment, fabulous meals, and a little fine wine was a part of the glue. These gatherings were hilarious and an annual recharging of the energy cells of our bodies, minds and souls. Don and I were hikers and over thirty years we probably hiked thousands of miles. one on one. Those times were precious. Margie and Jane were great friends and as a traveling foursome, our trips were adventurous and memorable. We enjoyed each other’s company and our senses of humor and love of the comedy in life were lifelong bonds. Many, many tears were shared; most were from laughter, some from sorrows. Friends for life.

I see today what I most admired about Don, both his gentleness and strength, easygoing joy and stubborn tenacity for issues he strongly believed. He was a wonderful older brother, a navigator of my life and gently turned my compass a few degrees, and without my knowing the change in direction was taking place. He was beyond a friend and a precious gift in my life. Thank you, Don.

A Force for Good by Michael F. Rotondo MD

As the pearly gates swung open on May 1, 2019 and Donald Trunkey strode through, head held high, wry smile on his face – I am certain that St. Peter stood, offered a crisp salute and yielded his post. That’s because everywhere Donald Trunkey went, he was, by the sheer power of his personality and intellect, totally, completely and unequivocally in charge. His natural charisma, quick wit and his high-minded values made him beyond formidable. Everyone wanted to be around him. Everyone wanted to be like him. Everyone wanted to be him. He was a force for good.

He was in a category all his own – a man of utmost integrity – I’ve met no other single human being more capable of leading a righteous cause, the right way, for the right reason. Not only did Donald Trunkey change the national consciousness regarding care of the injured patient – and in the process save the lives of thousands upon thousands, he brought generations of surgeons, nurses and medics along with him on the journey. I know because I was one of them. If you were to ask him why, he would have quickly served up a humorous quip and likely never answered the question. But in the exchange, you would have garnered the answer – because it was the right thing to do. He was a force for good.

He had intensity without tenseness and a powerful mind without an ounce of arrogance or guile. When Donald Trunkey spoke, everyone listened. An autodidact with far reaching intellectual curiosity across a broad range of topics, he had the unique capability of captivating those around him with his skills as a raconteur and the practicality of his approach. After having met Donald Trunkey some years before while working with my mentor, Bill Schwab at the University of Pennsylvania, I vividly remember receiving an unexpected phone call from him in 1997. It’s hard to describe the feeling in those brief seconds between the moment my assistant informed me of the call and the moment I heard his voice. But I can still feel it now as I recount the story. It was as if I knew something really important was about to happen. Dr. Trunkey told me that there was a hospital in eastern North Carolina looking for a new Chief of Trauma. He told me that they were sincerely committed to building the center and the surrounding trauma system. They needed leadership and he urged me to go and visit and consider it. He also made it clear that the people who lived there needed help and that the mortality rates were inordinately high for injured patients. With no expectation of ever actually going to such a place, I respectfully followed Dr. Trunkey’s recommendation, interviewed for the job and well, as you might expect, took the leap of faith that he proffered. I left Penn, went to East Carolina University and for the next 14 years, endeavored to follow in his footsteps and change the fate of injured patients in that corner of the world. He was a force for good.

What can we do when these sorts of monolithic characters move on to otherworldliness? How can we express all that they have meant to us? How do we explain to those around us how they have changed our lives and, in this case, saved countless lives? To me, the answer is simple: live as he lived. Do right as he did right. Carry the mantle for those who cannot carry it themselves. And work as Donald Trunkey worked because he truly was – a force for good.

One of my Heros, by Dr. John Mayberry

Don Trunkey, as my fellow surgical resident Brian Gilchrist liked to say, was Lincolnesque. Always a calm demeanor, always a joke or an anecdote ready, and always leading others where they were afraid to go. Like Lincoln he was tall, lanky, and folksy and was raised in a rural environment among family that favored hard work. And like Lincoln, he rose to the top of his profession. I never heard Don Trunkey character assassinate anyone. The most negative thing, and it’s not even all that negative, I ever heard him say about another surgeon publicly or privately, was, ‘He’s an iconoclast’. Some people might even say that’s a compliment! And that attitude of acceptance permeated down from him into the surgery faculty at Oregon. I consider myself very privileged to have trained with him.

From “Mayberry, John. Pioneers, Heroes, Brooders, Surgeons. American Journal of Surgery, 2019, Published Ahead of Print”

The Don Trunkey Years at San Francisco General Hospital by Karen Deveney

Don Trunkey spent 14 years on the faculty at San Francisco General Hospital (SFGH), the last 8 as the chief of surgery. He was an outspoken, confident, and decisive leader beloved by the staff, faculty, residents, students, and patients because of his warmth, self-deprecating humor, fairness, obvious regard for the opinions of others, and courageous stance to defend “doing the right thing”. He never hesitated to take what he felt was the right and necessary step to improve patient care, even if it was politically unpopular or raised the hackles of someone in power who had a secondary agenda to maintain the status quo or simply save money at the expense of the largely poor or minority patients who relied on SFGH for their care.

After he had completed his surgical residency at the University of California, San Francisco, he spent one year with Dr. Tom Shires at Parkland Memorial Hospital in Dallas doing trauma research on cellular function in shock, then returned to join the faculty at SFGH in 1972. At that time the chief of surgery at SFGH was Dr. F. William Blaisdell, who had been a mentor of Don’s when he was a resident and had played a large role in influencing him to follow his footsteps as a trauma surgeon.

Don established his academic research at SFGH on the pathophysiology of shock under an NIH grant and published extensively on the subject, while focusing his clinical activities on trauma and burns. He had learned a great deal about burn treatment while in Dallas, where the Parkland Burn Center was already established as a national model for care of the burn patient. At SFGH at that time, burn patients were admitted to any surgical bed that was open, not ideal for prevention of infection and management of the patients’ sometimes extensive wounds. They lacked, for example, a (hydration tank) or dedicated procedure room for dressing changes. Don wanted to establish a dedicated burn unit, which Dr. Blaisdell agreed would be a worthwhile and important step in improving their care. Unfortunately, Don discovered that the hospital director was opposed to the idea of a separate burn unit for financial reasons.

Dr. Trunkey nevertheless pressed on, identified some empty ward space, recruited nurses for the unit, found an old bathtub to use, and invited the mayor of San Francisco, Joseph Alioto, to dedicate the “Alioto Burn Center.” Dr. Blaisdell invited the famous chair of surgery at Louisville, Dr. Hiram Polk, to give a talk at the dedication ceremony. City dignitaries were invited. Only on the day of its opening did the hospital director find out about it, but it was already a fait accompli, lauded by the mayor and Director of Public Health, who had found funding for it!

When Dr. Blaisdell left San Francisco in 1978 to assume the chair of surgery at the University of California, Davis, Dr. Trunkey was appointed chief of surgery at SFGH. He served in that capacity for 8 years, until becoming the chair of surgery at the Oregon Health and Science University in 1986. Although he was only 41 when he became the chair of surgery at SFGH, he had already achieved international stature as a trauma surgeon due to his research, his publications, and his larger-than-life persona. Just the year before, he had co-authored a landmark study that demonstrated the superior outcomes of injured patients who were cared for in a trauma center rather than a private community hospital without special expertise in trauma. He became chief just as a property-tax limitation measure, Proposition 13, had been passed in California that severely decreased the funding available for public services, such as supporting a city/county hospital for the poor. Fortunately, SFGH had by then gathered such high regard as THE place to go if you were injured, that it was able to survive as an institution. Its survival was in no small way due to the skill, personality, and great accomplishments of its leader.

Over the next 8 years he solidified the importance of organized systems of care in achieving good outcomes for the injured patient. He and a small cadre of his contemporaries on the American College of Surgeons Committee on Trauma (COT) established the Advanced Trauma Life Support (ATLS) system as a mandatory aspect of trauma care and developed a system of certification and verification of hospitals’ ability to manage trauma patients. He served as chair of the COT from 1982 to 1986. He became a director of the American Board of Surgery, President of the Society of University Surgeons, and President of the American Association for the Surgery of Trauma.

Although Dr. Trunkey was required by his many national roles and his growing international fame to travel from San Francisco frequently, he assembled a distinguished and highly capable cadre of surgeons at SFGH, each of whom had gained expertise in the broad range of surgical and medical skills needed to provide the highest level of care for the most critically injured and ill of our society. He continued the research program begun under Dr. Blaisdell’s leadership, but expanded it to include more clinical and collaborative research. He developed the Trauma Foundation as a major force in trauma prevention.

By the time Dr. Trunkey left San Francisco for his position in Oregon, SFGH had been firmly established as one of the nation’s foremost trauma centers and its existence was secure. He left an indelible mark on the institution.

Karen Deveney, M.D., F.A.C.S.

The above remarks are drawn from both personal recollection as well as from the excellent account contained in the book, The History of the Surgical Service at San Francisco General Hospital authored by Drs. William Schecter, Robert Lim, George Sheldon, Norman Christensen, and F. William Blaisdell.