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.