When you spend your life in trauma, you learn one thing very quickly: if you try to be a lone hero, your patients will pay the price. The hardest problems in surgery and critical care are team sports. That is as true in a combat hospital in Afghanistan as it is in a university trauma center in Oregon.
That reality was front and center for me at two recent meetings: the 181st Meeting of the Society of Clinical Surgery in Rome and the 3rd Annual Neurotrauma Symposium, where we wrestled with the stubborn problems that keep traumatic brain injury trials from succeeding. In both settings, it was clear that the biggest breakthroughs are not coming from the loudest individual in the room, but from groups who are willing to share data, share credit, and occasionally share jet lag.
Rome is a good place to be reminded of the power of collaboration. You cannot walk five feet without tripping over something built by a lot of people over a very long period of time. The Society of Clinical Surgery meeting had the same feel, just with fewer marble statues. The conversations ranged from surgical innovation to system-level performance. What struck me was how often we landed on the same idea: no single center can generate the kind of evidence we need for modern trauma care. We need multicenter studies, shared protocols, and a little humility about our own anecdotal experience.
The 3rd Annual Neurotrauma Symposium took that theme and made it very specific. Traumatic brain injury is notoriously difficult to study. Two patients can arrive with similar scans and walk out with completely different futures. The timing of intervention is critical. Measuring meaningful recovery is complicated. On top of that, the very patients who are most in need of better treatments usually arrive unable to consent to a trial. If it sounds messy, that is because it is.
Sitting in a room full of neurosurgeons, trauma surgeons, intensivists, emergency physicians, statisticians, and military colleagues, I found myself having flashbacks to deployment. In a combat support hospital, you learn quickly that you cannot fix a severely injured brain with a great operation alone. You need the pre-hospital medics who stopped the bleeding, the anesthesiologists who kept the patient alive through the rough parts, the nurses who will catch the first subtle change, and the rehab teams who will carry the baton after the ICU. Clinical trials are no different. If the neurologists, surgeons, pre-hospital teams, and trialists are not aligned from the start, the study is in trouble before the first patient is enrolled.
One of the most productive parts of the Neurotrauma Symposium was not a flashy new drug or device. It was the discussion about how we design smarter trials. We talked about using more adaptive designs, harmonizing data elements across centers, and combining biomarkers, imaging, and functional outcomes so that we are not pretending a single score tells the whole story. It may sound less glamorous than a miracle therapy, but without good trial design, even the best idea will quietly fail.
These meetings also reminded me how important it is to bridge military and civilian worlds. Many of the concepts that now feel routine in civilian trauma care were stress-tested in war: tourniquets, whole blood, damage-control resuscitation. At the same time, the military learns a tremendous amount from civilian centers about imaging, long-term outcomes, and rehabilitation. If we keep those domains in separate silos, we waste hard-earned lessons on both sides. If we connect them, a young soldier in a faraway place and an older driver on a highway at home can benefit from the same shared knowledge.
After a few decades of this work, I have come to appreciate that collaboration is not a buzzword. It is often the difference between a promising idea and a practice-changing standard of care. It is the difference between a beautiful single-center publication that no one can reproduce and a body of evidence that actually changes guidelines.
So when I sit in a lecture hall in Rome or at a neurotrauma meeting closer to home, I am not just listening for the latest therapy. I am watching for the networks that form in the hallway, the investigators who decide to pool their data instead of guarding it, and the younger surgeons who realize that the most powerful phrase in academic medicine might be, “Let’s do this together.”
In the end, my job has always had a simple goal: give trauma patients, whether they are warfighters or civilians, the best possible chance to live and recover. I have learned that the shortest path to that goal is rarely a straight line, and it is almost never a solo run. It is a crowded, occasionally chaotic, always rewarding journey that we make as a team. And if we get the collaboration right, our patients will never know how many people it took. They will just know they made it out of the trauma bay alive.
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