In trauma, unpredictability is not an anomaly, it is the environment.
You can be as prepared as any human being possibly can be: your drills rehearsed, your team aligned, your mental model sharp. And then a case arrives that does not behave the way you expected. A physiology that collapses sideways. A wound that hides its true depth. A situation that bends away from everything you predicted.
It dips. It deceives. It curves.
And in that instant, many freeze. They tell themselves this is unfair, unmanageable, outside the boundaries of what they trained for. But we must remind ourselves of something essential:
A curve ball is still a ball.
The laws of physiology have not changed. The threat is still approaching. The patient is still salvageable. What matters is not the strangeness of the trajectory but the readiness of the person trying to catch it.
Trauma Favours Those Who Train Their Reflexes
Good reflexes in trauma are not a divine gift; they are earned through exposure, repetition, and the willingness to engage with cases that scare you. They come from watching physiology closely, seeing patterns where others see noise, and learning how to respond even when your internal alarm bells are ringing.
Curve balls in our world arrive disguised as unexpected bleeding, silent hypoxia, missed injuries, abrupt deterioration, or that moment when everything you planned becomes irrelevant. They ask a single question:
Are you anticipating, or merely standing at the table?
You will never have perfect information.
But you can be perfectly ready.
The Bravery of Acting When You Cannot Be Certain
I often tell trainees this:
It is better to act boldly and adjust than to hesitate and drift.
Because in trauma, hesitation is its own form of injury.
Every decisive action teaches you timing.
Every misstep deepens your judgement.
Every attempt signals that you are still fully engaged in the fight to save a life.
Fear convinces clinicians that the consequence of action is failure.
In truth, the far greater danger is paralysis, the quiet, insidious erosion of clinical courage. A misjudged intervention can be corrected.
A lost moment cannot.
The Regrets That Stay With You
Anyone who has worked long enough in this field knows that the memories that linger are not the interventions that failed despite our best efforts. We mourn the things we did not do. The incision we delayed. The call we avoided. The deteriorating physiology we convinced ourselves was stable enough for “one more minute.”
Regret in trauma rarely comes from trying.
It comes from waiting.
Action, even imperfect, carries intent and hope.
Inaction invites regret, and regret in trauma is a weight that does not lift easily.
Stay at the Table
So, when a case curves away from everything you expected, do not step back. Do not resent its trajectory. Do not convince yourself that unpredictability is unfair.
Track it.
Adjust to it.
Act.
Miss if you must, but act with intention.
Because as long as you are willing to stay at the table, to meet the unpredictable head-on, and to respond with courage rather than hesitation, you remain a clinician who can change the outcome.
Every curve ball is still a ball.
And in trauma, the game is won by those who refuse to step aside when the unexpected arrives.
