The emergency department serves as a socioeconomic barometer for trauma surgeon Heidi Lee Frankel, M.D. When the economy slips and community morale declines, shootings and stabbings increase.

Although violence is not as frequent now as it was in the 1980s when she began her training, Frankel has seen the relationship between poverty and violence from the vantage point of the trauma service in inner-city hospitals in Baltimore, Washington, D.C., Philadelphia and now New Haven. Guns are commonplace, and young people are “living their whole lives saturated with violence in movies and on television. Violent behavior therefore becomes an acceptable way to interact with others.”

For Frankel and her colleagues, caring for victims of that violence, or of an accident, is guided by a protocol that is “burned into your brain.” It goes like this: ABCDE, or Airway, Bleeding, Circulation, Disability (check for neurological signs) and Exposure (undress the patient to uncover undetected problems).

Frankel, 41, did not expect to thrive in the trauma ward. Early in surgery training, during her residency at Sinai Hospital in Baltimore, she was required to work for a month in shock and trauma medicine. She remembers telling herself: “Thank God it’s a short month. I’ll be done with this soon, and I’ll never have to do this again.” By the end of that short month, “I knew what I was going to do for the rest of my life.” She’d discovered that she loved the pressure. It’s not that she’s normally an “adrenaline person.” She laughs, saying, “I have a tame life outside of the OR.”

Frankel said seeing the results of violence and accidents affects her in two ways. First, she would never consider endangering others or herself by drinking and driving or neglecting to wear a seat belt. And yet working in trauma reminds her that life “is sometimes capricious. … Every day is precious and every day something can happen to you that can dramatically alter the way you live your life.”

Frankel came to Yale from the University of Pennsylvania three years ago to head the surgical intensive care unit where she spends half her time, and to participate in trauma and emergency general surgery. She works from 50 to 100 hours per week, including one or two overnights. Despite the long hours, her schedule is predictable. “University surgery is very female-friendly because of that lifestyle potential,” says Frankel, who is married and has three stepchildren. She finds time to study jazz dance and to read, particularly contemporary Japanese fiction.

Frankel’s research focuses on improving performance and safety in the intensive care unit. She has found that routinization improves safety. “If we can view our life more in a corporate way, as an assembly line of things we have to do to a patient to get them out of there—not to dehumanize them—but if we can control all the steps in a systematic way, we can minimize errors.”

All is not traumatic in the trauma bay: Frankel met her husband there. Now pastor at Trinity Lutheran Church in Milford, the Rev. John Plessner served as a chaplain at the Hospital of the University of Pennsylvania.

When she witnesses tragedy at work, Frankel discusses it with her husband. “There aren’t always answers: Why was this patient injured? Why did this patient die? … It helps to know that everyone has these questions. There’s comfort in community.”