19 SEP 2007 Surge and Sustain

Hi, All!

Hope that you all are doing well. I haven't had much of chance to write lately. First we had a surge in wounded patients, then the Morale, Welfare, and Recreation Internet connection went down. In spite of this, morale is good. We are working hard, but getting good results, and it is rewarding to be part of an effective team.

Yesterday, I was hanging around the PLX desk: that is the pharmacy, laboratory, and X-ray desk. This is a name that carried over from the old tent hospital, because the surgeons used to hang out at the intersection of these three areas. Now, in the new brick and mortar hospital, these areas are more spread out, but the surgeons desk has kept the same name, PLX. As I mentioned, it's also the unoffical information desk of the hospital because everyone comes up to us and asks where the bathroom is.

We heard the announcment: "Seven incoming wounded from an IED attack". And IED is an Improvised Explosive Device, and the term refers to any variety of bundled explosives and dangerous fragments that are buried, thrown, or even carried into an area by a suicide bomber. The medical team began to gather in the Emergency Room. There were troops from the outgoing staff mixed with new members like myself. There was quite a crowd of nearly fifty people. ER doctor J. divided the crew into teams and assigned them to the different beds around the emergency room.

The helicopters started landing and unloading patiets. The first dropped off two elderly women covered head to toe in black gowns called burkas. Both had bandages on their face where shrapnel had cut their skin and eyes. I started examining one of the women with surgeon M. who had just arrived the night before. She struggled to keep us from uncovering her as we looked for injuries. Our translator, a woman from the U.S., assured her that she was okay.  Besides the injuries to her face, she was peppered with small fragments of metal up and down her body. There was a large open wound on her leg and we could feel no pulse in her foot. We were concerned that one of the metal fragments had injured the artery that supplied blood to her leg. After some medications for pain and some x-rays, M. and I took her to the operating room as the other teams cared for an additional six patients arriving from the scene of the attack.

We set to work on her leg while orthopedic surgeon S. repaired another wound on her hand. Back home, M. is a vascular surgeon and was well prepared to find and examine the artery in her leg. The wound in her thigh was a small crater, and we found the artery at its base. The artery was not injured, but when we checked the blood flow, it was sluggish and slow. Using a video x-ray, we checked the blood flow to her foot, and there was no blockage. But when we injected the fluid that filled the artery up to her belly, we saw on the screen a small fragment of metal and a blockage in the artery high up in her groin. We opened her skin at the groin and found the artery at that location. The metal fragment had nearly cut the artery in half, and a blood clot was blocking the vessel. The fragment had entered the skin at her knee and had traveled all the way up her leg to the groin. We repaired the damage to her blood vessel with a small patch of her own vein. As our ophthalmologist began to repair her eye, I felt her foot and detected that a normal pulse had returned.

It was a relief that we were able to help her. The new hospital staff had responded strongly to their first challenge. Of the eight patients who had come to us, six of them needed operations. As evening came, we finished the last of the operations. The wounded men and women were brought to the intensive care unit to begin a slow recovery. It is offensive that civilians, and old women at that, should have to bear the risk and pain of these injuries. War has no care or respect for the wisdom of our elders. I think of my grandmother at home, whom I miss very much, and I can't bear the thought of her having to experience such a thing. No one's grandmother should.

I had missed the departure for team dinner. That just meant there was a little more room in the trauma chief's truck on the way to the dining facility. I grabbed a big plate of mystery meatloaf and chicken cordon bleu to make up for a missed lunch. I wandered over to the physical training facility for a workout. During my lunges, the Alarm Red sounded and we all hit the deck. I heard the attack helicopters thunder off to investigate. We waited a while but heard no impact. Fortunately these alarms are rare, and it is even more rare for anything to get hit. We are a strong and well defended base, and one would be more likely to get a sports injury than anything else.

That day ended and a new one came. I'm still here. This morning I visited the woman on whom we had operated. I felt her foot and there was a strong full pulse that seemed like it was there to stay.

LTC Christopher P. Coppola, USAF
332 AEW/EMDG/OR
APO AE 09315-9997

Christopher.coppola@blab.centaf.af.mil

DSN 318-443-2925