10 October 2007

10 OCT You're never fully dressed without a smile

10 OCT You're never fully dressed without a smile

Morning, all. I got off easy last night and did not get bombarded by too much work. Still, I don't rest as well during my call nights. If I am busy, that's easy, I just flow to and from from the operating room, working on one after another. When nothing is happening, I drift around the hospital, looking for trouble. Is there anyone in the ER? Have any Blackhawks radioed in? I visit postoperative patients in the ICU and see if their wounds or drainage bags show any signs of infection. I visit the interpreters to hear news of the surrounding towns. Usually I'll settle down for a movie or a three hour chunk of sleep. Of course, my hooch will never be home, but after the call night is over it is a quiet place to lay my head and forget the hospital for a few turns.

The toughest operation we did last night was work on an Iraqi policeman. He had been injured by shrapnel from a suicide bomber. One large fragment had entered his belly, tore holes in his intestine, and came to rest in the plump veins in front of his tailbone. When he rolled into the ER, he waved his arms about aimlessly and scanned the room with wide panic-stricken eyes. He appeared tired and his speech was confused. A small blob of fat protruded from the hole in his belly. His pulses was diminished and he shifted weakly on the NATO gurney.

We quickly transferred him to the OR where the anesthetist sedated him and placed a tube in his throat. As we prepared his belly for surgery, the team flushed bags of fluids and donated blood into his veins. Vascular surgeon M. and I widely opened his belly. A half a gallon of blood spilled out onto the sterile sheets and my boots. We quickly controlled this bleeding by bundling bulky cotton pads into his belly. We used a surgical stapler to close the multiple leaking holes in his intestine. He was starting to get cold which is dangerous. The cold would prevent his blood from clotting. After placing a watertight dressing with a drainage tube over the hole in his belly, we delivered him to the intensive care unit where he could be warmed and given more fluid.

Before and after that excitement, there were only gentle waves of activity in the hospital. Nurses and techs went from bed to bed giving patients the frequent gentle treatments that ensure that they will survive. We held a brief excercise to prepare resources in the event of a sudden surge in new patients. Surgeons S. and E. grilled bratwurst stewed in near-beer and onions. The brats were a gift the aeromedical evacuation team had brought from Germany. The company of surgeons headed out to the DFAC for dessert after offering to bring back a snack for the on call team.

So, after my sedate evening, we rounded and I presented the new patients to the team. There was a woman with some intestinal bleeding, a man with an infection in his injured eye, and others. Then I started the scheduled operations of the day to be done before I headed back to my hooch for a spell.

I'd mentioned before that I was treating a boy with a burn. He is five, and a week or so ago he stumbled into a cooking pot with boiling water that was on the floor of his family kitchen. He has had a rough go of it. I bring him to the operating room each day to scrub dead tissue off of his burns to prevent infection. Yesterday we were able to make a step forward in his progress. While he slept deeply under the anesthetic, surgical oncologist J. and I used a long blade to shave layers of dead burned skin off of his back, and then placed thin lacy slices of his own unburned skin over the wound. We stitched the healthy skin in place and covered it with a secure bulky dressing. I will see how well it is healing in four days. The new skin is like sodded grass on a bare lawn. It needs protection and hydration for a bit for the roots to take. Today I operated on him to once again scrub clean the burns elsewhere on his body. He knows me too well now and cries out for his father whenever he sees me coming to get him. Each day I work on him, I silently salute the nurses at specialized burn centers who treat severely burned patients day after day. It is emotionally demanding work.

Next I looked inside the belly of the man who had been injured by the suicide bomber. The bleeding had all but stopped. he was warmer, his hydration had improved, and his remaining intestine looked like it was healthy enough to survive. He will have a few more operations at our hands to get him all connected, but I feel he has made it over a serious obstacle by surviving the night.

Time in the OR is golden. No matter how tired I am, I feel fully focused and engaged. My mind works faster than my hands as I soak in the condition of the tissues, note the time elapsing, and do the calculations to search for the best choice of many possible treatments. I am a member of a skilled team; we work in concert. Staring down at a bloody incision isolated in a border of bright blue surgical towels holds the longing for home at bay. I forget how far I am from my family and gladly throw in my efforts to try and get one more out alive.

After surgery, there is more time, and my heart and thoughts return to my dear ones, so far away. I take great joy and satisfaction in getting this chance to rub shoulders with such incredible colleagues, but I will be marking time until I get home. M. sent me something to help when it is tough to smile. It's a smile on a stick. It looks a little sinister to me, like a carnival clown, but I supopose it will do until I can find my own a little easier at home.

Sleep well, I sure will today!


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