There is a brief pause in the action. We have been operating constantly since 0730 this morning. Now it is 2100. We know the reason, vascular surgeon M. is on call. He always has the busiest days. He has a black cloud hovering over him. He brings the rain. Monday we are on call together. I hope my karma overpowers his stool magnet.
I just finished an operation on a boy who stumbled into a fire. His house is a painted mud hut. There is a central cooking fire on the dirt floor. His father told us that they were burning leaves in the fire pit when the boy's clothes caught on fire. He is burned over more than half of his body. It is difficult to keep someone with such extensive burns alive. Perhaps if he was in a burn center he would have a better chance, but alas he is not. He is here with us. We will do our best.
Whoops! I have to restart this letter to you. Now it is 0200 on 12 OCT. We had the sudden arrival of seven injured patients. They ranged in age from a boy less than a year old, who cried loudly as we tried to get a working IV in his arm, to a woman over fifty with shrapnel in her belly and leg. All of them had multiple fragments embedded in their bodies and required many x-rays and operations. I just got out of a four hour operation on the woman over fifty. It was a snap to fix the hole in her stomach, but it was a frustrating grind fixing the artery behind her knee. The artery is hidden there in a little tunnel and small veins wind around it like the insulation in a coaxial cable. The fragment had torn holes in both the artery and the vein and I assisted Vascular surgeon M. as he worked intently until the bleeding was controlled. I'm tired and I need a shower.
The two boys with burns that I am caring for really have me worried. Their care is very complicated and is requiring much expert care from many members of the team. I know how hard the nurses are working to get them well. Tomorrow I will operate again on both of them, like I expect I will need to for the next several weeks. Burns are such misery. It is hard to tend them. It only takes seconds for the burn to occur, and then months of misery to slowly work back to health. Some never make it back.
Demoralizing events occur, but we have to do our best, chin up, and hope for the best. Today, (or rather yesterday, I'm forgetting what time it is) gunmen fired on a bus full of women and young girls. We received many of the injured. Some weren't lucky enough to make it to the hospital. One of the injured was pregnant. This wasn't her first brush with misfortune. She had delivered two other children, but one had died of a brain tumor. Her pregnancy was eight months along, but her husband had been killed seven months ago. Bullets and fragments of metal had pierced her hip and entered the tissue of her uterus. She lay on her side, in pain from the contractions stimulated by the injury. We gathered as much information on her baby as we could; how did the ultrasound look, what was the heart rate. We collected all the help we could find; an Army pediatrician across base in a sick call clinic, an OB nurse working on the ward. We called friends in Baghdad and back home for advice.
After gearing up the team and heating up the operating room, we opened her belly and looked for damage caused by the bullet. The tissue of her uterus was bleeding and she was leaking urine. I carefully opened her uterus, releasing the waters. I felt her baby's head and quickly unwound the umbilical cord from where it was wrapped around the neck. The baby quickly slid out of her womb. My partners Urologist S. and Thoracic Surgeon J. helped cut the cord and I brought the baby over to where Pediatrician S. was waiting with E.R. doctor J. The baby was a beautifully formed boy, with rich brown hair and covered in a waxy coating. His skin was a frighteningly purplish hue. We cleared out his mucus, warmed him, jostled him, wiped him down, and pumped puffs of oxygen into his lungs until he drew breath and gave his first cry. With some grunts and a stream of oxygen across his face, pink color spread across his skin. We bundled him into a makeshift incubator fashioned from a crib wrapped with food service cellophane and heated with a hose from a warm air blower. His mother required more work in the OR to control bleeding, but was able to make it to the intensive care unit, heavily sedated and on life support a short time later.
The successful arrival of a baby was such a heartwarming and encouraging event in our little hospital. It seemed like nearly everyone drifted by to sneak a peek-a-loo. The lucky bedside nurses got to feed him his first meal, which he took well. We fussed over his numbers and vital signs. We scowled over complications that might occur and brainstormed for stratagems to ward them off. He seemed to pay our worries no mind. I rushed back to my hooch to bring him a blue receiving blanket that M. had knit and sent with me to Iraq in case a baby might need to be warmed. His freshly cleaned tiny features are a calming precious beauty in our utilitarian combat support hospital. If he can emerge safe from such a horrible event, perhaps there is hope for even better days to come.
Waiting for that day,