22 OCT My selection bias

Good morning, Friends!

Hope today finds you well. It is a beautiful crisp clear morning over Balad. I'm gearing up for three operations on children, all secondary operations to get them closer to a strong enough state to get home or to an Iraqi facility. I find that nearly a majority of the operations I do over here are on children. That is fine with me, I trained in a career where all of my patients would be children if I had the choice. But of course, I have no objections to operating on adults. Striving for health and comfort for anyone is a worthy goal. Still, it seems like I am operating on more children than the last time I was here. I used to do 2-3 operations on children each week, now it seems like I do that many each day. However the scientist inside me says don't judge by impression, measure the data. I'm sure I do more operations on children than my peers do. This is because I seek out the cases on children, and my friends seek me out to do the operations on children. Ah, well, I'd gladly give it up if security improved and we could be out of the injured baby business.

I love to take care of children because they get better so fast! Just as I expected, the boy who got rid of his colostomy has done well. This morning, he had gotten out of bed to go to the widescreen TV to watch some football. He gave me a big smile when I greeted him. Now don't you believe it that you or me would still be whining the second day after a big belly operation! Our interpreter gave us the good news that he was "passing gasses." This is a big deal for surgeons. After an operation it is if the world turns on this question. How indelicate to be stuck in a hospital, sore from your operation, and every morning at an obscenely early hour a cluster of doctors comes in to ask you if you are passing wind. Such is the world of the surgeon's patient.

I passed by the darkened isolation room where the boy with severe burns died last week. I suppose I'll always see a fleeting image of him when I pass those windows. I proceeded on to the room of the other boy with burns. He is gaining strength every day and his skin grafts are taking like new sod in springtime. Two days ago I did his first dressing change after surgery to check his progress. His nurse had given him a sedative and pain medicine to make it easier, but he still looked up at us with fearful eyes and cried. The interpreter confirmed my impression that he wasn't in pain, but was just scared. One of our airmen strolls around the wards playing a guitar and singing. (It's not his official job, just a pleasant side benefit!) The nurses asked him to play outside the room while we changed the dressings. First he played "Hotel California", one of the interpreter's favorites. Not the most encouraging song for an impatient. Then he moved on to "I want to grow old with you" by Adam Sandler. It is such a pretty song, and I couldn't help murmuring along "I'll even let you hold the remote control." Another association my mind will always cling to.

Today we got this boy back on his feet. He stood crouched over like a catcher, too fearful to stand up straight. Bit by bit we coaxed him to an upright position. He took a few halting steps and stopped crying. I'm hoping to have him back in the nurturing circle of his family again soon. There are obstacles. I asked his father if he had a bathtub. No. I asked him if he had a reliable source of clean water. No. I am very fortunate that I have the backing of my commanders to continue this intensive burn treatment until I know the boy will be safe at home.

I've got to go prepare the OR for another skin graft I'm about to do. It's been nice to talk. Hope you have a great day!

V/R,

Chris

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

DSN: 318-443-2925

christopher.coppola@blab.centaf.af.mil