26 OCT Doggy cologne
It's Friday night, and I'm plugged into V.' MySpace site listening to "Cryin' in my Keyboard." Dude, did you have any idea how accurate that song was when you wrote it? There are a few patients in the OR with broken bones and the Orthopedic boys are pretty busy. Things move along here in Balad, and each sunrise imitates the prior one. They're all made out of ticky-tacky and they all look just the same. If I'm not needed at the hospital, I might bike down to the Sustainer Theater and catch "30 days of night." I should have a easier time dodging HMMWV's and Pathfinder's since I put a new headlight on the bike: "El Sol". It doesn't quite live up to it's name. At least I don't have to slap it back on after every bump like I did for the Pelican.
As usual, good news follows the bad. My patient who has had trouble with leaking from the repairs I have done on his intestine had more signs of leakage yesterday. The poor man has gotten so thin that he is little more than feathers over bone. We are working hard to get some good nutrition into him, but he heals slowly. At least he is still here. It is so hard to be patient when I want him well today! Now! I am cursed with impatience. He is usually sedated for comfort, but in his moments of lucidity he seems calm but bewildered at his predicament. I don't think a young man, even one in war, imagines that he would be trapped in a hospital bed, fighting for survival and troubled by tubes and wires throughout his body.
He reminds me of a little man I am hoping to treat in the upcoming months. He was born with an infection and needed a stoma bag to survive. In the many months since his birth, he hasn't put on much weight and you can see the bulges of his joints through his thin brittle skin. With the expert help of our dedicated Nutritionist S. we have sent him home with his father to be fed daily supplements and vitamins. It's been a few too many weeks since I've seen him and I'm starting to get nervous. In that time Nutritionist S. has enthusiastically tracked down other nutritional alternatives to give him the best chance to grow.
It is amazing how little we surgeons do. The amazing body does all the work. We may stitch a thing or two together, but with out the body's hard work delivering nutrients, trucking away waste, and defending against infection, nothing would ever heal. Be cruel to it or treat it kind, it's an extraordinary machine. That is why it is so frustrating and I am so powerless when the body is failing. I can only hang in there patiently and try to get the roots to take.
I did promise good news so I won't abandon you before delivering it. My little fried with the burns from his waist down is almost well enough to leave our nest and return to his home. His father has been doing his dressing changes, and we reduce the size of the dressing every day. More and more of his skin is healing over with shiny new waterproof intact skin. As the leak from his wound decreases, he grows stronger. His boggy swelling has all but disappeared and his appetite is growing. He still walks hunched over like a timid Yoda, but I think he just remains a little frightened. Nothing will be better than getting him home where he has to get off his butt and cross the room to reach his toys or dinner. It clears a cloud of fear and doubt from my heart to see his health returning. Once again, I did little. It was his extraordinary machine of a little boy's body that effected the miracle.
After I talked about the base's military working dogs, a friend offered to send over some sweet doggy treats. I didn't think they would allow it, but I promised to get a definite answer. While I was caching, I passed the Provost-Marshall's with the kennel next door. I stopped inside and was faced with a locked door and a smoky window. Suddenly I heard a voice that emanated from the ceiling, like the narrator in the Muppet Show's "Doctor Bob" skit. Like Dr. Bob and Nurse Piggy, my eyes darted around the little anteroom, searching for the source of the voice. "Where are you?" I asked.
"Behind the window" came the reply "we can see you and hear you."
I looked to the smoky window. I approached it closer. I pointed at the window and raised my eyebrows questioningly.
(as a brief aside, each time I append an adverb to a noun, I think of the old Tom Swift and Nancy Drew books with their unmistakable style. Unfortunately, I can think of no other way to express this. I raised my eyebrows, stared where I thought the speaker must be and tried to display a question in the features of my face, questioningly.)
"Yes, that's where we are. Now what do you want?" Now that I had my bearings I could tell that the man's voice was emanating from a gap filled with loose foam that ran under the width of the smoky window. On further examination I noted a sign handwritten in Sharpie to the right of the window that read "We are behind the window. We can see you and hear you."
I did my best to explain that I wanted to find out if a friend could send a care package of snacks to the military working dogs. The MP opened the window, revealing a fresh young face framed in close cropped reddish hair. He didn't know but he would call the kennel master right away, if I would just wait in the chairs.
Moments later a German Sheppard bounded into the room, leaped up to place his paws on my knees and began licking my face. She was such a friendly and excited dog, but I could tell by the bits of grey on her snout that she was a few years old. The kennel master, officer R., a seaman, followed quickly behind. As I expected, the dogs were on a strict diet but he was very appreciative that someone would want to give the them a little thank you from fans back home. He offered to email pictures but I told him that I was happy to do so since I had my camera on me.
I had so much fun playing with I. She was very friendly and affectionate and she made me realize how much I missed our standard poodle, L., back home. Of course when I talk to M. I hear that he is misbehaving, as you would expect an adolescent poodle would. He can be a real pain in the tookus, but I realized how much a part of the family he has become. Even though I biked home with a ripe bouquet of doggy cologne, I was happy to have a little puppy play time. It will be so good to be back with the whole family, regardless of species!
I track my progress toward homecoming on a Excel pie chart called the "Donut of Misery." Today I popped it open and it displayed "33% done". How fast it all passes! I will be very happy when only a little sliver of the donut remains and I can shake the dust of Balad from my boots! 'Till then, there's work to be done.
Over and out,
PS the Guy Raz NPR three part series on our medical system has come out if you are interested in learning more about how we care for injured troops.