28 OCT 2007 Needle in a haystack
Good Morning, all!
Hope life is good back in the world. I'm about to start an operation on a man who was injured when an IED exploded. Pieces of shrapnel flew into his body and he was burned over his exposed skin. Some of my colleagues operated on him two days ago to control his bleeding and stabilize his broken bones. My work today will be to give his wounds a good cleaning and to try to get the muscles of his belly put back together. It is a good sign that he has survived two days.
Anything reported to us from outside the hospital is a lie. This man is currently under guard. Maybe he was innocently proceeding down the street, and inadvertantly detonated the IED. Perhaps he was laying a fatal booby trap for our troops or some civilians going to religious services and erroneously set off the bomb as he was placing it. I don't know and he isn't talking, so he remains under guard. Anything reported to us from outside the hospital is a lie. This rule is true at home too. "Honest, I only had two beers." The stakes are much higher in a war zone. "Honest, I wasn't planting an IED." In the meantime, we will do our best to doctor and nurse him back to health.
One of the fragments embedded in his body was a three foot long peice of rebar. If you don't know what rebar is, it is the bristly spikes of steel that stick out of partially formed concrete structures you see as you drive down the highway. It gives concrete structures an internal skeleton to make them more durable. When I used to do fence and pavement work we would occasionally use it in some of the footings we poured. It is tough heavy stuff, as big around as my index finger. It is textured with a pattern of spiraling ridges so that the cement has something onto which to grab. In the explosion, a piece of rebar was shot through the muscle and bone of this man's thigh and twisted into the shape of a lightning bolt.
In the operating room, the team had to cut one end of rebar from the back of his leg to be able to pull out the other end that protruded from the front of his leg. They used what we used to use on construction sites, an abrasive disc cutter. An abrasive disc cutter looks like a chainsaw, but has a large circular abrasive disk made out of metal and composite that can cut through steel. It's the method Angle-Grinder Man uses to remove a Denver Boot without the key. As the cutter ground through the rebar, it threw a shower of sparks onto the patient and the arms of the operators. One team member was tasked with holding a metal shield over the man's genitals to keep them from being injured by the saw. Each time the saw blade hit the shield, it would emit a high pitched whine and vibrate the shield.
Once the rebar was divided and allowed to cool, it was easy to remove the remaining piece from his leg. It was the same as cutting the barb off a fishhook and removing the remaining wire, but on a grander scale. The bleeding muscle was treated and the ends of his broken thighbone were aligned with metal pins and a frame. He required treatment for other injuries on various parts of his body, then returned to the intensive care unit. Hopefully we will get him another step closer to well today.
Earlier today, I removed a retained bullet fragment from a soldier. It had been there a couple of months and was rubbing on a nerve. Usually we can leave all sorts of shrapnel in people because the body makes a tough wall around it. They usually cause them no worry at all. However, every once in a while, the foreign object stirs up some reaction and causes misery. It was tough to find the elusive piece of metal in his tissue. I had an x-ray to guide me, but I eventually found it by poking him with a needle and feeling the scratch as I made contact with the metal buried beneath his skin. Once found, it was quickly out. He's none the worse for wear and should be a lot more comfortable when he returns to duty.
The smaller fragments are toughest to find. It's tempting to try and remove them in the office with the patient awake, but I always go to the operating room. Sometimes it just takes a minute, but every once and awhile you find yourself struggling for hours as you hunt deep within someone's foot to find a needle they stepped on six months ago. A dear friend and honored mentor Pediatric surgeon R., taught me long ago never to attempt to take a foreign object out of a child in the office. I was caring for a boy who was playing with BB guns with his friends and had a ball bearing lodged in his forhead. It was right there under the surface of the skin, just teasing me. I followed his advice and did the removal in the operating room. That little ball bearing jogged left and right as I tried to pluck it out, and I was very happy that the child was asleep as I worked. I've since learned the wisdom of his words through experience. Even the the coolest teenager customer can become a wildman when you come at them with the numbing needle.
I've sadly neglected pumping iron in the yard, and am starting to feel small. As big as the embedded fragments are, I don't think they are going to take the place of some gym time. Sure surgery is important, but I think I'm going to have to hunt for some non-surgical steel to lift.
Be well and have fun!