1 NOV 2007 Danger open hole

1 NOV 2007 Danger open hole

My brother D. has the same appreciation I do for creative signage. I know because he has sent some bizarre translations of Thai signs to me in his newsletters. I've enjoy the pictures he sends of twisted translation into English, such as masseuses who proudly advertise "Foot agony here" in front of their establishments. He is a disaster management specialist, and is quite impressive, having written the premier textbook in his field. There were some beautiful examples of bizarre signs in disaster management produced by Ready.gov. This government agency published a set of uninterpretable signs to guide people in an emergency. They have since taken them down, I can only presume from embarrassment, but you can still find them on the Internet with their supposed interpretations.

The HMMWV's that patrol populated areas have warning signs on them in English and Arabic. They instruct bystanders to keep a safe distance away, or not to approach the vehicle because it might be interpreted as a threat. We thought it appropriate that the Czar Car have such a sign. We all pile into that pick-up to head to dinner together. A hungry surgeon, not to mention 10 of them, can be quite dangerous, so the danger is real. Unfortunately, we were directed through official channels to remove the sign. It upsets me because I think the sign was required for public safety, and also reliably gave a laugh to a few groups of soldiers on their way to dinner every night.

We have had a boy in our midst for about a month now. He was shot in the belly and the bullet ruptured his aorta, the biggest blood vessel in the body. He is an "incredible save." "Incredible save" is what we say when by rights someone really ought to be dead. He can talk now that his tracheostomy tube has been removed. He is walking and taking sips of liquid. He is skinny as a rail after a month without a good meal. He has been through near 10 operations, and has skin grafts covering some of his larger wounds. I put tubes through the skin of his belly to remove fluid and to give him liquid nutrition, like baby formula.

Today on rounds, I had a possibly great idea. I won't know if it is a great idea or a crap idea until a few days go by. He was leaking stomach acid out of the hole in his belly. Not only was he losing the nutrition he needed, but he also had a burning sensation like a diaper rash on the skin. This problem, an artificial hole into the stomach that leaks acid, is a frustrating, bang your head on a wall, nuisance to solve. In someone who is just feathers over bone like this young man, it can even be the death of someone. I have tried creams, bags, catheters, and have even resorted to an additional operation to get these holes to close in the past. Anyway, we have these suction devices that suck the fluid out of open wounds and look like vacuum packed sponges. They make wounds heal faster. We have put them on legs, arms, genitals and any of the unlimited variety of places that shrapnel can tear through a body. Today I rigged one up to the hole around the nutrition tube in this boy's belly, and it stuck. I was concerned that it would suck his stomach empty, but when he drank bottled water for me, none of it leaked out. This may be a new weapon in my arsenal against leaking stomach tubes if it works.

When I finished applying the device, his elderly grandmother, who had been silent the entire time, broke out into a long statement complete with hand gestures. I looked to M. our interpreter, who explained that all she had just said roughly meant "Thank You" but included specific requests that Allah make our lives easier by clearing the obstacles in our lives. She has slept by the side of this child's hospital bed the entire time he has been here. I guess grandmas over here feel the same way about their grandchildren as ours do back home.

As I ambled around the hospital, snacking as I always do, I came across a sign I'd never seen before. The doors leading out of the hospital were emblazoned with "Danger, open hole." That was an even better warning for a surgeon than our Czar car sign. I stopped to finish my Suzy-Q, satisfied that the public was sufficiently warned.

Eat well!

Chris