13 NOV 2007 Coming around again

13 NOV 2007 Coming around again

It is so good to have a chance to sit down and write. It is 2230, and much of the work is done for the day. It has been a bit busy today, and even though we are done with our operations, the new patients need a few details checked here and there. Such is the nature of medicine. You can never quite finish, there is always one or two tasks down the road. People aren't static, they change as time goes by, and someone who looks comfortable and well now, might be in trouble later. I am on call as Laparoscopic surgeon S.'s backup tonight. I've gotten a reprieve for the moment, but he will call if more trouble comes up.

A few days ago, we returned to the hospital from our family dinner in the DFAC to find two Stryker vehicles parked in the the hospital lot. Being the boys we are, we immediately jumped from the bed of the Czar car pickup and ran over to check them out. The Stryker crews were relaxing behind the vehicles in the cool evening air. Strykers are eight-wheeled armored troop vehicles that provide an easily transported, heavily armored vehicle with high speed and a wide range of weaponry. We introduced ourselves to the crews, and they were kind enough to let us check out the vehicles. The armor makes the inside a bit cramped, but it is amazing to see the array of technology on display to assist with networking and tactics. The crews were picking up one of their teammates who was at the hospital.

It is always so enjoyable to learn about another troop's area of expertise. These men were young, even the commander, but they clearly had a high level of professional knowledge about their platform and their mission. It is also great to meet other troops, find out where they are from, and talk about news back home. News may travel fast in this electronic age, but it still is a thing of value to hear the first person account from a brother in arms. It is a different world for troops who go outside the wire and risk their lives every day. They have a closeness because they are literally defending each others' lives every minute. The crews described their techniques and protocols for dividing the responsibilities of surveillance and defense. As they spoke it was clear that they relied on each other to each be an interlocking plate in their armor. It is similar in the way we surgeons rely on the anesthesiologist and nurse to work with us as a team, but there is a world of difference in the fact that we are safe from harm.

Today started calm. We have been taking care of a middle-aged woman who was shot with an AK-47. The bullet injured her internal organs, damage which we have repaired, but when it exited her body, the bullet left a crater of missing muscle and skin. After several operations to clean and prepare the wound, today Orthopedic surgeon H. and I finally got that wound shut. She isn't well yet, but she is one step closer.

Soon after, we heard the call "Trauma code in the ER, times (redacted), five mike." This meant that there were (redacted) injured patients arriving in five minutes. People from all walks of the hospital gathered in the ER. There were medical technicians, nurses, emergency medicine doctors, pharmacists, x-ray technicians, surgeons, administrative personnel, and others. Minutes later the Blackhawks began to land, and our technicians and volunteers wheeled the patients into the waiting bays of the ER. The casualties were US troops. They were the very men who had visited us in their Strykers a few days prior. They had been accomplishing an important mission when they were injured in action.

It was definitely a shock to see these strong, young, highly trained professionals bloodied and vulnerable. The medics had done an excellent job delivering skillful care and rapidly transporting them to our hospital. We worked urgently to give them the treatments they each needed.

One troop had lost blood and required a transfusion. We made the decision to call a whole blood drive. The troop's blood type was checked, and an announcement was made requesting volunteers to donate blood. Even though his blood type was uncommon, we immediately had more troops than we needed stepping up to help this person survive. I was involved with the required operation. I leaned heavily on the highly specialized skills of my fellow surgeons and other teammates. We worked in unison, even as we brought different perspectives to the care. The troop made it through the operation.

A brief lull was shattered by the call that six more trauma codes were en route to the ER. We regrouped in the ER to ready ourselves for the next wave. Across the radio crackled the information that an Iraqi troop transport carrying (redacted) troops had crashed. Some victims were seriously injured and they were en route to our hospital. Over the next half hour, the airspace above our helipad became a Blackhawk parking lot. Helicopter after helicopter landed, eventually leaving (redacted) soldiers entrusted to our care. We worked furiously to ensure that the worst injured were treated first. I saw Urologist S. managing several patients in one end of the ER, directing a team of nurses and technicians to ensure that none fell through the cracks. Patient by patient we inserted intravenous lines, performed diagnostic tests, and brought some to the operating room for procedures.

The men were in pain from broken ribs and other injuries. Some spoke limited English. Our capable Arabic interpreters flitted from bed to bed, helping translate wherever they could. I approached one man and used my limited Arabic to find out where he was hurting. I readied an ultrasound machine to examine him for internal bleeding. When I spread the ultrasonic conduction jelly over his belly, he protested loudly, pushing my hands away and covering his skin. I gathered that he mistakenly thought that I was about to open his belly with him awake. It is a hurdle to treat a person when obstacles to communication prevent me from building trust by preparing them for what is to happen next. Fortunately the injured soldier next to him spoke enough English to help me communicate that I was not going to cut him open. I was pleased to find that there was no sign of bleeding on the ultrasound examination.

Typical of blunt trauma, (what happens when a person is bounced around in a car crash), there were few men who were injured seriously enough to require an operation. Man by man we got them settled into the appropriate section of the hospital. As the evening drew on, we filled in the remaining gaps, checking an x-ray of a sore leg here and changing a bandage that had soaked through there.

We were put to use today. What more could a body ask for. We'll start over again tomorrow.

Best wishes,

Chris