25 NOV 2007 I can almost taste home

25 NOV 2007 I can almost taste home

Well, soon after I last wrote, I went to the hospital. It was freezing! It was probably 50 deg, but it felt like the arctic on my bare legs as I biked into the hospital compound. I met up with Surgeons J. and S. who were on call. Soon after, a helicopter landed, delivering a young US contractor who had been blown up in an IED attack. Our combat medical system is set up in levels. This man had gotten Level 1 care right at the scene of the attack. His buddies and the responding medics placed tourniquets and bandages. Then he was moved to a Level 2 hospital for an emergency surgery. Surgeons stopped his bleeding and replaced an injured artery in his leg with a temporary plastic tube. Following this, he was quickly moved to our Level three hospital. We were able to examine him head to toe, check his body for hidden fragments with a CT scan, and perform specialized surgery. I helped Thoracic surgeon J. repair the injured artery in his leg with a piece of his own vein taken out of the other leg. This vein will become a living replacement for the artery and can last for years, unlike the temporary plastic tube. The repair was tenuous, because the vein in that leg had been mangled in the course of his injury. The blood had an easy way into his leg, but it was difficult for blood to get out. All the tiny veins in his leg would have to gradually grow to replace the job of the central one that had been injured.

After this operation I got a few hours sleep before my call day started. I began the day by working on one patient to place a surgical breathing tube through the skin of his neck, called a tracheostomy, and a surgical feeding tube through the skin of his belly, called a gastrostomy. He had a serious head injury and had not regained consciousness for more than a week. It was only 0900 when the first new traumas began coming in. Three young Iraqi policemen had been attacked using an IED. They were each peppered with small and large fragments of metal. One had a fracture through his skull, another had fragments in his shoulder, and the third had fragments breaking his arm and leg on one side as well as entering holes in his flank. In the operating room, we removed many of these fragments. Some looked like large metal ball bearings, others were rectangular chunks of iron. Some of the fragments buried in his arm were wrapped in little packets of his uniform that had been forced into his flesh, like the filter on a teabag. One of the fragments in his arm was a metal hook from a shower curtain. The IEDs are packed with all sorts of projectiles intended to do harm. He still has his arm and his leg, but both are supported with external braces of metal pins and graphite rods which looks like the scaffolding on an old building.

The rest of the day had been relatively slow paced. I had to have my pistol inspected. A defect was detected in some of the M9 handguns issued to officers. When the slide is racked, this defect causes the weapon to come off safe by itself. The security forces Arms Marshall was very professional as he checked our guns one by one. We stood in a line with our weapons tucked into holsters or the waistbands of our scrubs. After my weapon was checked, I received another piece of paperwork. Paperwork is a real favorite of the military.

Laparoscopic surgeon S. organized a barbecue tonight. We pulled together food from the PX, the dining facilities, and some bratwurst we had been saving since the last delivery from Germany. In the cold night air, it felt good to huddle around the flames leaping as the grease dripped off sizzling burgers into the coals. We used an improvised surgical device to flip burgers since we didn't have a spatula. The freshly grilled burgers were a great taste of home. As we sat around the PLX chomping on hamburgers and bratwurst, we could have imagined that we were back home in our backyards. Only the supposed beers we drank were non-alcoholic and our wives and children where not gathered around us.

After dinner, I finished "The Kitchen God's Wife" and watched a few episodes of "The Family Guy" saved on the morale drive. I scored a great comforter from the ER and curled up on the couch in the PLX for a midnight nap. One of the nurses woke me to come see a patient on the ward. He was having trouble breathing. He was a detainee, and a few weeks ago he lost one of his arms and legs when he was struck with a missile. He has gone through numerous operations and was fighting off an infection. When he is up to speaking, he often remarks that he will shoot us all. He is under constant guard and is kept blindfolded. I listened to his breaths using a stethoscope the nurse handed me. I sat him up and tapped his back to try and dislodge phlegm that might be clogging his airways. I needed the interpreter to tell me the word for cough. I asked what word I could use in Arabic for "Mister" since we were not supposed to ask the patient his name. I had thought that "Sayed" which means "Sir" would work, but the interpreter said to use "Ente" which means "you". I got the ICU doctor to look him over with me. Hopefully we won't have to use a breathing tube tonight, because he has a better chance of warding off pneumonia if he can continue breathing on his own and trying to cough. The nurses looking after him will keep a close eye on him and make sure he gets the best care possible.