8 NOV 2007 Reviewing Tape

8 NOV 2007 Reviewing Tape

Hi, Friends.

It's 0300, and I have a break to write. The mood is somber around here because the boy we operated on two days ago is in a flat spin. He fell off a roof and ruptured his intestine. Even though we were able to repair the hole and drain the leakage, the intestinal fluid sat in his belly for six hours before he came to us, and he now has bacteria growing in his blood. I was going to start the morning's operations when he had difficulty with his vital signs. We tried medicine to stimulate his heart, but his heart rhythm slowed and then stopped altogether. The nurses and technicians circled and helped. One pushed on his chest to keep the blood flowing. After several minutes and several medications, his heart started again. We checked his intestines again today. We did the operation today right there in the intensive care unit because he was too sick to be moved. We left the cut on his belly open with a clear layer of plastic covering his intestines. He was so swollen that they could not fit back into his belly. Through the day, his legs turned cold and he stopped making urine. We removed a blood clot from one of his arteries and gave him transfusions. He is receiving many strong medications and I'm amazed that he is still hanging in there.

I have been in and out of the intensive care unit and have spoken with his father many times. Each of the interpreters knows the boy's story because each one of them has had a turn helping me speak to the father. His father knows very little English. I have heard him say "good" and thank you" in English. Neither seems very useful at this time but he never fails to thank me after every conversation. This little boy is the same age as our middle boy. I see the fear and pain in his father's eyes and I can't stop a rush of worry and the thought of how incomprehensibly frightened I would be if I were in his position.

I don't claim to know the future. I didn't conceal from the father my low expectations that the child will live , but as long as he is here we will keep fighting for him. The nurses and technicians in the intensive care are working so faithfully around his bed. We are going to stick by this boy, but if his heart stops again, I don't think we will be so lucky to get it restarted a second time.

The day has been a cycle of operations punctuated by visits the boy's bedside, and snacks of Gatorade and potato chips. I have operated on gunshot wound victims to wash out their wounds and close up their bellies. One patient arrived shortly after midnight. It was his first day on the job as an Iraqi policeman and someone shot him in the belly. What an unlucky policeman! The bullet entered near his belly button and blew a small chunk of muscle off of his backside where it exited his body. He came to us with a roll of gauze stuffed into the wound in his buttock to slow the bleeding. We quickly got him onto the operating table. Colorectal surgeon J. and I opened his belly and spread the muscles aside to look at the intestines. We looked for a hole. We searched the large intestine and the small intestine. We felt the bladder and looked for leaking urine. We looked and looked but found nothing but healthy intestines. We washed him and sewed the incision shut. He had a little fatty padding, and the bullet must have curved around his body, under the skin, in a path like a fake arrow through the head gag. It left the internal organs completely unharmed. As we cleaned him, I found a linear burn like a stripe on the edge of the left side of his chest. It was the mark where a second bullet had grazed him, the hot slug burning the skin under which his heart beat only a few inches away. What a lucky policeman!

Earlier today we worked to keep a blown up child alive. He had been injured in an IED explosion. He was covered head to toe in a bloody slurry of mud. As we cleaned him off, we found numerous cuts on his face where fragments from the explosion had shredded the skin. he had a large hole on the front of his neck, and whenever he cried out, a froth of bubbly blood would rise from this hole. With the help of Ear, nose, and throat surgeon C.,we got a tube into his windpipe and used a little telescope to search for injury. Then Thoracic surgeon J. and I widened the opening on his neck and searched through the delicate working parts looking for signs of leakage or blockage. Fortunately, we didn't find too much damage, just a few flaky disks of metal that might have been fragments from the bomb or the ground around it. One such fragment pierced his eyeball so Ophthalmologist H. waited patiently for his turn to wash and repair the eye. The boy's heart and lungs are strong so we can count on them to pump the blood and oxygen to healing tissues.

My eyes dim and my head bobs. I feel the need for the night's next dose of coffee lifted from the anesthesiologists' lounge. I'm backup surgeon for the evening. I've got Laparoscopic surgeon S.'s six. We've only a few hours until dawn when we pass the baton. I hope my little friend in the intensive care unit makes it until morning too.

My Grandma's funeral was today. My mother described it to me in detail. Dear friends wrote to tell me about the ceremony. My brother A. read aloud a letter from me, so it was almost like I was there. I've closed my hand and I don't think I will be able to open it until I get back home. Maybe I'll be able to let it slip away slowly.

I've given you my burdens these past few days, so I want to share something more exciting about my base. A few days ago, we got to tour the grounds of the F-16 fighter plane squadron near the flight line. One of the pilots brought us through the gates that isolated the planes when they are on the ground. They were in protective bunkers, sheltered from elements and attack. He walked us around the jet, pointing out parts and explaining their purpose. Under the wing he showed us where gas tanks hung and where struts held the fighter's missiles and bombs. He described the ways the munitions could use radio, satellite, and laser to guide them to specific targets. I didn't get to climb aboard the bomb like Slim Pickins, but he let us get up close and touch the different parts of the plane. I had to get a picture that appeared to show me touching the missile's laser window, but I assure you it's an optical illusion.

He took us out to another jet that was being readied to go on alert. When they are on alert, they can be launched in an incredibly rapid period of time. This allows the jets to respond very quickly when danger is detected in any part of the country. They can stop people who are planting IED's in the roadways, like the one that shattered the face of the child on whom I operated tonight. He let each of us climb into the cockpit and see how it felt to have the canopy down. Of course my eyes were immediately drawn to the "nuclear consent" button, but you can be sure the Air Force is extra careful about that after recent events.

The sun began to set, silhouetting the F16 Falcons in their hardened aircraft shelters. We watched as a pair of the jets took off with afterburners blazing. Each night as I search for sleep I hear and feel them as they soar off the runway, shaking my hooch. The pilot let us try his night vision goggles. The goggles use optic tubes to intensify any available light source. With them on my face I could see each leaf shaking on the eucalyptus tree next to the barracks in the dark of a moonless night. Millions of faint and distant stars, too dim to be seen by the naked eye, shimmered above me through the goggles like sparkles rippling off of a breaking wave stretched across the night sky. The pilot explained how missions are controlled and coordinated with other troops across the theater. He described how the plane can record what he sees and also high resolution images captured from the observation pod on the belly of the fuselage. He told us that when he has a terrible, no good, very bad day he reviews the tapes from successful missions which show the supersonic acrobatics and precision tactics of which his team is capable. He reviews tapes of those victories and feels a little better.

Time to check the boy.

Salud,

Chris