17 DEC 2007 Feast or famine

17 DEC 2007 Feast or famine

A couple of days ago, we had some distinguished visitors. They were congressmen and governors, visiting from the US. Each had a tour of the hospital at some point on their agendas. Their visit occurred during a calm spell, so the hospital was pretty empty. Most of our patients were Iraqi. In fact, there was only one American patient, a man who was being treated for testicle pain. Through the day, each visitor touring the hospital would be paraded by this unlucky man. Of course every one of them had to ask the question. “What are you in for?” When the answer came, it was embarrassing for both parties. That poor troop will think twice about coming back to our hospital. He probably thinks that the government is keeping pretty close tabs on the budget for military medical care.

It is my turn as SOD today. It’s a Sunday, so I squeaked in an extra hour of sleep and got a good shower. We had the usual roster of maintenance operations to do: wash out abdomen, close wound, replace drain, etc… We were only on to the second case in each room when the fresh traumas came to the door.

“Trauma code in ER, times (redacted)” the announcement sounded overhead. Three waves of patients came at intervals of about 45 minutes. When they had all arrived, we had a healthy burden of patients, all fresh traumas from the field. They numbered in the double digits, but never to the point that we were overwhelmed and had to activate the Mass Casualty recall. Except for one US soldier who had been injured when a concrete block fell on his head, these individuals were all Iraqi Civilians from a nearby province. They had all been injured in the same village.

Our translators spoke for them. We removed tourniquets and examined wounds; we sent them for CT scans. One man was shot through his chest. Another had a broken bone on three of his four limbs. Another had holes in his colon and small bowel. Nearly all of them needed an operation. We worked together to find every last injury. They were sorted according to most life-threatening, and given an order in which to proceed to the operating room. We operated on three patients at once for about 18 hours straight. Everyone pitched in. There were strange parings. Neurosurgeons worked with orthopedic surgeons. Thoracic surgeons worked with urologists. When there were multiple limbs injured, we each took a limb and washed until all the wounds were cleaned and dressed.

One of our translators, N., used to travel with a unit that patrolled outside the wire. He said that Al Qaeda knew that it was outgunned by US forces, so they would adjust their tactics. They would not directly engage US troops. They would wait until soldiers had left an area, then attack anyone who was in the open, be they civilian or military. He said that Al Qaeda would attack with continuous small arms fire and grenades. It seemed that they were attacking in waves, with one wave reloading while another was emptying their magazines on full auto. He said that it was impossible for anyone to move while they were attacking. They didn’t care who they shot; men, women, and children were targeted equally. It was always hard to know when an attack was coming, because the Al Qaeda fighters wore the same garb as civilians. After the attack, those who were not neutralized would blend back into the population. I told him I was happy he was working in the hospital, and no longer going outside the wire.

The attack today that brought us so many patients was directed against a concerned citizens’ group. They had rejected Al Queda from their village. They said that Al Queda had been driven out of a neighboring area. As the Al Queda fighters fled, they entered the village. The people we were treating told the translators that the Al Queda fighters had opened fire on a crowded public area. There was no warning of the attack. They were shooting indiscriminately. The men told us that they hit adults and children. We did not receive any children at the hospital.  All the children shot in the village died on the scene.

After midnight, I received a few last patients. One was an Iraqi man who had fallen off his motorcycle. He didn’t know where he was and made some very confused comments. Some things are the same no matter where you go. Another was an Iraqi highway patrolman whose car was blown up. So we had CHiPs and Walker, Texas Ranger. The last operation I did for the night was to clean to wounds of a soldier injured by an IED. He had lost one of his legs and injured his testicles. Another hospital had operated on him, but he still had a lot of dead skin and muscle that needed to be removed. We dressed his wounds, and he is safely on his way to Germany.