18 DEC 2007 Livin’ FOBulous
Happy Birthday, M.!!! I love you. I wish I was there with you. Hopefully I get a chance to call later. I’ll try to call you later. Fortunately I realized that it was far too early to call, and didn’t mark your birthday by rousting you at the crack of dawn.
Today has been good. What a load of clean up operations we have to do from our surge of patients two days ago! Fortunately, after this round, most of them will be well enough to leave. The wounds from this war are usually high energy tissue damage. AK-47 and M-16 rounds enter the body through a small hole. When they leave the body, they blast out a large crater of tissue. As they travel through the body, it isn’t just the path of the bullet that is injured. There is a cone-shaped shock wave of damage that destroys flesh, even if the tissue isn’t blown away. We learned early that it is important to cut away a large diameter of tissue, otherwise gangrene sets into the dead tissue left behind. We almost never close wounds the day they were made. Instead, we bring patients back to the OR every other day and wash and trim their wounds. After a few trips, they are usually clean and healthy enough to be closed. Some have such huge holes in their body that we need skin grafts to cover the damage.
IED wounds are even worse. The fragments go everywhere. They drive in dirt, river pebbles, and bits of uniform. Even on the fourth or fifth washout we are still finding pockets of sand at the edges of the wound. It’s amazing that people survive it at all.
After helping with the maintenance operations, I attended clinic. The man with seventeen children had brought in his daughter. (Yes, since I had seen him last, one of his wives had delivered another one.) The child was doing wonderfully. She cried a little when I took out her staples, but we got through it together by counting staples. I can only count to ten in Arabic, so we had to start over before getting to eleven. Unfortunately, her father told us that her brother wasn’t doing as well. He was vomiting at home and couldn’t keep anything down. We sent him off to bring the boy back to the gate. Hopefully he gets back before it closes for the day.
I also saw two burned patients. One was the little boy who fell into the pot of boiling water in his kitchen. His chubby cheeks told of how well he had been eating. When I saw him last, six weeks ago, he still had many open spots on his burns that bled when the dressings were changed. This time his skin was completely healed over. The pigment was even starting to return to the areas that were burned and the sites of skin graft harvest. He walked upright and smiled. (Except, of course, he screamed like crazy when I was examining him. He screamed the entire time until his clothes were back on!) He even had a stylish new haircut. He wanted to see Doctor J., one of the nurses on the ward who took care of him during his long hospital stay. I carried him over on my shoulders. He was met with much cooing and cuddling. I don’t get that reception when I visit the ward alone. He asked if he could have a soccer ball, and people came out of the woodwork to give him balls and toys. He left with a bag full of three balls and two toy cars.
The third patient I saw was a little girl who was burned a year ago. She was playing with some children in the street. There was a bonfire. She got too close and her clothes caught on fire. No adults were around, so she ran all the way home with her clothes still burning. She stayed at our old tent hospital for three months. Her family member had been trying to get her in the gate to see us. Since the girl didn’t have an appointment, the family member had been frustrated. This person has been a valuable source of information to the quiet professionals who keep our part of the country safe. The information this person provides had produced many valuable leads. The quiet professionals personally escorted the two of them to our hospital. They asked me to please see her, as a favor to this person who had been so helpful in the fight. I examined her burns. She had been burned from the hips down. She had healed remarkably. The skin had been harvested from her belly, back, and buttocks to cover her burns. These sites were also healthy and supple. The family member asked me if she would always have the scars. I told her that she would, but that as long as she ran, played, and ate well, her legs would work. I told him that it had been my experience that usually burned children are better able to accept the appearance of their burn scars than their parents are. I told the family member that it was essential that the girl be encouraged fully participate in life. I hope this helped, but it will probably take time to prove to the family member that this little girl is able to overcome the history of her injury. I don’t ask parents to believe my prediction, it is fine for them to just wait and see, and believe me after it happens.
I’m still waiting for the boy to be readmitted to the hospital. Since he also had a bladder injury from the explosion in his back yard, Urologist S. will see him too. It is a comfort to know that I am surrounded by such highly skilled professionals, like Urologist S. I am so lucky to have the resources of a clean modern hospital and such dedicated fellow Airmen. I really am livin’ FOBulous in this bitch.