26 December 2007

26 DEC 2007 Tween Calls

26 DEC 2007 Tween Calls

Yesterday I was backup call (and did nearly nothing, shhhhh!) Tomorrow I have my 24 hour shift on duty in the hospital. Today was calm. I started the day by putting a feeding tube in a baby who had been shot in the head. He has been in our hospital almost a week. The day he arrived, Neurosurgeon M. removed part of his skull and controlled the bleeding in his brain. He removed the bullet. He washed the brain gently. He reattached the panel of skull he had removed with short braces and screws. He left a tube in the brain to drain excess fluid and measure the pressure. That makes it sound like mechanic's work. It actually sounds more mechanical than what I do, and he's a brain surgeon! It may be fluids and screws, but yes, it is brain surgery. It's amazing what they do. The baby has survived this week, but still is deeply sedated. He's not quite in a coma, because when his sedation is lightened, he becomes upset and moves around in a disoriented fashion. This is good, because it means that part of his brain is alive. This is bad, because the agitation makes the pressure in his brain rise to a dangerous level. Time and gentle nursing is what he needs most.

A few days ago I put a breathing tube through the front of his windpipe. That day he was swollen tight and shiny. Today I was happy to see that he had regained some of his babyish features. His is such a sweet face. Little mouth and nose resting under long dark curly eyelashes. He will look a lot better running around than he will motionless in a hospital crib, sprouting tubes from every orifice.

In the OR, I made a cut in his belly, found the stomach, and sewed in a soft rubber tube. He will receive his food this way until he is awake enough to use his mouth to eat. Back home I use a tube the size of a pencil, but today I put a tube the size of my thumb into this baby's belly. It is hard to get the medical nutrition formulas here in Iraq. We give the families a supply when they leave our hospital, but once that is gone, it's gone! They have to blend food and force it through the tube with a syringe. A common combination that delivers great protein is egg, honey, and milk. Early on, we used our usual petite tubes, and they quickly clogged when the patients left the hospital. A clogged tube is a useless tube. It is no better than a handle. We learned to use the biggest tubes available so that they would stay open long time.

I worry for this boy. Of course it is my most earnest hope that the pressure in his brain stabilizes and he begins to cry and play like he should. But my visions of his future are darkened by paranoid thoughts of paralysis, brain damage, and pneumonia. I don't know the future so all we can do is carry on and hope for the best. I hope that I am being my usual pessimist self.

The operation went smoothly. Instead of the usual Balad closure of a row of steel staples resembling railroad ties, I closed his skin with delicate transparent thread that will dissolve in two weeks and a thin layer of surgical superglue. He won't need to have any staples removed or any bandages stripped off. It was probably a meaningless gesture, but it gave me comfort to remove one tiny discomfort from his future, and also gave me a transient flash of my usual techniques back home. My mother sent me a card that read "We give comfort, and receive comfort...sometimes at the same time." Story of my life. In fact, I think I have received far more in my meager service of the ill than I could return if I had several lifetimes.

After surgery, I accomplished yet another check box on my out-processing checklist! What an accomplishment for the day! Redeployment is a still (redacted) off, but we have to start early on our checklists! And to think, it feels like I just completed my in-processing checklist! Come to think of it, I'm not absolutely for positive that I actually completed every item on my pre-deployment checklist. What me worry, I seem to have gotten here okay. Shall I share one of the items on my out-processing checklist? Well if the mundane hasn't scared you off yet, this won't either! I was checked off by the library as not having any overdue materials. Since I had never been to the library before, it took me a while to find it before I could get my proof that I wasn't hoarding items from a library I had never visited. Ditto for the Supply Department and the Vehicle Maintenance Center. I was being signed off as having no maintenance deficits on a vehicle that I did not have. Did that mean that I had missed the chance to have a vehicle? I'm going to be pretty pissed if I could have been tooling around base with GI Joe and Combat Barbie in my very own Jeep all this time! Here is the item I want to check off: hauling my sorry carcass onto that plane about to taxi down the flight line. Done and Done!

Being 'tween calls, is a precarious predicament. You want to do something, so you don't feel like you have no life outside the hospital, but you don't want to push it too hard or you will be dragging keyster on call the next day. Back in residency, I was scheduled to be on call every other night for a majority of the nine years I trained. If you waited for a break in the action, you would never ever have a fun night. My usual choice was to stay up too late and reanimate my zombie corpse with beau coup coffee the next morning. So today I went and worked out, picked up clean laundry, dropped off a package at the post office, checked the shelves at the PX to make sure the same old scheiss was there, and biked around base. What a wild and crazy guy, no!? When I ran out of exciting errands, I returned to the hospital like a moth to the flame.

A seven-year-old girl had fallen off a roof. She fell nine feet and passed out for half an hour. Her uncle brought her to the gate. I don't know why her parents didn't bring her. Maybe they are dead. I hope not. Her uncle hadn't seen her fall and didn't know for sure what had happened. She was screaming her head off. This was a good sound. There is no sound more beautiful than someone else's child screaming. You need oxygen in your lungs to scream. She was pissed off that we had a collar around her neck to protect it. You need oxygen in your brain to be pissed off. She had a black eye, and just as this predicted, she had a mild fracture of her skull. In addition to the lungs and vocal cords, it seemed that everything else was working too. This was very reassuring. This was the kind of trauma that we didn't even need to go to war to see. And best of all, there didn't seem to be any serious damage. Neurosurgeon M. and Ophthalmologist J. didn't think she would need any surgery; only ice and Tylenol. It was a relief to us all. Eventually we got her settled close to her uncle and she was able to calm down.

I had seen this injury before. Years ago, one of my fraternity brothers suffered something similar when he was demonstrating the forward flip he could do off the front hall stairwell. He did it, but the slate floor in the foyer seemed to win. He went on to graduate college, if that is any measure of brain function. In addition to the ice and Tylenol, he needed to sober up, but he was going to do that with or without a head injury. At least for a little while. How similar are the inebriated and children! Both share poor judgement, top heavy gait disturbance, and annoying noises. It is like alcohol is a temporary fountain of youth! Even though my nights with heavy drinking buddies are largely over, I get to relive those days through my children!

But to move on, we are in a war, and head bonks aren't the only trauma we see. Late in the day on Christmas, a woman and child were brought to our hospital. They were taken from a car stopped by coalition forces. The driver of the car had given chase, and when the car was disabled, fled on foot. As the coalition forces closed in, the primary target detonated a suicide device he was wearing. The woman and child were brought to us. The woman will be detained elsewhere after her limb injury is treated. The child is uninjured. I don't know where he will go.

I wonder, will I see worse tomorrow? I've given up believing that I can't.



Ted said...

Funny... I was just discussing that little frat incident with Barry F., Alex H. and Aaron M. as we headed to Sunday's Pats game. Be well and Happy Holidays, my friend. Stay safe.

lainy said...

You seem to have many different kinds of patients, which can be good when they aren't hurt to much. I pray for the one's who need you most.

God bless and take care.

Bag Blog said...

I knew a 7 year old who fell on a steep ski slope, slid down the ice, and cracked his skull on snow-making facilities. He immediately began throwing up. He was taken to Santa Fe. When I came to visit him the next day, he was sitting up in bed in the ICU. He looked terrible, but he was talking non-stop, "Hey Lou, you want to go to the movies, how about Burger King, ooh cool, you brought me legos..." The nurse told me not to worry that he was just agitaged because of the brain swelling. I started laughing, and told her, "No, that is Nathan!" He is now a twenty-something young man who is doing great. The brain is an amazing thing.

I can't believe you have not rented a car and driven around Iraq to see the sights.

Kypdurron5 said...

I suppose an attempted family suicide is a downer for Christmas Day....but at least the wife and child have a new lease on life. Assuming the child is put info foster care, perhaps he will end up with a family a little less...eager to kill him?

Chris said...

Dear Ted, Lainy, BagBlog, and KPDurron5,

Thanks for writing. Lots of patients, but they seem to be able to get injured in the same ways. Kids do seem to have the best chance of recovery. I'm sure the family of the suicide bomber lived with desparation. I'm just glad that He didn't succeed in hurting anyone but himself.