04 December 2007

5 DEC 2007 Undertow

5 DEC 2007 Undertow
At the beach, I grew up having my parents warn me about the undertow. When I was four years old, my father finished his training as an obstetrician/gynecologist, and we moved to the shore. I took swimming lessons in the Long Island sound. The water was so cold. Our instructor would toss us in the waves, and we basically learned to swim by trying not to drown. The waves crashing on the shore of Connecticut are some little piddley waves, but to a kid who has never swam, they look like trouble. The water would rise and fall over my head. As I was swept up by the churning current, I could feel my body spun and scraped along the rocky bottom. Then the wave would cough me up on the shore. I would hold on with my hands and feet to the sand and resist the undertow as the wave slid back into the ocean to join its brothers. Quickly the sun would warm me and I would dash out to meet the challenge of the next inevitable wave.

Tonight I’m pausing to fill my lungs and get warmed before I jump back into call tomorrow. Yesterday was a heavy call day, and the work continued until about 2100 tonight. There was the interesting announcement that we were adopting an increased uniform posture. That may not make much sense to you, but basically it was a change in the amount of protective equipment we were required to wear at all times. It didn’t affect me much because they had lifted the change before I was able to leave the hospital. We also had an alarm red, but since we were in the middle of an operation, we had to continue with business as usual. The guards sat down along the walls until the all clear was sounded.

We had to treat two policemen from the ‘hood. They were on duty in the city nearby, when a sniper was able to land a non-lethal hit on each of them. The first had bullet wounds through and through both of his hands. The second had been shot through his thigh and penis. Orthopedic surgeon H. took the man with injured hands to the operating room to pin together the fragments of his fingers. Urologist S. and I brought the other policeman to the adjacent operating room to see what we could do for him.  As we wheeled him out of the CT scanner he told me through Translator M. that he wasn’t married. He told me that he wanted to be able to marry in the future. I knew from conversations with other Iraqi men with similar injuries in the past that what he intended to say was that he was a virgin and wanted to be able to father a child in the future. I was relieved at what the CT scan showed. It showed that the bullet had not entered his belly, and the artery in his leg was intact. I told the man, who was probably about 22-years-old, that it looked like everything was still there, and I didn’t think that we would have to cut anything off. I smiled and tried to reassure him.

As Urologist S. and I started working, I quickly realized that I had probably been too optimistic. It put me in a foul mood to see that under the tattered skin, the base of the man’s penis had been almost completely severed. The tube for his urine was uninjured, but it didn’t seem like he had what he needed to ever have an erection again. It was questionable if most of his penis would even survive. I was even more upset because I had foolishly opened my mouth and given him a hope that wouldn’t be able to back up. We didn’t amputate anything, choosing instead to give all the tissue a chance to recover on the slim chance that it would survive. We shall see on subsequent operations.

Helicopters brought us four more patients. They had been in the same car together. The man who had been driving told us a story. His cousin had been killed. His funeral had taken place that day. He was driving from the burial site to a gathering of relatives. He noticed a helicopter approaching from the side, and then without warning or explanation the helicopter opened fire. His wife was shot through the leg in several places and bled to death on the way to the hospital. His cousin had been shot through her breast and her abdomen. The man himself had a minor wound through his hand. I took care of his other cousin who had been shot through his neck and the small of his back.

My patient had a tube in the hole in his throat that had been placed by a skillful medic in the field. ENT doctor C. worked with Maxillofacial Surgeon W. to clean the wound in his neck, search for any injured structures, and move the breathing tube to a safer place in his windpipe. When they were done, we turned the patient on his side and Vascular Surgeon M. cleaned the wound near his tailbone, and packed it with cotton gauze to stop the bleeding. As the night wore on, the wound started to bleed again. The man returned to the OR, and Vascular surgeon M. used fine catheters and wires to clot the artery that lead to the site of the hemorrhage. After this, we worked together to locate the broken artery where it emerged from the side of the man’s tailbone, and tie it shut with fine silk thread. We brought him back to the intensive care unit where the nurses could tend him and lead him back to health.

Translator M. explained to me that people have started to become afraid to attend funerals. Any place that that people gather together has become a liability. Sometimes people are too afraid to even go to the morgue to claim the bodies of their slain relatives. They are afraid that they will be killed by insurgents or sectarian violence. Some will make sure that when they do risk the journey to a funeral, they make sure that the women are seated up front so that they are highly visible. Sometimes if the insurgents see women in the care, they will refrain from attacking. But you never can tell with terrorists. Travel just isn’t safe yet.

The day brought more patients. There was a 15-month-old girl with burns on her buttocks. Her wounds were washed and dressed. There was an elderly man who had been shot through his abdomen. We struggled to squeeze his massive, swollen, ailing heart back to life as his cracked liver oozed blood. He died. Another had been shot in the head and Neurosurgeon M. opened his skull to relieve the pressure. This afternoon I operated on a little girl who had been struck by fragments from an IED. We had to remove her kidney and I repaired her bleeding spleen.

Now the water recedes from me. I still hear helicopters landing as I rest in my hooch. In a few hours I’ll awake from what sleep I can find and jump back in. For the moment, I’m trying not to get caught in the undertow.



lainy said...

I don't know how you do it. I know this, you deserve and award, you all do.

I hope you get some rest and have a better day than yesterday.

Take care.

Jen said...

I hope that you can get some rest...it must be so difficult not to get overwhelmed. The work you are doing does make such a huge difference to so many people, but I'm sure that there are days when it's just impossible to see over the number of people that you are treating, and everything that is going on.

Hang in there!

Chris said...

I think that doing what we do is easy; it is more difficult for me when I'm not doing anything and I just marinate in the war. Something about idle hands...

ChefSara said...

Just reading this is overwhelming to me...i can't imagine actually having to experience it!

HollyB said...

Wow, just wow!

emergencyem said...

You have a way with words.

Hope you day goes wonderful.

Bongi said...

keep up the good work. some time ago a top dog in american military medicine gave a talk to us about surgery in iraq. it made me think about seeing if i could get involved. for numerous reasons i decided against it. there is enough to do in my own country.

but keep up the good work.

Chris said...

Dear Sara, Holly, Em, and Bongi,
Thanks for the comments. Someone described deployment as the million-dollar experience that you wouldn't buy for a dime. Since I finally have a moment to breathe tonight, I'm feeling relieved, tired, but also that we accomplished something useful today.

Take care,