7 DEC 2007 Stack 'em up
Today started calmly enough. Eggs and salsa, morning rounds, and then onto the scheduled operations. We had a pretty full load of eight cases. They were all patients who had been injured on prior days, but needed to return to the operating room again. They needed bones aligned with metal pins and rods. Their numerous wounds needed to be washed out and closed over drains. They needed surgical tubes placed for feeding and breathing without a machine.
Now it is 2200, and we still have about five of those cases to do. We got a little disrupted over the course of the day. Early this morning, there were two suicide bombings in Iraq. One was a truck bomb, and the other was a female suicide bomber at a security checkpoint. The crew at the FOB radioed our ER to tell us that there were as many as 20 inbound. We activated the MASCAL response. We called in all shifts of the hospital and congregated in the ED. Shortly thereafter the first helocopter landed. The helipad crew rolled in with a skinny nine-year-old boy with a hole in his armpit and a drainage tube already placed between the ribs of his left chest. He was writhing in pain and drawing his legs up to his chest. We quickly got him some pain medicine and a sedative. When we opened the valve on his chest tube, about two cups of bright red blood splashed out onto the floor. He was calmer with the medication and still had good vital signs. X-rays confirmed that there was a metal fragment the size of a pencil eraser in his heart. Thoracic Surgeon J. and I quickly rolled him into OR1A.
All of our operating rooms had been converted to double rooms with a second operating table brought in. We quickly slipped large catheters into the boy's arteries, veins, and penis, and had his chest and belly prepared with an orange antiseptic solution. We opened the skin in the middle of his chest and used a small battery-powered saw to cut his breastplate in half. After the rib spreader, a hand-cranked device that prys the chest open like a jack, had spread the incision open wide, we cut into the thick white sac that holds the heart. we quickly found some clotted blood and sucked it out. The heart had a hole on the left side, then the fragment had gone completely through the heart, and had lodged in the muscle on the right side. We could feel the fragment poking out of the fatty lining of the heart. It was incredibly fortunate that the boy's blood had clotted the two holes in his heart shut and he hadn't bled to death in the first few minutes after his injury. We used fine stitches like fishing line and patches of Teflon felt to repair the two holes in his heart. The fragment was wedged in the delicate web of muscle in the meaty part of his heart, so we left it where it lay rather than causing more damage by removing it.
With the heart repaired, we turned our attention to his lung. By this time, another team had already started working next to us on a man with fragments through his belly and legs. Once the bleeding in the lung was stopped and the breastplate had been drawn back together with thick loops of wire, I left Thoracic Surgeon J. to start on another patient. So it continued through the day. We are still operating on patients who arrived freshly injured today. With any luck, there will be enough of a lull in the action to take care of those patients who have been stacked up, waiting patiently for their operations since morning.