31 October 2007
30 October 2007
29 October 2007
28 October 2007
27 October 2007
26 October 2007
25 October 2007
It might be time for another buzz. My hair is getting away from me. Luckily the care package that my sister A. and her coworkers sent has shaving gel and some triple blade razors. Ooh, how smooth I'll be!
My mount has a lame foot. Last night as I left the Air Force Theater Hospital, I noticed that my back wheel was riding a little low. As soon as I mounted, I felt that sinking feeling of grounding the rim on a completely flat tire. My bike was a generous pay-it-forward from Plastic surgeon M. who is happily and safely stateside. He warned me that the tires had a slow leak, Each week or so, I pump them up and go merrily on my way, but this was a full deflation. We've had a touch of vandalism lately. I entertained the though that perhaps the peace symbol on my helmet locked to my bike had invited commentary, but it was just a plain old leak. As it was midnight, and my patch kit was in the hooch, I rode the rim "home". Feh.
Today I borrowed the Czar Car and trekked to the PX. First I tried Army PX and them moved on to West side KBR PX. No luck, no inner tubes were to be found. In the usual pot pourri of random items I did find tubes for a 16" child's bike and one for a three speed beach cruiser, but none that would fit my Huffy mountain bike. This is how it goes at the PX. It has lots of stuff at good prices, but it is a pawed over lot of remnants like a Railroad Salvage. I need a new PT uniform (shorts and T-shirt) but I can only find petite Bruce Jenner shorts and a XXXL top that comes to my knees. Maybe I'll go gangsta. As for my bike, I had to settle for a hot glue patch kit and a tube of slime. Now I have my project for tonight. I can get the leak fixed (back tire, wouldn't you know it) in my own little bike clinic. It also needs the derailleur tightened, a new headlight that doesn't flicker, and I'm going to make fenders out of casting fiberglass. (The peanut butter mud is coming soon.) Of course the PX had new bikes for sale, but what is the fun in that? All I gots is time. But that's okay. I'm no doctor, but I do know this: You can't stop the clock.
What really gets me about the military is how they take every opportunity to go large. Yesterday we organized a hospital staff photograph on the helipad. We arranged for a medevac Blackhawk to park behind us. In true military fashion, instead of just climbing up a ladder, The photographer was perched in a ginormous construction cherry picker crane. We fell out into formation, taller tapped to line up by height, and then held formation for the next half hour. In that time, the crane operator moved the photographer up and down, scoochin' and oochin' to every possible position. For a nervous while he was precariously perched 40 feet over the head of all our commanders as the crane arm wobbled with the herky-jerky maneuvers of man at the helm, who probably didn't operate cranes at home. Then the crane broke and the basket wouldn't move up or down. Someone fetched a ladder in case we couldn't get the photographer out of his tree. After the backup compressor kicked in, the crane operator lowered the basket to a position eight feet above the ground. This, it turns out, was the ideal vantage point for the photograph. The photographer motioned for us all to "squeeze together", like at a birthday party at Uno's. If only we had gotten the ladder first, we wouldn't have needed the crane at all!
We surgeons stopped in front of the mural honoring the Tuskegee Airmen for a small group shot. Our Wing is named after the Tuskegee Airman and carries their number. It's our turn now. It will take a lot of heart and effort if we are to earn that name. I hope that our actions maintain the brilliance of that tradition so that a century from now they can look back and say that we earned the Tuskegee name and number.
24 October 2007
Good afternoon. I've got a moment to chit chat before we go into conference. It is a warm windy afternoon in Balad. Already people are starting to wear the long pants of their physical training uniform. I don't use my air conditioner at night. The cold and rain is on its way.
Our famous Vascular surgeon M. seems to have momentarily lost his black cloud luck. He's gone from Eyore to Tiggr. He was on call last night and thankfully few were injured. One unfortunate story did however end in tragedy.
Before the call to the hospital yesterday evening, I had been free to get some time away. I took advantage of the break in my duties to get out and cover some miles on my bike. I also got a good chance to put the worries of the hospital on hold while I went geocaching.
Not everyone has heard of geocaching. Before last year, neither had I. Geocaching is a sport where the player uses a global positioning satellite receiver to locate hidden items. Players hide items across the globe and then publish the coordinates on the Internet at sites like Geocaching. The boys and I have found a bunch around Texas, and when I logged on over here, I found that over 150 geocaches had been hidden in Iraq. After programming coordinates into my GPSr, I saddled up and hit the trail across base. I searched for five and found two. One other had been destroyed, but that's not surprising given the amount of construction and heavy equipment rolling around here. I've posted a picture of of one cache that was the size of a lip balm container and was hidden in a (redacted).
23 October 2007
I am immensely grateful that Congress has acknowledged that the rare honor of serving my country, separated from my family, is worthy of notice. The amounts are nice, but it is the fact that it is recognized at all that I appreicate. That brings up another point. I work for you. You have paid your taxes. They have gone into our national budget, and 67% of the $1.1 trillion dollar budget goes to national security and defense, some of which trickles it's way down into my pocket. Thank you for the job. Thank you for letting me work for you. I say this on my own behalf, and that of the less than 2% of the US population who choose to serve in the Armed Forces. But I can't stay here forever. I need to get back to my core.
22 October 2007
Good morning, Friends!
Hope today finds you well. It is a beautiful crisp clear morning over Balad. I'm gearing up for three operations on children, all secondary operations to get them closer to a strong enough state to get home or to an Iraqi facility. I find that nearly a majority of the operations I do over here are on children. That is fine with me, I trained in a career where all of my patients would be children if I had the choice. But of course, I have no objections to operating on adults. Striving for health and comfort for anyone is a worthy goal. Still, it seems like I am operating on more children than the last time I was here. I used to do 2-3 operations on children each week, now it seems like I do that many each day. However the scientist inside me says don't judge by impression, measure the data. I'm sure I do more operations on children than my peers do. This is because I seek out the cases on children, and my friends seek me out to do the operations on children. Ah, well, I'd gladly give it up if security improved and we could be out of the injured baby business.
I love to take care of children because they get better so fast! Just as I expected, the boy who got rid of his colostomy has done well. This morning, he had gotten out of bed to go to the widescreen TV to watch some football. He gave me a big smile when I greeted him. Now don't you believe it that you or me would still be whining the second day after a big belly operation! Our interpreter gave us the good news that he was "passing gasses." This is a big deal for surgeons. After an operation it is if the world turns on this question. How indelicate to be stuck in a hospital, sore from your operation, and every morning at an obscenely early hour a cluster of doctors comes in to ask you if you are passing wind. Such is the world of the surgeon's patient.
I passed by the darkened isolation room where the boy with severe burns died last week. I suppose I'll always see a fleeting image of him when I pass those windows. I proceeded on to the room of the other boy with burns. He is gaining strength every day and his skin grafts are taking like new sod in springtime. Two days ago I did his first dressing change after surgery to check his progress. His nurse had given him a sedative and pain medicine to make it easier, but he still looked up at us with fearful eyes and cried. The interpreter confirmed my impression that he wasn't in pain, but was just scared. One of our airmen strolls around the wards playing a guitar and singing. (It's not his official job, just a pleasant side benefit!) The nurses asked him to play outside the room while we changed the dressings. First he played "Hotel California", one of the interpreter's favorites. Not the most encouraging song for an impatient. Then he moved on to "I want to grow old with you" by Adam Sandler. It is such a pretty song, and I couldn't help murmuring along "I'll even let you hold the remote control." Another association my mind will always cling to.
Today we got this boy back on his feet. He stood crouched over like a catcher, too fearful to stand up straight. Bit by bit we coaxed him to an upright position. He took a few halting steps and stopped crying. I'm hoping to have him back in the nurturing circle of his family again soon. There are obstacles. I asked his father if he had a bathtub. No. I asked him if he had a reliable source of clean water. No. I am very fortunate that I have the backing of my commanders to continue this intensive burn treatment until I know the boy will be safe at home.
I've got to go prepare the OR for another skin graft I'm about to do. It's been nice to talk. Hope you have a great day!
LTC Christopher Coppola, USAF
APO AE 09315-9997
21 October 2007
20 October 2007
Ah yes, on call, and a moment's peace. We have enjoyed a temporary lull in the action and haven't had to run marathon days in the O.R. I've done a few operations today, admitted a few men to the hospital, but had time to enjoy three meals . That's a measure of a good day. I even had time to pee without having to wait for a break in operations. It may not sound important, but when there isn't time to visit a restroom, the day is too busy. It reminds me of one of the rules of residency. During a busy call night it is important to prioritize. Not just the patients, but also essential personal activities. They are, in order of importance, 1)Pee, 2)Call loved one, 3)Eat, 4)Sleep, 5)Shower. If you make it as far as #3 it is a good call night and you have nothing to complain about.
Yesterday's loss of the poor burned boy is a sad event that will stay with us, but we have to cowboy up and get back to work. Today was much nicer. Strengthened by kind wishes from home, I was able to get back into the fray. The morning had a great start with a smooth operation on a boy who was getting rid of his colostomy. I worked with Colorectal specialist J. who showed me some good tricks he uses in his practice back home. The boy had been using the bag on his belly to go to the bathroom for six months, after having been shot. Today was his graduation and we reconnected his intestines. Not only is it our victory, but it also is a credit to the work of the surgeons from the previous rotation who kept him alive at the time of his life-threatening injury. I visited him this afternoon to give him a coloring book and Crayolas sent to me from family at home. He was tired but looking good. He moved like a little old man in the bed , turning gingerly to avoid straining his sore abdominal muscles. I asked him how much it hurt and he held his index finger and thumb close together and clucked his tongue to tell me "just a little". It will be good to see him up and walking around the room soon.
I also worked on a girl who had suffered a serious penetrating head injury. She had not woken up, even after several days of treatment in our hospital. I put tubes in her to make it easier for her to breathe and eat while she was in this unresponsive state. She is still alive and I will maintain hope for her to wake up and start moving. I have been surprised in the past by children who have made amazing recoveries after head wounds that I was sure would kill them. If there is life there is hope. Children seem to have a remarkable ability to recover from injuries that would be hopeless in an adult. The young may not be immortal, but they try to be with every fiber of their being.
Later in the day, our general led a group of visitors through the hospital. Usually when a DV (distinguished visitor) tours through the hospital, we have some advance warning. One of the command sergeants walks ahead to make sure there isn't any embarrassing behavior going on. Most people take it as an opportunity to vacate the area and high-tail it out of there. When the advance warning came, I was entering patient notes into the computer, so I stood my ground and didn't flee with the rest. When our general entered the PLX, I rose to attention with the others present as he led members of the Congressional Armed Services Committee. They shook our hands, and thanked us for our service. There was nothing going on at the hospital at the time, so it looked like we were spending our deployment surfing the Internet. There was one trauma call during their visit, so the party relocated to the ER. It turned out to be a 10-month old baby who had been in a car accident the day before. He came to us escorted by six relatives. The just kept climbing out of the ambulance, one after another. He was crying vigorously, and had but a bump on his head. We ran some tests, comforted his mother and sent them all on their way back home.
I don't think I would recommend the trip, but we certainly do have a lot of visitors to the hospital. A few weeks ago I got to meet Adm Michael Mullen, Chairman of the Joint Chiefs of Staff. He came with quite a security detachment and we narrowly avoided missing dinner waiting for the convoy to clear the exit. He was very interested in the hospital and asked us questions about the work we did and how we thought we were able to get our jobs done. He was kind enough to give us his coin as recognition for our work. He had a straightforward and open manner about him and showed a true concern for us. He is one man who has a much tougher job than I do.
Prior to that we were also graced with a visit from Poison front man Bret Michaels. He dropped by the hospital to visit injured troops.He was kind enough to pose with us for pictures. His security was a mountain of a man who could have bounced in any roadhouse. Later that night Poison gave a wailin' show in the Sustainer Theater. Troops had lined up hours before and the crowd was SRO.
We are very appreciative when we have visitors. It is always an encouraging vote of confidence to know that we are remembered back home. I'm impressed that people would choose to risk their own safety to schlep it out to Balad. I worry for them. I remember once I was in Al-Udeid when a different Congressional delegation was visiting. One of the Congressmen asked a Sergeant at the terminal if there was anything Congress could do for him. He replied that they could stop sending Congressional delegations to Iraq, putting themselves and the aircrews at risk! His answer holds truth, but the concern for us is still appreciated!
I wish you well, and STAY SAFE, STAY HOME!
19 October 2007
17 October 2007
Ah whew! It is the early afternoon and we actually finished out scheduled cases before midnight for once! That's even with Vascular surgeon M. on call, but I won't dwell on the point because that would tempt the fates to deliver a influx of patients. I operated on two men this morning who had been injured a few days ago, but needed their wounds washed and their open abdomens reconstructed step by step. Before that, I started the morning operating on two youngsters with burns. Both have been with us several days. One is still severly ill and spends his days in the intensive care unit, hooked up to life support. The other is on the ward and is able to take a few hesitating steps, flexing his burned legs. We are encouraging him to eat more protein so that his body can heal his opened layers of skin. He has beautiful long eyelashes and large round dark eyes. His father has bronzed skin that wrinkles around his mouth an eyes when he smiles. His face is roughened with sun and age and he wraps his head in white. Whenever I visit, he gives me a thumbs up and looks to me inquiring with his creased eyes if his boy is improving. I return the thumbs up and say "Zien", for "good" one of the few Arabic words that my age-addled brain has been able to commit to memory.
Each day our crew sedates these boys and I scrub the dead material off of their burns. Today was a good day. I did not see masses of gangrenous skin threatening infection. The wounds seeped bright red blood as I scraped, signaling to me that there was healthy blood flow that might in time heal the skin whole again. They will not be well until I give them adequate coverage, a new layer to defend them against the bacteria in our environment and keep in necessary hydration. Soon I will place skin grafts, shaved off of their own healthy skin, to further their healing.
The boy in the intensive care unit is more severly burned over more than half of his body. There are fewer patches of healthy skin available to us to move over the burns. Just today we received a shipment of artificial skin substitute from friends at a military burn hospital back home. I called them for help in the middle of the night and they hustled to help us out. I am hoping that this artificial skin will help tide this unfortunate boy over and give his body a chance to recover from the initial shock of the injury. It take a huge effort from many of our hospital's staff to give these kids the care they need. I am in awe of the dedication and professionalism of my colleagues. I don't know the future, but as long as they stay alive, I'll do my best to get them coverage.
Some of you really responded to the story abut the military working dogs. Tara Parker-Pope of the NY Times emailed me a great story about stray cats in Baghdad called "Nine Lives: What Cats Know About the War".
When I transported a patient to the Combat Support Hospital in Baghdad a few years ago, I spent the wee hours waiting for a helicopter in the recreation room in the basement. Every few moments, a cat would come in the ceiling level window, make a mad dash for a morsel of food to steal, then head back out. I didn't see any rats, at least!
I hear "Trauma call in the ER, times five" so I'll sign off for now. Time to fly M.'s flag.
Take care and be safe!
LTC Christopher P. Coppola, USAF
APO AE 09315-9997
16 October 2007
15 October 2007
I crashed hard last night after 7 cases, and I wanted to let you all know that things were cool here.
I'm on today, and I'm waiting in the ER for 5 casualties to arrive. Some start to the day. An hour ago, an explosion went of just off base: we heard it and felt it. Word is there was a 1000 lb IED detonated in Balad, and there were civilian casualties. Their first source of medical care is Balad city hospital, but chances are we may receive some if they are overwhelmed. We are ready if so.
The newborn is doing so well. Everyone is trying to get by and get a chance to feed him a bottle. I found our Col in there the other day on the rocking chair, smiling widely with that little bundle of joy wrapped in his blue blanket.
His mother has done so well. She is well enough to breathe on her own, sit in a chair, and has held her baby.
Well the first injured man just rolled in.
Be well, we'll keep working hard over here.
Your man in Balad,