10 JAN 2007 A fistful of dinar
It’s the wee hours of my waning call night. Soon I’ll get the list of new admissions from Patient Administration and I’ll be able to prepare my morning clinical openers talk for the boss. I’ve had a bit of a breather since midnight. I lay down on the couch in the swamp for a while and drifted off as “Donnie Brasco” played on the TV. So far it has been a reasonable call day as call days go. During daylight hours we were running around like chicken heads because there was a rush of casualties. We finally got them squared away. After that we could resume the scheduled operations for the day, and I finished the last one at 2200. Forget about it!
We are training one of the newly arrived surgeons. He has jumped in with both feet and had already scrubbed into a case about four hours after his plane touched down. I worked with Surgeon J. a few years ago when he was a resident. He is such an even-tempered and solid guy that I know he is going to be a great asset to the patients here. He seems to have blended into the rhythm of round, operate, and eat. Two nights ago, we piled into the back of the Czar Car together for his first family dinner. As we passed by landmarks in the fading twilight, we pointed out where he could swim in Indoor Pool or work out at Old Man Gym. It was good to let him know that there are activities to do here that help keep a body sane in between the riots in the hospital.
We were called to the ER to treat two trauma codes early this morning. An Iraqi couple who had been injured together were brought to us by Blackhawk helicopter. The woman was moaning in pain and curled on one side to favor her right leg. She had been hit by two bullets. One had ripped a chunk of flesh from the meat over her scapula, and the other had torn a hole through the inside surface of her thigh. The wound in her thigh was covered by a thin bridge of skin. When I looked through the hole, I could see the bed under her through her leg. We ran tests to be sure she did not have internal bleeding or injured arteries, and inserted a breathing tube. I washed the small splinters of metal and fibers of clothing from her wounds. She had also cut her hands and feet when she was hurt. Perhaps she was knocked over by the impact of the bullets. There was a mixture of blood and mud driven deep into the wound on the sole of her right foot. The nurses and I used a motorized sprayer to slowly wash all the bloody mud out of her foot.
The man that came with her had holes in all of his limbs. His skin color was a lifeless purplish grey. The medics had been performing CPR as they flew him to us. As soon as they had rolled his NATO gurney into the trauma bay, we took over the chest compressions and puffs of air into the lungs. We intubated him and made sure that his lungs weren’t collapsed. We checked to see if his heart was leaking blood into the sac that surrounds it. We checked for any electrical activity with the electrocardiogram. We looked for any motion of the heart muscle with the ultrasound. We felt for pulses, listened for breath’s movement of air and watched for any muscle reflexes. There were no signs of life. We stopped pushing on his chest and let him finish dying. In his pocket was a thick stack of Iraqi 250 dinar bills, stained with his blood. They were locked away with his other belongings.
The woman with whom he came has not regained consciousness yet. She is still sedated after her surgery. I don’t know what relationship exists between them. When she is awake enough, one of us will have to tell her that her companion is dead.
Later several troops were transported to our hospital. Their injuries resulted from an explosion. When they all arrived at once, our ER was flooded with personnel responding to the call for help. Each patient had several doctors, nurses, and techs working on them. I even saw volunteers from other areas on base such as Security Forces or the flight line that were spending their off-duty downtime in the hospital trying to help an injured troop. The troops were quickly triaged and the ones who needed it were spirited off to the OR.
I spoke with one of the injured men while we were waiting for the CT scan machine to be free for him. He described the explosion to me. He said that one of his fellows had his legs broken by debris. He said that they were “twisted like spaghetti” and the most disgusting thing he had ever seen. I asked him the name of the person whose legs were broken. I was surprised to hear that it was the man two beds over, on whom I had just been working. I had splinted his broken legs, and I distinctly remember thinking that his legs looked great, and I was relieved that the breaks weren’t as severe as most I see. I was relieved to see that there were pink wiggling toes below those broken bones, not just a bloody stump with a shard of bone sticking out where a foot was supposed to be. I realized that my perspective has been changed by conveyer belt that has been dumping multitudes of injured men and woman at our door. My definition of what looks disgusting has been drastically changed.
Eager to get back to boo-boos,