12 January 2008

12 JAN 2008 So much to see

12 JAN 2008 So much to see

It is amazing how every new day brings a new experience. As I walk through my paces here, I feel like it is just more of the same, but every new patient experience or visit with tactical forces is a new world so far from my quiet little practice back home.

Just now I finished a burn operation on a 10-year-old boy. He was so calm and brave in the emergency department before we sedated him for surgery. He and his father had been in town when a VBIED (vehicle borne improvised explosive device) exploded next to them. I examined him and found a whitish silver pallor to his skin. I have seen patients burned with white phosphorus, or "Willy Peter" as the the troops call it, and it is dangerous because it continues to burn int the tissue until you cut every trace of it away. But this was different. I rubbed it and a little came off on my finger. It was silver paint. I went to talk to the boy's father. His sweater and sandals were covered with the same silver paint. He said that when the truck detonated, there was an expanding cloud of silver that emanated from it. Everything around it had been coated. We washed the boy's burns, removed fragments of metal from his face and legs, and dressed his wounds. Our Ophthalmologist C. looked in his eyes and Otorhinolaryngologist R. (or for those of you who don't want to say Otorhinolaryngologist, Head-Hole Doctor R.) looked in his breathing and swallowing tubes to see if there was any injury.

After that I visited a little girl recovering on our ward. She is the one who was shot in the neck three years ago and developed an abnormal artery in her neck. Two days ago, the high-tech equipment we had been waiting for so that we could fix this vessel, finally arrived. I got to witness amazing work by Vascular Surgeon M. and Radiologist B. in the OR yesterday. Here is this girl with a rare complicated problem caused by an injury long ago, and they were heroic in their efforts to give her some remedy. The problem is an AVF (arterio-venous fistula) where the trauma causes an abnormal bridge between two vessels. Because it was partially in her brain, it was an extremely complicated case. In an incredible exercise of modern surgical care, Vascular Surgeon M. and Radiologist B. performed a delicate procedure using long tubes and wires in the blood vessels to eliminate this AVF. There is no where in Iraq where this procedure is available except now and here in Balad. The girl's father had been trying to get to Jordan but had been unable to obtain the money or visa necessary to go. He had been trying to get his daughter help for three years. It is incredibly generous and exemplary that my colleagues would take her case.

I tagged along in the OR as go-fer on the case. I watched in wonder as they worked the delicate catheters through the blood vessels. Some features of the girl's problem made this case extremely difficult and the work took nearly six hours. Both of the doctors had been working on trauma victims tirelessly the night before and could just as well have been resting in their hooches. It was almost like watching Nintendo as they made deft movements of the catheters and watched the progress on the TV screens of the fluoroscopy X-ray machine. The little girl has been waiting for the devices to arrive and has been in our hospital for a while. She has become a whiz at Wii bowling and can beat me easily. I can't wait until she is back on her feet and well enough to play again. When I saw her today, she was up and out of bed, but still a little sore. You can imagine that six hours of surgery can do that to a person! But if I know kids, she will bounce back, and even faster than an adult would.

We had a visit from a troop that is special to one of our staff members. Physical Therapist S. has a son who is in an Army unit to the (redacted) of us. He was on base to pick up a new tactical vehicle for his squadron. It is called a MRAP (Mine Resistant, Ambush Protected) vehicle. This particular model is a RG-31 Caiman. It is an incredibly well protected six-wheeled vehicle. Thick plates of steel protect the hull, and the hull is shaped with a V at the bottom to deflect the blast from IED's. It is much more protective than an HMMWV when faced with a deadly IED. I have treated patients who drove over massive IED's in an MRAP and suffered nothing more that bruises. They showed me pictures of the scent. The Hull had been separated from the frame, and the engine had been blown out of the forward compartment. But since the hull had not been breached, they were safe inside.

Physical Therapist S.'s son took us for a ride around base. The RG-31 has a gun turret for defense. It has 360-degree protection when the weapon is inserted into the crease. The driver is high above the road. In the cockpit, there is a screen with Blue Force Tracker, a system for telling the crew where they are, where all friendly forces, and any where any known enemy forces are. They can communicate across the whole network of forces in the area. the rear is a spacious cabin with crew seats and a reinforced swing out door.

As safe as they are, the troops told us that they like it best when they can dismount and get out to do their job. They said that the vehicle is so intimidating that enemy forces flee into houses when they see them. They have to get out and go house to house to capture enemy fighters in the area. They are in more danger once they exit, but these young men told me that they feel that their excellent training and equipment still gives them a huge advantage in a person to person confrontation. Recently, their squadron lost (redacted) young men. I was incredibly impressed that these young war fighters were still so strong-willed and dedicated, even in the face of this recent tragic loss. I was struck with an impressive level of professionalism that belied their young age. America's best are giving their best each and every day over here.

I got my mug on the Internet at the MinnPost.com. It can be found in a good slide show here. One of their writers, whose pen name is John Sheldon, visited to write about the troops. He got to see a lot of the activity on the base including in the hospital.

Well it is time to hunt for some dinner. I'm following that old deer path of work, eat, sleep. Even had some Congressmen come through here today, but that changed nothing about the wounded or the work. Hope you all are well at home and hope to see you soon. There is so much to tell that I feel I could go on non-stop.

Be well,


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