08 January 2008

8 JAN 2008 We clean up our act

8 JAN 2008 We clean up our act

I start by bidding a sad farewell to Army Major Andrew Olmsted. He was killed by a sniper in Iraq on 3 JAN. Before he died, he entrusted a friend with his final blog post to be published posthumously. You don't have to read long before you realize that our great nation is eternally in the debt of troops like him who risk and sometimes lose their lives in their faithful service. As he asks that his life not be used by anyone to make a point, I'll say no more, but let his words speak for themselves.

Here at the hospital we have been told that we are too M*A*S*H-like. I took it to be a high compliment. If we could come close to the level of tireless function and teamwork displayed in that movie and TV show, I would think that the hospital would be running quite well. But the comment was raised as a criticism, in someones skewed view of the universe. Apparently, there have been distinguished visitors that have seen an Army hospital, and then have come to see our house. Their comment was that the Army facility seemed to be regimented and squared away, where we were a little more colorful. I think that because we are so intense in our efforts to save lives, we have less time and inclination to make the place seem like a spic and span, to the letter military institution. We spend a little more time checking patients' vital signs then we do starching our uniforms.

I came to the conclusion that you could separate people in the theater of operations along these lines: One group is over here for the purposes of taking lives, or saving lives. As a surgeon, I think it is a fair assumption that I'm in this group, and I hope my counts are much higher on the side of lives saved! The other group of people here don't take lives or save lives, but they sure to provide a lot of headaches to the troops who do! Who could blame them; since they aren't busy taking lives or saving lives, they have to put all that empty time into thinking how to annoy us!

At any rate, the "colorful" aspects of the surgeons' PLX desk have to go. No more "man-love Thursdays" when we seek out the flowery feminine scrub tops to wear. Only solid blue scrubs from now on. No more working in black T-shirt only with Air Force field jacket off when you are trying to hold the bloodied head of an IED victim steady to get the stabilizing collar around his neck. If not in scrubs, blouse must be worn over T-shirt. The (de)motivational posters hung around surgeons desk such as this one from Despair.com have to go: "Demotivation: Sometimes the solution to morale problems is just to fire all the unhappy people." This one came from treasured 2007 Calendar given to me by Trauma Surgeon B. just before he was promoted to civilian.


We had to take down our pictures of our faces morphed onto animals or movie posters. The list of "Most Wanted Terrorists" who bore a strange resemblance to the surgical staff with scarves wrapped around their heads, such as the dread criminal, most wanted terrorist #6 "Hous Bin Pharteen." And yes, it was a early excuse to sweep away the menagerie of Christmas toys on the counter (don't you all leave Christmas decorations up until April?) However, as unlikely as it may seem, we are professionals, and work goes on, sans flair.

It has been a long day. I just finished a tracheostomy tube on a five-year-old boy. I told you about him a day ago, he was burned when his family's generator blew up in his face. I got to talk with his Dad a little more about him. The poor man is so worried. It drains my heart to see the look on his face because I recognize the fear that he may lose his son and there is nothing he can do but wait and pray. He has three boys. The generator is outside the house, in the garden. His boys are seven, five, and three-years old. They were investigating the generator together out of curiosity. One of them opened the gas tank cap when the fumes ignited. The oldest and the baby had only slight burns on their hands, but the middle boy, who is in our care, caught it full on in the face.

After our failed attempt to let him breathe on his own, he has settled into the ICU for what will be a longer stint than I expected. There are a few small patches of dead skin on his face, but the majority of it looks like there is a good recovery coming. The nurses continue to keep it so healthy and clean. None of these nurses staff a burn center nor usually take care of children at home. It is a high mark of their ability to adapt and innovate that they can provide such skillful and professional care outside of the scope of their usual practice.

Just around the time we were to leave for family dinner, we heard an overhead announcement calling for a surgeon and anesthesiologist to come "stat" to his bedside in the ICU. I ran to the ICU, and I'll tell you that I barely ever run for anything. The staff in the ICU couldn't get enough oxygen in to his system. As you can imagine, it gave his poor father quite a shock to see so many people rush in so urgently. A quick review of his vital signs and the sounds of his lungs showed us that he wasn't so bad after all. But it was clear that the long thin tube in his throat was intermittently clogging with mucus. We carefully and deliberately changed it for a fresh clean one that was a little wider. After a few hours for him to stabilize, I took him to the OR and cut a small hole in the front of his windpipe for a tracheostomy tube. This short, secure tube will be a more direct route to his lungs, and easier to clean than the longer tube. After all his facial swelling goes down, He should be able to heal the cut on his neck quickly.

It's almost midnight now. I got to do the trachostomy with Otorhinolaryngologist B. who is a recent arrival from the states. It was good to see a new face here. He will fit right into the collaborative atmosphere of attending surgeons working together. Back home, the egos would get in the way too often. Over here, the importance and urgency of the mission comes first. And for at least the moment, we will do that mission without out our usual flair.

10 comments:

Anonymous said...

I was so sorry to hear about Maj Olmstead this morning on Yahoo. The blogs people like you and Maj Olmstead write are a great glimpse into life during war. Sorry to hear about the criticism. If it makes you feel any better, we definately see a difference in the priorities among the services here at USUHS. One Army Col said that it sucks to be an AF provider these days compared to the Army. He fully acknowledged the AF's priorities of patient care, access and RVUs. He wasn't saying the care was any different, just that he never thought he would see the day when an AF provider had a worse working condition than an Army provider. Over course he was talking about working at home not deployed. :) I hope you'll can find ways to keep humor in your work and remember how important your work is to the kiddo you help!

God bless,
Danielle

Bag Blog said...

There are those that bring joy into the world and there are those who try to snuff it out. The snuffers are the ones who have no imagination - their lives function only on rules - anal retentive. I try to avoid such people.

May you find new ways to make the snuffers crazy.

lainy said...

My condolences for the loss of Maj Olmstead. What a tragic loss. God bless and keep him sage among His angels.

I understand military policy, but why take all of your fun away?

Loved the SNL clip;)

Hope the little boy gets better soon.

Take care Chris.

Jen said...

I'm sorry that they took away your "flair"...I would imagine that it made things at least a tiny bit better there.

Thinking of the little boy!

membrain said...

They took away the flair but they can't take way the care. Bless you for your work saving lives. That little boy is in my thoughts.

By the way, reading your blog has always felt like you were channeling your inner "Hawkeye".

All the best.

David M said...

The Thunder Run has linked to this post in the - Web Reconnaissance for 01/09/2008 A short recon of what’s out there that might draw your attention, updated throughout the day...so check back often.

Anonymous said...

Thanks for posting that link to Major Olmstead's blog. That was pretty incredible to read; it sounds like he was a remarkable man. I especially approve of all the Babylon 5 quotes he used *grins* and I hope that people will respect his wishes. May he rest in peace.

I just don't understand why anyone would think that a cheerless, flair-less hospital would be a better/more efficient/somehow superior working environment! That's just silly. Obviously, they are not familiar with the Spinal Tap motto. *smiles*

Be safe and keep up the flair!

RRP,
Blanche

ChefSara said...

Rules for the sake of rules annoy me (one reason I never did well in the federal govt. and wouldn't do well in the military either). You guys see so much trauma, death, despair every day, you need the morale boost that people like Hous bin Pharteen can provide. And it wouldn't surprise me if the fun scrub tops bring a little light into the eyes of the patients, especially the kids, that you are treating. Utterly ridiculous!!

TX MOM said...

As creative as you are I fully expect that you will be able to find a way to express your fun side within the boundries and still annoy the hell out of the powers that be...the ones that have no clue how hard it is to treat the little kids of war.

Keep up the good work...I know you are ready for a break. Thanks again for sharing your thoughts and point of view every few days. You have helped me better understand what my family member over there is faced with and how he too is dealing with difficult situations in the litter box called Iraq.

Keep the MASH music playing and know that you have made a difference to many.

HollyB said...

Thanks for the link to Maj. Olmsted's blog. He sounds like an outstanding officer and an amazing person.

To the REMFs hassling my FAV mil. hosp. in ALL Iraq: Get a good solid grip on reality, folks, take a DEEP breath and untwist your Vickies! Try to remember this is a Flippin' HOSPITAL, you know a place with INJURED people in it? The staff, the ones who get blood and guts, and brain and bone fragments all over them don't always have time to look spic and span, you frickin' MORONS!!! And as for the knick-knacks and decorations for which you seem to have no tolerance... don't YOU have things on the wall to make YOUR work space more inviting? Pull your heads out of your collective anal cavities: these people are 7,000 miles from home, missing their fam and friends and you want to take away one MORE thing from them? Go F*C* yourselves, and I mean that as a taxpayer, a voter and a civilian. Go visit my webpage for contact info if you have a problem with that! \Rant OFF.

I mean really...some people need to pull their heads out of where EVER they have them buried so they can see daylight.

You seem to take it in such good humor with just a touch of cynicism. But it really ticks me off.
And I just found out about Despair.com through a friend last week. I LOVE DespairWear and everybody I know well enough to gift this year is getting something from there.Hilarious site.