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.