Saturday, April 17, 2010

More on fried chitlins

I have already confessed my professional ineptitude for dealing with pedi-burns (burned children).  Luckily, we have one pediatrician and one pediatric anesthesiologist deployed here, so they do most of this care, but I do ocassionally get called, and have to break out the calculator...   ..."80mcg/kg for first 10kg, then 5mcg per each 5kg, and pt is, how many kgs?" 

I am happy to report two more relative success stories from facial burns in kids who would have died if for not the American medical support provided them. 

One 18 month-old child had 2nd and 3rd degree face burns, but because of the accompanying inhalation injuries, was intubated for 18 days, and even survived a respiratory code and flatline.  He is extubated and smiling, his wounds are healing, and though he may have some slight scarring at the areas of deepest burning, he will recover nicely, and his small scars may actually provide him masculine ruggedness as he ages.  His largest advantage, beside his medical care, is his mother, who, despite her full headdress and inconveniences of modesty, has slept by his side every night for nearly 3 weeks.  I wondered for a while why his father or others didn't come to replace the mother, and it was suggested recently that they were not welcome.  Indeed, it could have been that they were not allowed to come see the boy while he is on base as they are known to be affiliated with bad guys, or were bad guys themselves.  The mother was allowed visitation, and I know nothing of her beliefs or intentions, but know her gratitude and manners are replete.  Perhaps the outcome of this child will turn some hearts and change some minds, and there will be less bad guys to deliver AK-47 rounds to the heads of 29 year old women the day prior to their birthdays, as happened last week.  [Sending this soldier home 3 weeks prior to her scheduled departure was bitterly ironic].

The other small child with facial burns will have some unsightly scars after a hot oil spill, but she will survive, and soon she will leave the hospital to join her family.  Her mother has never visited for reasons I do not know, and her father, or the man who claimed to be her father, is no longer allowed to visit her, given solicitious and improper behavior he exhibited on his initial visit.  [I was tending to a patient's wound and looked up to see him curiously peering in the wound with a smirk on his face, as if to say, "That SUCKS for that guy!"  He was also found propositioning the nurses - that didn't go over well].  I wonder how she will fare.  The young man I described above will grown in a family that loves him.  I am unsure if he will grow to be a man who loves or hates America, but he will grow to be a man.  This girl, I fear, has a less certain fate, not due to her wounds from the fire, but perhaps from the wounds already imprinted in her mind, and the environment she will return to for the final stages of her recovery.  Do girls with dozens of siblings and half-siblings from one father who has multiple wives receive support she needs to completely recover?  If she does, what happens to young women with scars on their faces who come from families like hers, here in this chaos?

Caring for individuals who have homes to return to in the United States evokes different emotions, but never regret.  We are used to a social structure that has evolved to assist the wounded and ill.  One cannot help to wonder, however, the fates of these local nationals, when it is time for them to go home.  Is Iraqi society prepared to handle them?  Will their family be able to provide what they need?  Paralyzed or severely injuried Iraqi patients released from military hospitals have been know to show up in the Tigris days after discharge; cooly dispatched of by cruel, or maybe just realisitic families who have to ration resources carefully.  The thought of discharging a child like this, and hearing of her found dead in a ditch or river evokes indescribable rage.

As a physician, however, you must handle that what is your charge, and can do only what you are meant to do - in your training, and in your position; you have to compartmentalize.  As a military physician, you must do so within the context of the mission.  There is frustration when the mission changes on the whimsy of a bureaucrat up the chain, but discipline to the mission keeps things together - or that, at least, is what I try to tell myself.

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