Sunday, June 13, 2010

Weeping heart

I have been told that this war is over by many people here and back home.  On the muslim holy day, Friday, a platoon of American soldiers were lured to investigate a bogus grenade threat in northeastern Iraq.  When they went to re-enter their vehicles and return to their rally point, a suicide bomber drove a car full of explosives into them, killing 2 Rangers, 2 Iraqi civilians, and injuring dozens.  Seven of those injured from the targeted platoon came to our trauma center.  All seven are alive, and they will all leave this hospital without unrecoverable injuries, and with all 4 limbs.

We cared for the troops, several of whom ambled, with lemon-sized shrapnel in their legs after the explosion, as much as 50 yards from where they were targeted to the transport along tortuous, crowded city streets, and back to a safe landing area for their helicopter.  Once on the Blackhawk, they were kept warm, resuscitated, and bandaged or torniqueted as necessary. They arrived to our ER where 50 waiting doctors, nurses, and techs were arranged in 7 physician-run patient care areas.  The platoon leader, a 30 year old lieutenant, was triaged to me.  I quickly assessed him; all the while he screamed, not for pain, but in anguish for what he knew were his lost soldiers, and in desperation for the wounded aside him.  

Calming him with talk, morphine, and ultimately, a stern order, I was then able to glean the story related above in which some devious assassin set a trap and killed our soldiers in a war that is supposed to be over.  It took me a moment to suppress my anger and gather myself after this.  Yet, I continued with his assessment, and organizing the efforts of my team in his care.  I shot lidocaine into a dozen wounds in his legs, carefully excised, and then filled a specimen cup with shrapnel.  He will recover fully from this and his significant, but relatively simple, orthopedic injuries; barring any findings on film that were unforseen on his exam, he would have escaped this tragedy unscathed, at least physically.  Wickedly, fate revealed a tumor in his brain, incidentally found on the CT, and compounding the anxiety of the day.

Our surgeons spent the night repairing a mangled arm of the most sick individual.  His radial artery was severed, and the trauma surgeon was, amazingly, able to harvest the saphenous vein (much like a cardiothoracic surgeon would for a bypass), and use it as a vein graft for the decimated radial artery.  We spent the better part of the day completing his resuscitation, and controlling his pain.  He was extubated, clear to his surroundings, moving his injured hand, anxious to hear of his brothers.  With pride and ease, I was able to tell him of his 6 healed, and healthy comrades.  Watching his eyes when I told him of the others who had fallen, tore away at my own soul, as my heart weeped inside my chest for those we lost after a war had supposedly ended.

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