Memories

I sent a 24 year old home on the ventilator last night.  He has a ball bearing in his cervical spine, and no ability to breath on his own.  He will likely die within the year, with injury worse, and resources less, than Christopher Reeves. 

A young woman's neck was ripped open by rocket frag, and she died in the emergency room a couple of months ago.  Another was shot in the base of the skull and died in the OR in heroic attempts to put his brain back together.  A young man who was rescussitated with 10 hours of abdominal surgery and 20 units of transfused blood was found brain dead from the closed-head-injury not noticed until the aforementioned surgery was complete, and the head was scanned.

Post-call, I had the day off to go exercise, sit in the sun, read a book, watch a movie; a juxtaposition, on the day to remember these, and the countless others who died, and continue to die, here, and in Afghanistan.

Memorial day had always been a day of historical references: broken black and white film of bombers over Germany, the famous flag-raising photo from Iwo Jima, a video clip of a man running through the bush, and rapid fire of Viet Cong to an evacuation Huey in a jungle clearing.  During the OIF/OEF there have been clips of rehabing amputees or kevlar-laden soldiers and laughing arab children, fading to a longitudinal, diagonal view of headstones at Arlington or Normandy all to the backdrop of America the Beautiful. 

I lost a handful of acquaintances and friends over the past few years to the wars, and I do think of them on days of remembrance, but their passings were sterile and distant, despite surely shocking and painful.  Memorial Day will be a time I will remember the smell of burnt flesh and blood, the high-pitched steady ping of the heart monitor reading asystole, the silent ceremony for placement of the folded flag upon the chest of the HR (human remains) before zipping up the black rubber bag.  The dominant images in my mind, and the most poingant memories will be of those who were carried into the hospital with life already all but gone, those I pronounced dead, those I struggled to heal, but failed.  For those, I salute.

Tarred and feathered

I am officially off of the nightshift, ready to rejoin the living!  So, in the morning on my post-call day off, I showered at the hospital and began my walk into the day.  Quickly, I generated a reasonable sweat in the 95 degree morning air under my all-season wear ABUs (Airman Battle Uniform = USAF for camouflage).  I was swimming through and tasting the dust within the thick air; the opaqueness of which explains why I walked around a corner, downwind - a very steady, fierce wind - from the poop truck which was vacuuming its targeted contents, while another South Asian contractor power-washed the innards of one of the many PortAJons littering the base.  The fetid mist ricocheted onto what had now developed into an adhesive slurry of perspiration and dust coating my exposed skin. 

I have been tarred and feathered, Iraqi style.

Tomorrow will be better.

Lucky Joe

The overhead intercom announced "Trauma times one to the ER.  Trauma times one to the ER."  Shortly thereafter, and prior to the arrival of the pending "GSW to the face," there were 15 docs, nurses, and technicians geared and gloved up awaiting the helicopter. 

As the Blackhawk landed outside the door on the helipad, everyone assumed their positions:  ER doc to the head of the bed, the surgeon and I at the foot, the nurses and respiratory technicians on each side awaiting or gun shot victim.  Then, nonchalantly, the medic from the helicopter walks through the door aside a man with a bandage around his head, and a large compress of gauze held into place against his left cheek. 

Someone ran around the corner to grab a bed - for this patient did not come in on a gurney or litter as per normal, but walked in, on his own accord.  We waited for the bed, and in those few seconds, the ER physician and he had the following conversation:

ER MD:  How are you?
Patient:  Shitty.  My face hurts.
ER MD: What happened?
Patient: I got shot in the face.
ER MD:  Did you lose consciousness or fall?
Patient: No.

The bed arrived, and the patient, again, who walked into the ER holding his face as if he had a toothache, was layed supine where a complete survey of his body was done in less than 1 minute.  His pants were cut off, though he walked into the ER, as soon as he layed down.  He was examined, radiographs and blood samples were taken.  He had a rectal exam, and something close to the following ensued:

Patient: Why are you checking my rectum?
ER MD: This is part of what we do in the evaluation of trauma patients.
Patient: Yeah, but I just got shot in the face.  Not in the butt.
ER MD: I understand, it will only take a minute.

It turns out that a sniper had shot this young man but only entered the left side of his cheek, with the bullet lodging in his sternocleidomastoid on the same size.  He is a lucky Joe.  So, we often get these patients from the front lines with no real background story, and there has to be a systematic approach to trauma patients, in order to avoid missing things that are catastrophic if not attended to. 

That said, this is pretty absurd.  And damn funny.

Run, Forrest

We run for different reasons, but anyone who spends any appreciable time running stops, at some point, and asks, "why am I running?"  Forrest Gump ran a few thousand miles before it occured to him that his means had no end, and in the end, he did not understand the means.  Haruki Murakami wrote a book about the less obvious utility of running - Things I think about when I think about running, averring the clearness of thought, and tranquility his daily run has brought to him.  Clearly, running is more about getting from one place to another quickly.

Maintaining the mental and physical stamina to continue running through the parenting years (also the career building years) is undeniably difficult, and in the case of the author, was a failure.  From marathons and sixty miles on my feet a week, to arthritis and sixty miles of driving a day.  Being here has allowed me an unfettered opportunity to slowly overcome the orthopedic ravages and sloth and return to Murakami's running zen.  This is an exaggeration.

However, there is no beer here (at least no quality beer with alcohol), you walk everywhere, and, most importantly, there is nothing else to do, except exercise.  [The list of leisure activities has been well vetted on a previous blog: exercise, reading, movies].  So, outside of the 60 hours a week that I am at my job - and the slowing pace of incoming traumas has allowed for this working pace since I have been here - there is always time to exercise.  Admist the weight training that the rickety shoulders and knees tolerate, I am on the treadmill, and slowly reducing the spare tire (have gone from p195/75 R16 to p185/65 R14 thus far), and my R-Zen is on the horizon.

Even when you have accepted your fate in this minimum security prison (see previous blog), and you have agreed to make the best of your sentence, ennui looms large (btw-can ennui loom?  or be large? ??).  This is not a unique phenomenon, or a surprise, I guess, as this is the military.  There are, however, nearly weekly 5k running races (universally won by one of the east African gazelle contractors here on base) with hundreds of entrants, sometimes thousands.  Maybe they just want the T-shirt, but I think that they are looking for  clear minds and their own R-Zen(s).

Power up

The hallways in the hospital have been dark tonight.  Air conditioners are turned warmer (or off).  The base stopped carrying the AFN (Air Force Network).  There was an initial request to reduce power consumption, followed by a second, more forceful message which basically said, "if you don't, we're gonna 'insert-punative-action-here'."  Just like anywhere else in the world, people are very slow to voluntarily reduce their power consumption.  If they weren't we would not be talking about global warming as much as we are.

The military, is a dictatorship, however, and punative actions happen regularly to meet demands.  Often the demands are mutually exclusive; for example, "double your output, and half your work force."  In this case, continued power consumption at the rate the base was using was not commensurate with the amount of fuel left to burn.  So, when everyone (not me, as I avoided doing my laundry and wore dirty clothes to save warming wash water and powering a dryer) ignored the warnings, the electricity nazis sprang into action.  Some Army battalion commanders just shut off the power, making surly infantrymen even more so.  Granted, that was an easy fix, albeit Draconian when the temperatures are over 110 degrees.  The kindler, gentler Air Force commanders have assigned squandron superintendents to reduce consumption, in a more nuanced fashion.  This explains why only the emergency lighting is turned on right now in the hospital.  It also explains why the hospital is 28 degrees Celsius.  This is ok when you are dressed in scrubs.  The fevering patients are not pleased, however.  [It is striking that everyone of the 200+ CPUs in the hospital are cooking all night, even though only about 20 need to stay on for the nightshift.  The hilarity of this was not lost on this author who was told by the "systems" people (see tomorrow's blog) that shutting down the CPUs was a bad idea as the network links would be irrevocably lost.  Why, you may ask, would a network connection be forever lost because the computers shut down and turn back on in the morning?  They couldn't explain this to me].

I digress.  Power has been spotty, except for mission-essential (weapons systems, hospital, planes), due to this shortage, but not bad overall.  Again, nothing to complain of in the scheme of things.   It does make one wonder why we don't have an overabudance of solar power given the abundance sun here, but I guess for the same reason Arizona isn't off the grid.

Life, limb or eyesight

Friday is the Muslim holy day.  On May 21st, it was a pleasant evening in Khalis, and a crowd of locals were relaxing outside of a coffee shop in the busy market, enjoying the change in weather.  A vehicle containing an improvised explosive device exploded in front of this crowd, and destroyed many shops.  The blast killed 30 people, and left another 4-5 dozen injured. 

As this town less is than 15 minutes from here, we started to receive report that the bulk of the seriously injured patients were on their way here.  This caused an initial panic, and in the end we only received 2 of these patients, one who had minor injuries, and ther other, who came to our ER pulseless, had his leg amputated, but who is now eating breakfast and happy to be living.  There were rumors that the road and bridge over the Tigris from Khalis to this base was blocked - presumably, by terrorists - but I have no idea of whether or not this was the case. 

Given the quality of care we have provided for many Iraqi citizens here, we have daily requests from outside of the gate for admittance and care at our Joint Theater Hospital.  Obviously, we are not set up to become a local trauma hospital (or community hospital for that matter) for ill and injured Iraqis, but the policy, as stated by people above me who make policy, is to accept only patients from the community who arrive at the gate with risk to life, limb or eyesight.  The same day as the aforementioned bombing, for example, a head-on collision just in front of the base led to 5 trauma patients (all of who survived, and 3 of whom have already been discharged) come in to our ER simultaneously. 

The "life, limb or eyesight" policy has its holes, but does, at least, provide some humanitarian assistance to truly urgently ill patients.  It is a tough call for a 20 year old Army medic to make, however, with only a walkie-talkie to the ER to help sort through information.  Head-on collisions, for example, are particularly dangerous, and lead to high-impact low-survivability trauma, so taking these 5 patients from the accident, when only 2 of them really ended-up having urgent needs, is acceptable.  There are those who try to game the system, as you might imagine.  Patients are sometimes driven to the gate, unloaded from a still-moving vehicle (sometimes supine from a pick up truck), as the delivery vehicle speeds away.  When this happens, the patient often has IVs and a name bracelet from another local hospital.    We do what we can for these people, but you can imagine how this makes steam come out of my bosses ears.

And it can lead to confusion.  A young burn victim who alights himself making a bomb gets free admittance and care, but an infant with a potentially fixable birth-defect, may be denied and returned to the hands of a sobbing mother, destined to go without a life-saving (eventually) procedure.  Children with cleft lips are turned away, even as our head and neck surgeon has no planned cases.  Though all of these decisions are made through reason, and with the best interests at heart, many people - outside of the gate, and within the hospital - cannot reconcile these decisions.  Sometimes, it is the greatest challenge to win hearts and minds.

Generally speaking

One of the benefits of working nights means that you aren't around during the day.  Particularly, here, that means you miss the Dallas Cheerleaders or Hooters girls when they come through, but you also miss the visits from the DVs.  Distinguished Visitors (DVs) are the military equivalents of VIPs, and they often are not distinguished, but they are almost always General grade officers in the military, or civilian equivalents.

We have had Iraqi and American legislators, governors, heads of agencies (eg. Red Cross) and all of the paparazzi-worthy military (eg the guys you see on the evening news).  This week General Green, the 3-star general in charge of the USAF Medical Corps paid us a visit.  He is supposedly a nice guy, and approachable enough.  I have heard different things of General Odierno, the head of the military in Iraq, who was due this week also, but canceled do to something, undeniably more important.  I lack firsthand experience with any of these people because I come to work at night.

The funny thing about their visits, however, lies in the preparation dedicated to each of their visits.  The "Bio" or CV for each DV comes via email to the whole installation prior to their visit.  If the DV is important enough, we are usually also sent instructions on how to act with a reminder to hold our backs particularly straight, and have our desks particularly orderly.  There is a literal red carpet that sometimes comes out (though I have not seen this here in the AOR) - as if they came to receive their Oscars - and their are near life-size portraits of these individuals on placards at entrances to the building.  Each duty section selects a particularly spiffy, well-put-together individual to give a prepared 30-60 speech about the capability of their duty section; "Our patient wards include 20 beds with the capability to expand to 40 beds in the event of a mass casualty..."  Laughing, visibly, within the line of site of these individuals during their sermons is considered poor form.

And then, there is the entourage.  The aide-de-camp, the public affairs official, the body guard(s); the more important the DV, the larger the entourage.  This gaggle always includes the local commander, or in the case of the less important DVs, the vice commander.  Rounding out the entourage are the chief master sergeant (top enlisted person) and the local superintendents (the top enlisted persons aside of the chief - whose jobs are most amorphous), and a token soldier, seaman or airman who either suffered a battle injury, earned the Medal of Honor, or represents an underrepresented ethnic group.  Sometimes, the Chief gets lucky and finds someone who can be all 3.