Monday, October 31, 2011
We made the most of a pointless holiday in a foreign country, on a base where children are not allowed. And we had a great time. During the daytime, a bunch of us from the Forward Surgical Team went reverse trick-or-treating, knocking on doors and handing out Halloween bags of candy. Americans, Polish, Afghans, and others all got some candy. It seemed like most of the locals had been here long enough to understand that October 31st means free candy.
Later there was a Halloween party at the dining hall. I expected very little from it, but I thought I should go out of social obligation since the staff had worked so hard decorating the place. Those of you who remember my teenage years will not be surprised that I was among the first on the dance floor when "Ice, Ice Baby" was played. Did I request Billy Jean and do the Michael Jackson dance, throwing my military cap to the side after a high kick? You KNOW this!
Wednesday, October 26, 2011
We rushed him into the operating room to control the bleeding from the main arteries to the legs, both of which were torn open. The surgeon firmly took the hands of a terrified 22-year-old surgical technician and placed them around the patient's heart, talking him through how to squeeze the heart as the surgeon himself placed a clamp around the aorta, and hurriedly sutured the arteries. And so I found myself trying to reassure this kid who joined the Air Force to be a mechanic, "Keep it up, you're doing great. I feel the pulse in his neck when you squeeze like that. Good job." "I don't know what I'm doing! I'm scared s***less!" was his panicked reply. Even through the surgical mask, I could tell the color was gone from his face. So I tried my best to help him see that he, more than any of the doctors, was keeping the patient alive.
Soon freshly drawn blood arrived, some of which was from the base commander who happened to be the same blood type, and some from his buddies on his team who were with him an hour before, when he found a detonation wire for a bomb. Perhaps the enemy wanted him to find it so they could shoot him from their sniper holes. I imagine some of his buddies were the ones shooting back, and some were the ones carrying him to safety, but they were all there to try to give blood.
Even with all the blood I gave him, and many kinds of heart medications, his heart just wasn't squeezing enough on its own for him to be stable for long. I gave him what little anesthetic medications I could, and found myself talking gently in his ear. "Partner, I'm so sorry if you're feeling any of this. We're doing surgery on you, and I can't give you very much pain medicine right now because your heart is too sick. Just hang in there." The other anesthesiologist is my friend and a devout Christian, so I asked him to pray quietly with me. We asked God to bless this soldier so he won't hurt, bless all of us taking care him to know what to do, and bless his family back home. Then we quickly went back to infusing blood as fast as we could get it from the many volunteers.
When the wounds were all repaired, they sewed him back up as I gave him more and more heart medications. We took him to the recovery room, and the surgeon asked me,
"Is he stable enough to fly?"
"He has a chance, but the longer we wait, the lower it is."
"That's not the question- can he fly or not?"
Well, if I'm going to err, it's on the side of optimism. "Yes. Send the helicopter."
The helicopter did not even have time to get off the ground from Bagram. I was wrong. He was no longer responding to the heart medications. I can't tell you how hard it was to say, "Cancel the helicopter. Stop giving the blood; we have to have save it for someone it might help. Tell his friends outside to come in and see him because he is going to die soon." I hate this decision. The surgeons have done all they can do it fixing his wounds, and it's my job to say we either keep trying to make his heart beat or declare it futile, and save resources for others. I know it's the right decision. And that doesn't help at all.
His heart kept trying to pump for few beats at a time, only to get weaker afterwards. We turn off the loud things like the suction machines and ventilator to give his friends a more dignified setting. I breathe for him quietly by hand and ask my collegues to help me clean him up a little bit before his friends come in. We can't look at each other because we are in varying stages of holding our emotions together. I tell the patient how proud I am of him, how I have a family back home that is safer because of his bravery, and how he is surrounded by friends that love him. I don't know if he can hear me or if it helps him. It helps me.
One by one, leather-skinned, battle-hardened soldiers come in. Some kiss his forehead, then have to walk out because they are overwhelmed. Some stay and talk to him, and caress his forehead or pat his shoulder gently. One of them is the other patient on his way to the operating room for his own surgery. They place their stretchers side by side, so he can reach his bloody, bandaged hand across the gap to touch my patient's face and say goodbye.
My co-workers ask me if I need a break, but understand when I tell them that I want to be there with him through everything. I feel his pulse stop, give him his last breath, nod silently to the nurse to note the time, and let his friends know that we'll step away to give them privacy and time.
I went to the ramp ceremony tonight, where they load the coffin draped in a flag onto the helicopters. No bright lights are allowed to prevent enemies in the surrounding mountains from knowing people are gathered. I can only see a few feet in front of me, but the sobs and shuffles on gravel from many directions tell me that much of the base has gathered here. We render salutes to a hero's body hidden in the darkness, carried by his friends. "Somewhere up there is the soldier I spent the day with," I think somberly to myself. Soon we hear the roar of helicopter engine, and I see blurred silhouettes of two helicopters rising in front of me. A brilliant flare in the sky makes them invisible, and renders its own dazzling salute to the fallen hero. The desert wind sends a chill, and everything inside me feels cold.
Thursday, October 20, 2011
Monday, October 10, 2011
Wednesday, October 5, 2011
Men and women process stress differently. After a difficult week, the women did a lot of talking, and discussing, and sharing feelings. And yoga.
We men are not that sophisticated when it comes to stress. We went to the shooting range and fired at water bottles, plywood silhouettes, and a poor stuffed Teddy Bear, or as we named him, the "Tali-bear."
This is a video of my tactical charge. The Army commander of the base caught up with us at dinner at said "we're not going to have the doctors unsupervised on the firing range any more, OK?" Yes, sir. But that bear has it coming to him...