Wednesday, June 07, 2006

The Real World Of A Field Hospital In Iraq

I was over at Mia Culpa and found this, I was crying so hard at the end I could barely see my screen. War sucks.
Philadelphia Inquirer | 06/04/2006 | A surgeon at the Iraqi front whose soul is often wounded: "Within a few minutes, the litter team burst into the ETR. The patient's arms dangled off the stretcher with bone exposed, and I immediately knew that this was going to be a bad one. When the litter was pulled beside the bed, I saw the full extent of what I was up against. Driver, I thought to myself. Drivers always seem to get the full force. There is a pungent smell of gasoline and burned flesh.

My first order of business was to remove his body armor before we move him over; to do this, we have to sit him up to pull the arms through the sleeves. When we did, his arms, each broken in several places, flopped around like a puppet's. As we moved him over, I tried to ignore the massive destruction of his legs and focus on potential life-threatening chest and abdomen wounds. He was moaning, actually a good sign: The brain was still getting blood flow. Anesthesia moved to intubate him, as the emergency medicine physician started the primary survey. Nurses started lines, lab was there to bring blood, medics held pressure on bleeding wounds, all in a dance that has been repeated so many times before.


I began to focus on the problem and my plan. Both legs had massive injuries. The left thigh was torn apart and burned with a tourniquet at the groin. The right leg was mangled below the knee with a tourniquet above that. There was a neck wound that wasn't bleeding and shrapnel to the face. Both arms had multiple levels of open fractures. The pulse was weak, and the blood pressure was barely readable.

We hung blood immediately. The chest X-ray did not show any thoracic injury. We shot an abdominal film to look for shrapnel that may have gone into the belly - none. As we moved to the operating room, the hospital commander stopped me to ask if this patient was going to make it. I told him I was worried that once we started to resuscitate him, the bleeding would become even worse; I didn't know whether he would make it. His head dropped as he walked back to the chaos of the ETR.

In the operating room, we started by getting control of the external bleeding of the legs. Blood was coming from everywhere: bright-red arterial blood, dark-blue venous blood, and swirls of the two together in pools between the flesh.

Two orthopedic surgeons and I worked frantically to get control of the bleeding, which, as predicted, became worse as we started to resuscitate him. Anesthesia was struggling to keep a blood pressure, infusing unit after unit of packed red blood cells and plasma. I was going deeper and deeper into the groin to track down the source of the bleeding. Suddenly, my hand broke into a space, and a gush of blood came out. I realized I was in the retroperitoneal space; the bleeding was coming from there. This was the worst-case scenario. Bleeding from this location is the toughest in the body to control. Bleeding from this area is almost always from large veins that cannot be controlled with sutures or arterial control.

We opened the abdominal cavity and clamped the arteries that feed the pelvis, but it didn't help. We packed as tight as we could, and then put a sheet around the pelvis to pull the bones together in an attempt to tamponade the bleeding, but it was not enough. His heart went into a lethal arrhythmia. We shocked him and pumped epinephrine into his bloodstream. After a few minutes, his heart stopped for the last time.

There was an immediate silence in the operating room as soon as I announced the time of death. Most of the staff had tears running down their faces; this was a long year for them, with so many of these kids dying in this room. I could not move for several minutes. I looked at this kid, a child, and I apologized to him for not being skillful enough to save him.

As a trauma surgeon, every death I have is painful; every one takes a little out of me. Losing these kids here in Iraq rips a hole through my soul so large that it's hard for me to continue breathing. After a few minutes, I collected myself and began to direct the care for his final journey home. We closed what we could of the wounds and wrapped the ones we couldn't get together. We washed all of the dirt and oil off his skin, combed his hair and washed his face. He was transferred to a litter and brought to a private, enclosed room where we placed him inside a heavy black body bag. The body was draped with the American flag, and a guard was posted. The chaplain gathered some of the providers, and we said prayers over the body.


The body was eventually taken to the loading zone and loaded into a helicopter with some of his buddies as escorts. He is taken to Baghdad International Airport (BIAP), where mortuary affairs prepared the body for transport home. When the casket is brought onto the airstrip, all personnel stop what they are doing and attend a 45-minute ceremony on the airstrip. They tell me that this happens two to three times a day, but everyone takes time out to attend the ceremonies. An honor guard then brings the flag-draped casket onto the C-130 with full military honors.

In Kuwait, the casket is removed first, again with a full honor guard. The Marine will be brought to Dover Air Force Base in Delaware and eventually home and to his final resting place."
That's the way it is in war and we have been receiving an edited and sanitized version of this war when we receive any information at all. There is always more than one victim and these doctors, nurses and medics have images that we cannot comprehend as memories for the rest of their lives.

How many funerals have Bush and Cheney been to? Any? I thought not. Support our troops by sending them off to die behind closed doors and without civilian oversight, hoping that nobody would notice that we aren't winning.

Bring our troops home now. Please.
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