Wednesday, August 24, 2011


Last night is still clouded in my mind and I’m not sure what the truth is; let me explain.  It was 6:00PM and we received notice that five Afghans were coming to our FST for significant injuries sustained after a probable attack on Taliban forces by an apache helicopter, aka “angel of death”.  No more information was given and we were told an ETA of 15 minutes.  When the two Blackhawks arrived 30 minutes later 2 of the 5 Afghans succumbed to their injuries leaving 3 to administer our surgical prowess.  Charlie Company met the bird and transferred them to us; it was immediately apparent 2 of the 3 patients were severely injured.  The worse one was brought into the FST immediately and evaluated. After about a minute he was taken to the operating room in a concerted effort by all three of us surgeons; the first time all three of us have worked together on a patient together.  Joe and Mike focused on his compromised airway which was significantly damaged by shrapnel, I focused on his right leg first followed by right arm which was mutilated; both had tourniquets stopping blood flow.  I dropped the tourniquet on the right leg and gained control of his bleeding.   It was obvious that this Afghan had a significant open fracture and was already displaying signs of “compartment syndrome” (excessive pressure in the leg from swelling) so I proceeded with a fasciotomy (release of compartment to decrease pressure) of his leg and externally fixation.  Once his leg was stabilized Joe and I focused on his mangled right arm.  Before we started we were informed that this patient and one of the others could be Taliban insurgents. I knew it was possible from the beginning that I might end up in this position but now that it’s before me I was shell shocked as well as everyone else in the OR.  We as physicians take a “Hippocratic Oath” when we graduate from medical school; that oath was being challenged at this moment.  I’m glad there was uncertainty about his insurgency status because it made it easier to follow the course of human compassion. There was really no time to dwell on the possibilities so we marched forward.  His whole right upper extremity was in bad shape.  Joe and I released the tourniquet with adrenaline flowing expecting to have to stop a life threatening outflow of blood.  I gave a count of 3 and then we released it; blood flowed rapidly but at a pace we could regain control in a relatively short amount of time. We worked through the night and in the end likely saved this “uncertain insurgents” arm. No further information could be gleamed through our command about their Taliban status. Would I treat them any different if they were determined to be definitively insurgents? I can’t answer that at this point but I’m sure in the near future my back will be against the wall to make that decision; I would like to think I’m a compassionate person. 
Once we finished it was well after midnight and our patients were transferred out to another medical facility. My well-deserved time of sleep approached and I collapsed into my bed; forgetting to set my alarm.  The result was waking up refreshed and ready for a new day of the unexpected at 9:45AM. Morning report was at 9:00AM, I hope they didn’t miss me too much. 
At 10:00AM my commander got a call there was an unknown Afghan that show up at the front gate of our FOB to see me, I guess my international fame has spread to Afghanistan; not exactly.  I learned this person was a disabled Afghan National Police officer who has been seen here at our FST multiple times in the past for significant injuries sustained from an IED blast 2 years ago.  I agree to see him so after a thorough search by U.S. army MP’s he is brought to the FST. He is here for a follow-up of a chronic bone infection of his left leg, and evaluation of his amputated right leg which is now replaced with a prosthesis.  I was expecting the worse based on past clinical noted but to my surprise he was doing well. I formulated a plan for him which was explained by our interpreter “Rocky”. I assumed he would just get up and walk to the door but I was surprised; he stood up came over to me, put his hand on my shoulder and proceeded to hug me; I was speechless and overwhelmed with emotion. I truly wish there was an “easy button” to push that would end war.  If people would look past government, religion, and conflicts they would realize we are all human; one in the same. I guess I found the answer to my question above.
P.S.  I love you Melissa, Turin, Talon, and Myla.


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