Operating in the Dark

Twelve year old girl and her brothers were playing around the house, and she was accidentally shot with an AK-47. We don't know the specific circumstances of why or how it happened. It just did. Nor does it matter to us, of course. Not part of the job description. We are here to do all we can irregardless of who, what, how, or why.

The bullet ended up causing some internal damage. Double chest tubes were placed and open abdominal surgery was performed, including liver and stomach repair. Stable for the case but critically ill, she needed immediate MEDVAC to a higher level of care. At the level III hospital, they will be able to perform diagnostic tests that we just can't perform at Charlie Medical, such as an extensive CT scan looking for subtle damage and/or hidden bleeding that won't be found unless you know exactly where to look.

Little known fact: Ar Ramadi is run entirely on generators. Every light bulb, DVD player, TV, you name it is run from a generator. Walk anywhere on base and you will quickly notice the maddening and inescapable drone of a nearby generator. Unlike the stable power grids in Western countries, generator power fluctuates, causing routine brownouts and surges. Brave is the soul who uses a computer on Ar Ramadi without surge protection. Generator power also happens to be a lot less reliable. The picture below was taken as the power went out during the middle of the case. "Grab the flashlights" RH quips as one of the corpsman runs outside to start the axillary generator for our lone OR light. Monitors and anesthesia machine had to rely on battery backup for 20 minutes while we waited for power to be restored. As for our case, not a beat was missed. We kept right on operating in the dark.

Stable for the flight to Al Asad, I was able to give a liberal amount of pain and sedation medications to keep her comfortable for the helo ride. The image below was taken in-flight. I have her in a protective bag we refer to as a "hot pocket" to prevent evaporating heat loss at altitude. The doors are all open, and a lot of air is streaming through during flight. Oxygen tank slipped between her legs, I have the ventilator and monitor placed on a folded blanket pad on her lower legs. We are ever vigilant to ensure anything placed on the patient has thick padding to prevent any discomfort. I left myself an IV port taped on her shoulder for quick access as I give blood and medications during the flight. Just off to the side is my flight bag, an extra oxygen tank, and a portable suction unit. No time to sight see during the flight. It's an endless loop of assessing vital signs, ensuring the ventilator is working correctly, the oxygen tank isn't empty, and checking her to make sure she is comfortable and isn't waking up. For her to awaken in this environment would be a frightening, disorienting, and frustrating experience......so I do all I can to keep her peaceful and blissfully asleep for the ride.

After dropping our patient off at the medical helo pad at Al Asad, we fly directly to the "fuel farm". Aircrew told me repeatedly we were "on fumes" as the helo sat on the medical pad, resulting in a mad dash to grab flight equipment and make a run for it. After a top-off, we race back to Ramadi with the Cobra Gunship close behind.

A hot and hazy day in Anbar. Put a little damper on my ride back, since I was hoping to take some pictures. This was my second time flying to Al Asad during the day, and I'm already starting to see some familiar landmarks along the route, crossing over the Euphrates River several times. The desert is made of endless swaths of flats, dunes, crags, and ranges of rustic browns and tans. But for all of her beauty, she is still devoid of greenery or overt signs of life. The only exception being the major bodies of water: lakes, rivers, and their tributaries. Anything small just evaporates in the torrential heat. In these select and reserved locations the desert wells up and seems to burst with life. Thick foliage and luscious date groves reveal a vivid palate of colors as they cling tenaciously to the river bank. Beautiful..........

Surveyed a few homesteads clustered close to the water banks. They have taken advantage of the fertile strip of land running parallel to the water and are actively cultivating small orchards and tending farms along the Euphrates and small tributaries. A lack of equipment, and possibly know how, is preventing any of the farmers from truly efficient irrigation farming, the modern day practice of storing water to tightly control soil saturation. Instead, they have either fallen back, or never stepped forward, from flood irrigation. At least once a day, the family turns out for the "bucket brigade" as they form a chain a short distance from the river to their crops. They just fill the buckets from the Euphrates, and dump it on the fields. Despite the hardships the Iraqi people endure, an encouraging sign that life sustains and thrives........with suffering comes perseverence. With perseverence, character. And with character.......hope.

Update: I receive many curious inquiries as to how our patients fair after they are taken to a larger hospital. The surgical team keeps tabs on patients two ways. First, we have a computer program on a secured terminal in the office that allows us to track patients not only in-theatre, but all the way to Landstuhl or the States'. Second, our surgeon calls the accepting surgeon the day after. He will call daily if the patient is serious or unstable, then passes down patients' status to the rest of the team.

The little girl I flew to Al Asad is doing great. The CT scan showed a little fluid collection around her liver, which is to be expected considering the injury. She went back to surgery the next day and was weaned from the ventilator the day I brought her. My friend at Al Asad emailed and said our girl instantly became the ICU princess.