Past few days-quiet. A welcome reprieve from the storm.

I've been spending my downtime reading The Crisis of Islam by Bernard Lewis. He mentions some interesting facts about Bid Laden's comments before 9/11. Muslims are, for the most part, acutely aware of their history more than Americans (this is a vague generality, of course). They rarely identify themselves by geographical location as we do, instead refering to geneology.
I mention this, because Osama Bin Laden declared a call to Jihad based on "what has taken place over 80 years ago." Asking any American at that time what the reference was would have resulted in an inability to answer. But Muslims are very aware of the events early in the 20th century: The downfall of the Ottoman Empire in Constantipole. In 1918, the British empire defeated the last Caliphate, leading to a de-centralized Islamic faith. And after three centuries of weakening Muslim influence and stongholds, Christdom and the Western World in general prevailed.
And now the Western World finds itself in what we would like to call a War on Terror. Undoubtedly, we stive to have Muslims on our side to fight a common enemy, the terrorist. But so far, we have been unsuccessful.....and have been losing ground the last few years instead of gaining.
We need to ask ourselves if the Muslim majority is really with us, or does the seemingly sympathetic view of the foreign fighters and Jihadists reflect their true feelings? I feel I am qualified to possibly add one informed comment on Iraq, and the Anbar Province in particular: The U.S. is struggling to police a sectarian civil war.......we are absolutely caught in a wedge that seems impossible to get out of. It wasn't our original intent, but is the paradox we currently find ourselves in.

Our dangerous dance

Update: the patient we tried so hard to save quickly died after arriving at Baghdad hospital. He's in a much better place than we are, to be sure.

This brings me to this post's topic: Resource Management. The team has spent a lot of time talking about how to manage trauma over the past few weeks. Taking care of patients in this austere environment is much different than treating the same patient in the United States....supply is always a consideration, but out here supplies become downright precious.

Besides dealing with trauma and loss, the next hardest thing we have to face out here is the judicious management of resources.....

We just want to do the right thing: we are trained to save the life....and giving up is the last thing to cross our mind--ever. But we have had some heavy debates over the past few days, and had to set some unfortunate boundaries and limits. When we activate the walking blood bank, we are taking potential future donors out of the picture for two months....activating it twice in one day for the same patient is unheard of. One false move on our part, and a future blast or gunshot victim with very treatable injuries may die weeks from now because of a futile decision we make today.

Deciding who gets the resources and who doesn't forces choices on us that quite frankly we just don't want to make......it has deep and lasting ramifications for a trauma team that just wants to "do good", but especially for the patients and their families and friends back home.......the fact that every decision we make out here has consequences one way or the other is constantly on our thoughts.

Carry on, Old Glory

Pictured in front of our barracks is Jeff, an old acquaintance of mine from Portsmouth Naval Hospital. He's an orthopedic surgeon, and was part of the trauma team we just replaced.

Jeff was the barracks officer, and worked hard at making some improvements, including the addition of a flag pole and a flood light to fly our colors 24/7. I have taken on the responsibility of displaying Old Glory from Jeff......and it's been another welcome diversion from shock/trauma.

The flood light wasn't working when I took over the job, and Jeff and I got that fixed the day before he took the freedom bird home. That night, a wicked sand storm kicked up, and broke my flood light within two hours.....back to square one. I got it fixed again two days ago....so far, so good.

Abram's oasis

Al Asad is located just a few short clicks from the Euphrates River about 180 kilometers due West from Baghdad. This base is built on a historically biblical site.......the local population has maintained for thousands of years that Abram, Sarai, and Lot stopped here and camped a short time while travelling from Ur to Haran. This spot is so revered, that it is one of the reasons Saddam Hussein built his premier airbase here. It is well known that he spent a lot of time on this base, and used it to train Iraqi Olymic teams alongside the military.
The oasis is tucked away on a protected area of the base, and is only a two mile run from the barracks. Standing here felt surreal.....what a priviledge to have somewhere quiet to retreat to from time to time that is sacred to Christians, Muslims, and Jewish faiths alike.
The picture can only capture a fraction of how beautiful this spot is.....I can't help but be struck by the beauty of the desert here........the date grove surrounding the oasis is lush, full of color, and bursting with life.

This is how we roll

My day typically starts in the afternoon, and carries on until the job is done. Our first patient arrived around 3 PM: multiple penetrating trauma from IED blast. By the time we got him off the helo and scrambled to shock/trauma, he was unresponsive......and pulseless. Our first clamshell (cracking the chest open to access great vessels and the heart quickly) of the day....and it was futile.
6 PM: We put the call out for all medical personnel-mass casualty inbound in 15 minutes! Two helos land simultaneously with four patients. Does anyone have to guess IED's at this point? Two more clamshells and 20 minutes later; two more fallen angels. My patient was devestated, but alive. Multiple penetrating trauma to his abdomen with fragments blown out his back.....legs flopping around from shattered femurs. His left hand? Nothing left. He came in initally responsive, and the surgeons wisked him first to surgery within 10 minutes (we already completely exposed, lined (large bore IV's) him, and intubated him within 2-3 minutes). Three hours later, and we had initiated the walking blood bank not once...but twice. For those in the know, I give you the following: He initially got all the packed RBC's we had (10 units). Following that, he received an additional 36 units of whole blood (this is not a typo: 46 total units of blood). We also gave two doses of factor VII (rapid acting clotting factor). In no way can I describe how tenuously he clung to life......our flight nurse just got back from taking the patient to Balad, and said he never worked so hard to keep a patient alive in his life..........
It's 4 AM and winding down. I'll be up at 7 AM for laundry turn-in (of all things). Formation at 8 AM for weapons and flak/kevlar accountability. Then a few hours after that: we roll all over again. Shock/Trauma goes back to work....
Can I just say that nothing, I repeat nothing, would have fully prepared me for this. The chaos, the mayhem, the disorientation of so much devastation pouring in with such regularity.

Faith...

Luke 14: One Sabbath, when Jesus went to eat in the house of a prominent Pharisee, he was watched carefully. Placed in front of him was an ill man. Jesus asked "Is it lawful to heal on the Sabbath or not?" But they remained silent. Jesus healed the man, then asked "If one of you has a son or an ox that falls into a well on the Sabbath, will you not immediately pull him out?" And they had nothing to say. To paraphrase Jesus' message of Luke 14, He again caught the Pharisees in a paradox.....and blasted and exposed how their strict interpretation of Sabbath and rules couldn't possibly be adhered to.....by anyone.
I heard a sermon once on Luke 14, and I quote the pastor saying "religion is one of the most dangerous things in this entire world." He started with this, and immediately had my full attention. I ask you to think about that statement....does it give you the same pause it gave me? His message: religion can be consumed with (and hindered by) sacrament, ritual, traditions, and rules. Now I ask you to think about how religion can be the most dangerous aspect of all mankind. This is when I came to the realization that religion is different than faith. Simultaneously intertwined....yet in a way also exclusive of each other.
I thought about this sermon and Luke 14 yesterday in the middle of trying to save a young school boy's life. The boys took a shortcut home from school, and it just so happened to be a common convoy route......they weren't so lucky. Four died instantly before we could get to them. Two made it to shock/trauma alive. Despite cracking open his chest, we lost another precious child in our arms. And it all makes me wonder why? In what name do the insurgents operate by? And I just keep thinking of Luke 14.....and how religion is playing a role in tearing this Country apart..........because it sure isn't the shared faith that we believe in the same loving God.

Imminent Move

Getting what seems to be a rare chance to add an entry. The hospital has been busy, and the en route care nurses are flying every day. There are five of us, and we take turns being "on call" for 48 hours. It isn't my turn to fly again until next week. Those that are not on standby to fly staff the shock/trauma bay and recovery/ward. When trauma comes in, we get a heads up, and usually it's an "all hands" effort. Every spare pair of hands is needed.
The sad reality is that there are IED blasts every day. I can't go into details due to security concerns, but we have unfortunatly received some high level patients recently.....these men continue to dedicate their lives to the security and wellbeing of Iraqis at the expense of their own health. Inspiring and humbling to all the staff. We are taking in patients every day and the hospital is humming with activity. Everyone is doing a fantastic job, and we are gelling together as a team very quickly.
Also, the Army has almost competed a Level III hospital (we are a level II....less diagnostic capability) right next door to us. They plan to be fully operational soon, and this will shut us down. The plan is to re-distribute us somewhere else in-theatre to "beef up" other Level II camps. Right now, my frontrunners are Ramadi or Falluja, but it's all just a big question mark right now.
Other than working, I have been catching up on my sleep and trying to keep myself healthy. The past few days have been rough, and I've been feeling a little under the weather. Hope to bounce back soon.......

I have updated the photo gallery and made some additions if you haven't taken a look in the past few days.
Also, I always make a little time to read the comments (thank you all!) but may not have time to address everyone individually on the blog itself. I have much better access to my military email account. Please drop a line when you get a chance......especially if you have questions about a post, or just want to say hello.
carl.goforth@acemnf-wiraq.usmc.mil