Ortho/Trauma Team

Ready, willing, and able. You call, we answer.

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Some days, more than others, we just want to come home...

http://www.youtube.com/v/ervaMPt4Ha0

Day Flight

Flew my first day mission a few days ago. Iraqi Police came in with a gunshot wound to his abdomen. After three hours in the OR, we had to remove his spleen and part of his pancrease. There was shrapnel lodged near his vertebra, but we were able to safely remove it without causing any neurological compromise. He ended up losing a lot of blood before and during the case, and we couldn't wait until nightfall to fly him to Al Asad.

D squared, Eric, and Mark helped me package him up for the flight. Then I drop the "nine line" with the evacuation team and we wait for aeromedical evacuation support. If it happens to be a day flight, the Marine Corps takes responsibility and will usually send an H-46 Sea Knight. At night, the Army responds with a Blackhawk that is specially outfitted with an "H carousel" for medical evacuation.

Sure enough, as the little black dots race into our helo pad, a Sea Knight touches down so I can fly my patient to Al Asad. As an escort, a Cobra Gunship touches down next to us.

The patient was stable for the flight. He isn't out of the woods, so to speak, but we have a good feeling he will do well. The Army 399th CSH at Al Asad is an impressive facility with dedicated staff and deep resources.

The Iraqi landscape is beautiful, and I was thinking about how I finally got the opportunity to see it in daylight. Too bad my camera batteries died on the helo pad right before takeoff. The photo ops would have been excellent on my return flight, since my only responsibility would have been to sight see.

The desert from 2000 feet in the air looked like a scene from the movie Dune. Every conceivable shade of tan, with burnt orange streaks running through numerous steppes and crevasses as if it were trying to carve out its own existence. We stick to the decidedly unpopulated routes for obvious reasons, but can't completely avoid small villages and outposts. I saw a few bombed out abandoned homesteads, but also saw a few outposts along a major highway that were thriving with activity and trucking. Most of the architecture is simple: concrete block or other hardened material. Others, however, were quite striking: they looked inspired by the Georgian Revival style. Two story with a large oval overhang from the front supported by 4-6 colonnades with a grand porch mirroring the overhang.

Cobra gunship flying as our wingman. He's to the right and just aft (behind), occasionally veering off to evaluate potential threats. The sun is positioned perfectly, and I can see both of our shadows silhouetted on the desert floor as we race along to Asad.

Another interesting sight was an abandoned train station. The station itself was completely intact, having escaped damage from the war. But the access road from the main highway had craters from rockets that perfectly prevented a vehicle from passing from the road to the station. I was thinking about how it was going to be cheaper and easier to repair the road compared rebuilding the station......I'll take the little victories along with any big ones that come our way, too.

VBIED's rock Ramadi

Sitting at my desk writing letters after lunch when the biggest crunch yet flings things off my shelf. D squared and I look at each other for a milisecond, jump up, and run out of the hut to go to Charlie Medical for our flak and kevlar. We take a quick look up and see the plum of smoke just a short distance past some barracks.

I jump on the HESCO barrier and snap a quick picture, D squared on my heels. "You know we are supposed to get our asses down when we hear an explosion, not climb shit to see what's going on!" I say to him. He laughs, and we mock our own stupidity as we make our way to the hospital backside. For those who now want to throttle me: the detonation already happened......trust me, I hear whizzing overhead I'm not the guy looking over the berm for a peek.

"VBIED attack right outside the gates. At least a dozen patients in route." the Army TOC says. Radios are crackling and humming to life as information starts pouring in. Better go drain the bladder; bad guys just ruined my day. Within minutes, patients come in groups of 2-4 on M-113's, Iraqi Police Vehicles, and humvees. I start roving around like a hired gun: sticking IV's, airway managment, initial assessments, pushing drugs, hanging antibiotics, pulling patients out of vehicles, preparing intubated patients for flight. Trying to make triage decisions about where they should go when they come in.........

Security is crawling around Charlie Medical this time. Marines and Army infantry with weapons at condition one (locked and loaded). Iraqi Police streaming in with patients-no time to clear weapons, everyone on edge.....second VBIED strikes somewhere else in the city as we treat the initial injured....thoughts of when it's going to end.


Children coming in. They all look OK. Minor lacerations here, little bumps and scrapes there. Smiling at me as I give one a hug. Small miracles in small packages.















Insurgents strike at the soft and vulnerable underbelly of the civilian population. Their only purpose is to create chaos and instability. Today was a restaurant. Charlie Medical and the surgical teams treat 39 casualties before it's all said and done. No chlorine this time, thankfully.




















Indiscriminant, without warning, and senseless. On one hand, we are proud to be here serving. Medical services to all comers: civilian, children, Iraqi forces. At the same time, team members expressing frustration at our inability to slow the violence. All the infrastructure we are dedicating to the Iraqi people, wiped out in an instant of flying debris, burning tissue, lives transformed to ruin. And for what?

It's 10:30 PM and I'm trying to put some final edits on this entry when the "big voice" starts bleating "incoming-incoming-incoming, I say again: incoming-incoming-incoming". The team sinks with dread as we hold tight for the all-clear signal and word of injuries. Tim can't wait, and gets out of bed and heads to Tactical Command. No casualties. 11:30 PM, and we start all over again "incoming-incoming-incoming, incoming-incoming". Nothing this time either, the only casualty being the sleep I was hoping to salvage after a long and emotionally draining day.
Funny thing about the big voice: It's almost the antithesis of actual incoming.....

Soldier's Angels

The Soldiers' Angels was started by a self-described ordinary mother of an ordinary young man turned hero, Sgt. Brandon Varn. Brandon was deployed in Iraq and has since honorably completed his mission and has returned back to his proud and loving family.
In the summer of 2003, he wrote home expressing his concern that some soldiers did not receive any mail or support from home. Being a caring and loving mother, she decided not to allow a situation like that to continue. She contacted a few friends and extended family to ask if they would write to a soldier or two. Within a few short months, Soldiers' Angels went from a mother writing a few extra letters to an Internet Community with thousands of angels worldwide.
With more and more merchants donating services, money and items for packages, the Angels reorganized as a 501 c 3 non-profit so all donations would be tax deductible.Soldiers' Angels currently supports thousands of American Service Members stationed wherever we raise our Country's Flag and the number is growing daily. Soldiers' Angels are dedicated in supporting our military during and after their deployment.
In December of 2004 a worldwide support forum was created. In hopes of providing a place where needs of our heroes can be fulfilled In July 2006 This ordinary mother's youngest son, Bretton Varn started Boot Camp and looks forward to serving his country.

"I was with that which others did not want to be, I went to where others feared to go, and did what others failed to do. I asked nothing of those who gave nothing, and reluctantly accepted the thought of eternal loneliness that I feel. I have seen the face of terror, felt the stinging cold of fear, And enjoyed the sweet taste of a moments love. I have cried pain and hope, But most of all I have lived times others would say were best forgotten. At least some day I'll be able to say, That I was proud what I was, A Soldier." ~anonymous

Please spend a few minutes navigating their website. Consider joining them to "adopt a soldier". There are men and women toiling on our battlefronts, possibly without the support they deserve from home. They need you......
http://www.soldiersangels.com/

Dedication...

"Two wounded inbound. IED attack" the Army coordinator says. We go to the OR, turn on the lights, start warming fluids, ensure the oxygen generator is turned on along with the anesthesia machine. After that we wait, always with a mixture of anticipation and anxiety.
"Headlights coming down the alley" yells one of the surgeons. Four soldiers quickly unload a casualty off the humvee and run into the trauma bay as we direct foot traffic. I'm standing in casualty receiving and start to follow the patient in when I'm frozen in my tracks: he is so dark from dirt and mud that he doesn't look like he has a uniform on and I can't make out his facial features. He has to be Iraqi civilian. I'm a little confused because the word was two Army soldiers? I do a double take and don't see anything beyond the upper portion of his thighs. Nothing there but empty space....
The medic is on their heels, and he looks as pale as a silverlit moon. His uniform is caked with dirt. Sweat streaming down his face into his eyes; he doesn't even notice, because he's practically running blind into the trauma bay when the chaplain and I stop him. Chaplain asks him if he's the medic, and he can only shake his head in the affirmative. We quickly thank him for doing such an outstanding job of getting the patient to us, and "chaps" takes him aside to talk to him and comfort him.
I, on the other hand, follow on the heels of the litterbearers into the OR. Staff is streaming in to help. I position myself on the soldier's right flank and establish IV access while simultaneously putting monitor equipment on. Quick scan of the room to see if crowd control is needed, and I spot an unknown visitor wearing a tan flight suit with no identification. I quickly walk over, introduce myself, and request he immediately identify himself. "Company Commander" he says. We talk for a bit, and I ask about the patient. "Just married a few months ago while on R and R. Such a good guy" he says. What to say back....? We both stand in silence for a few moments. I ask him if he's OK with staying, and he seems fine. I quickly go back to work. The orthopeadic surgeon, Tim, and general surgeon, Martin, are working on the extremities at the same time. Mark and I take great care to package him up for the flight to Al Asad....we start giving sedatives and pain medications immediately.

His unit: their love for him is unquestionable. His buddies press into the OR the second we finish working on what's left of his legs. A few with shellshock and patched up arms and legs from the blast are at his side and don't want to leave, hollow look in their eyes and mouths stuck permanently in "O" mode. Eric talks to them about how well their battle buddy, their brother in arms, did with the surgery....they are so upset with themselves as if they were to blame. Eric gives one a bear hug; reassures them it isn't their fault. We let them....no, we are honored to let them, be the litterbearers back to the ambulance for the short ride to the helo pad.

I help load him into the ambulance for Mark, and turn to run ahead to the helo pad. As I turn, I come to a screeching halt again for the second time tonight. His entire unit is lined up and at attention along the route to the helo pad. As the ambulance slowly pulls out, they render colors to their wounded brother. I was so proud of them all; they would see one of their own through anything........the air heavy and charged with emotion, I find myself stumbling because this time it's my turn to be blinded by tears as I try to make it to the landing area before the ambulance.
They all walked behind the ambulance to the helo pad, and helped Mark and I load him onto the Blackhawk. We stand together one last time as the Blackhawk spins up rotors and gently wisks him to the 399th CSH at Al Asad. Not a muscle twitches until helo and patient are out of sight.

Now we wait for the updates and pray that he will continue to have a good life with his new bride beyond this violent collision of reality. Who deserves it more than this man?

The team just walked back to the hospital from lunch.
"Patient coming in 10 mikes (minutes)." says one of the Army staff.
As we quicken our pace, we ask what happened so we can anticipate what we will need.
"Not sure, it was a roll-over accident. A Marine."
We are already at the receiving area, and wait for the patient to arrive. After a few minutes, I wander around the corner and see some of the Army staff running to the front of the hospital. Instincts kick in, and I'm right behind them. Sure enough, a few humvees come to a halt in front, and 8 Marines scramble out and put one of their own on a litter and make a run for the front door. We direct them to the trauma bay and quickly triage him straight to the OR.
"We don't think he's breathing" He had a nasal breathing tube placed in the field at the point of injury, but it comes out from the frantic activity. Eric places another within seconds. Checking for a heartbeat-just can't tell from all the confusion, but skin is dusky and pale. I start chest compressions while the surgeons start cutting. Instruments are flying off the sterile field, thorasic cavity is clamshelled and held open with rib spreaders. We find bleeding everywhere-thorasic cavity, retroperitoneal, and abdominal. Walking blood bank is activated as we pour lifesaving and oxygen-carrying hemoglobin into him. No idea, however small, is spared for saving a life.....desperation is in the anesthesiolgist's and surgeon's voice. Despite herculean efforts, we lose a Marine. He was the turret gunner. Another fallen Angel......
Just finishing some dinner when the radio blurts out gunshot wound just arriving in the trauma bay! Almost finished trays are thrown towards the side as the team runs next door to the hospital. A SF soldier on base is hit by a stray round from a firefight on the perimeter. He's wisked to the OR as we intubate and start the thoracotomy within minutes--all staff on hand and running around the room scrambling for supplies and sterile instruments for the second time in hours. The bullet rips through a lung and lodges in a vertebra. Bleeding is quickly controlled, so we close his chest, stabilize him, place double chest tubes on the affected side, and I fly him to Al Asad. He took the flight well, and I was able to give a liberal amount of pain and sedation medications to keep him comfortable.
The blackhawk finally gets me back to Ramadi after 11 PM, and we planned an Angel ceremony for the Marine lost today. After midnight, we line the route from the hospital to the helo pad with glow sticks and line up to pay our respects for a fallen comrade that was taken too soon. The desert winds kicks up and sends a sharp chill though my spine as I think about the fallen and my own mortality. As the H-46 gently lifts our Angel back to his family, we all gently lift up our prayers for him, his friends and unit, and especially his family.

Update: the SF soldier I flew to Al Asad had the breathing tube removed and he was talking to his buddies today.......prayers answered.