“Ok, you know where I will be,” I said and plugged back in to my music. Sure enough, after completing my fourth mile, he came back out from the clinic and got me.
The patient was a young man, no more than twenty years old, who was recently discharged from a hospital in Kabul after having some sort of abdominal surgery. His father brought him to us for help and they were standing just outside of the c-wire surrounding the firebase, next to a van they had driven in. The guards and several of the team guys were already outside talking with the father. The young man was laid out on a bed made of wood and moaning in pain.
As I pulled up his shirt I saw he had a vertical midline incision that extended across his entire abdomen and three small tubes that were covered with dirt coming out of his skin at various points. I assumed the tubes were their version of perhaps a colostomy bag, urinary catheter, and some sort of gastrointestinal tube. The patient looked very ill and his wounds were filthy. He was clearly in no condition to have been discharged from the hospital and I explained this to the father.
“My son was discharged because the hospital did not have any room for him,” he said.
“What procedure did he have?” I asked, but couldn’t get him to answer. “Sir, your son is very sick. He needs to be admitted back to the hospital for further care by the surgeons who performed this procedure,” I explained.
“I cannot go back to Kabul! The Taliban kept stopping me and questioning me the entire journey here,” he pleaded.
“Ok then, if you go on to TK, I know the surgeons and I can guarantee your son will receive excellent care,” I said, yet he still refused.
“I will still face the same risks along the way, it is impossible.”
“There are several other locations relatively close that will be able to provide a higher level of care than our minimal facility. They are not as far and less risk to get to,” I tried.
The father continued to decline my offers for help and he began to cry tears of desperation for his son. My heart went out to him as I knew my hands were tied and I couldn’t provide the care his son needed. I couldn’t call a medevac, I couldn’t care for him at the clinic, and I couldn’t do anything except offer broad spectrum antibiotics and pain medication. I offered again to call the FST and give them a “heads-up” on the arrival of the man and his son, but the man kept saying the same thing over and over again and I soon realized that I was talking in circles. At one point in the conversation I offered to try to get his son on the next ring flight to TK, but this still was not enough. The father began to raise his voice out of frustration and then made a statement that flipped the switch on my compassion meter.
He said, “Fine! I will leave him here to die then! I can’t take him because they will kill me!”
I felt my own frustration levels rising and again I pleaded, “Your son will surely die if he does not get proper care.” I tried to convince him that taking the risky trip to prevent this from happening was the best option. “Let’s look at the options; you have a chance of death on a trip for care that will prevent a sure death if your son does not go. The Taliban might attack you…or they might not, but your son will die if you don’t get him help.”
He continued to raise his voice in frustration and said, “I will leave my son to die.” Every time he said that I found myself getting more upset.
“Your remarks are completely uncalled for and I don’t appreciate it. I am trying to offer you everything I can to help him! He needs a surgeon…I am not a surgeon!” My voice was rising as well. We continued to argue for several more minutes and I eventually had to cut him off. “Listen…you can take the medication I am offering you, or you can leave it, but this conversation is not going to change the outcome.”
He finally agreed to take the medication and some of the guys that were there gave him some money to assist him on his travels. I knew the things he said were out of pure desperation and frustration and I still felt horribly for him. I wished wholeheartedly I could do more for them and I wished they were not forced to take a dangerous journey, but again, my hands were tied. This was the ultimate frustration for me as a medical provider. I couldn’t help him, yet help was what I was trained to do.
As I left the clinic I looked out at my track. I decided to finish my run and ended up running the fastest mile I had run to date; fully completing my five miles for the day. As I went up to my room I couldn’t even begin to guess what the next day or week had in store.
CHAPTER 34
Days 126-127
The Worst Day of My Life
2-3 September 2008
It started like any other day, our boys had continued to go out on missions, with the only exception this time being the team would be going with our friends the Aussies again. The briefing the night before warned everyone they would be going into a very dangerous area and so the extra help was certainly welcomed by all. After the meeting, I went up to the roof of the OpCen and had a conversation with Jay, the engineering sergeant on our team.
“So Jay, this sounds like a pretty big mission, how do you feel?” I asked.
“Are you kidding me? I’m pumped! I think this is going to be the biggest fight of the year!” he exclaimed. I watched him pace around me with determination, anger and excitement in his eyes. “I even have a special shirt for the occasion,” he bragged.
“A special shirt? Really Jay?” I joked.
“Yeah, it’s my ‘Screw the Taliban’ shirt,” he laughed.
“Well, whatever makes you happy I suppose,” I said with a smile on my face as I looked out to the sunset. I wondered what the next day would bring. Little did I know his prediction of the level of violence couldn’t have been closer to the truth. That night I had radio watch from 0300-0400 and Rod was my relief. He was going on the mission and when he showed up to pull his shift, I tried to convince him to go back to bed and get some rest.
“I can cover your shift,” I said.
“No, I need to do my part, just like everyone else,” he insisted, “Go to bed, I got this.”
“Whatever! You just want to search Bass Pro Shop sales online!” I joked and chuckled with him for a few minutes. On my way out of the OpCen, I turned around and said, “Hey Rod, if I don’t see you before you load up, good luck.”
He smiled and nodded his head; I could tell he was already preoccupied with thoughts of the upcoming mission.
The morning started off slowly with little happening as expected, but once they got to their destination an ambush was waiting for them as they had predicted. What they failed to predict was the massive number of the attackers. It easily exceeded the hundreds, completely taking our forces by surprise. The radio transmissions from the team were filled with gunfire in the background, making us all back at the OpCen extremely nervous for the team.
“Oh my God, Becky!” I screamed.
“Listen to them,” she replied “This is horrible! What the hell is happening?”
As we listened to them call for CAS I could hear sounds of explosions and gunshots, mixed with the pressured and fearful speech of the man on the other end of the radio.
“I need air support ASAP!” he screamed. “We’re in real trouble here!” My stomach turned as we listened helplessly from the firebase. The first call came over.
“We have a friendly USSF WIA,” he said. As I listened I felt the all too familiar heartache. He listed the battle roster number and I looked quickly at the list hanging by the radio and realized it was Jay. I couldn’t believe the irony of our conversation the night before.
“Injury sustained is a GSW to the left forearm,” he explained.
Thank God! I thought, He was likely stable.
The firefight continued and the team decided they were going to push through to the firebase for the medevac. A sense of relief came over me knowing he was ok, at least for the moment. Ten minutes later we received another call, “Be advised…two friendly WIAs, Australian SF. Injuries sustained: Patient One, GSW to abdomen. Patient Two, GS
W to the leg.” The gunshots were louder and more frequent in the background and the radio operator’s voice seemed to become more panicked as the time went on. Then I realized the voice I was hearing was Curtis. The voice of the team commander, someone I had grown to know as calm, cool and collected now carried a heavy tone of stress and fear. I felt an eerie realization things were going to get much worse. Several minutes later he was back on the line.
“Requesting emergency resupply of ammunition, we are running critically low. I say again, requesting emergency resupply! Over.”
At this point the plan had changed to a medevac in the field; the team could no longer wait to get to the firebase to treat the now three wounded soldiers. The area was still very hostile and they were going to attempt to push forward to an area they could secure for the aircraft coming in.
We waited some more. “Firebase be advised, we’ve sustained another WIA. Convoy will proceed to firebase; ammo levels are too low and cannot obtain secure airspace for medevac. Over.”
“That’s one, two, three…now four patients right?” I asked Becky, as I looked at my notes.
“That’s my count,” she whispered. Her eyes were filled with shock and horror.
“Ok, the medevac is going to be rerouted to us; I need to get down to the clinic to prepare to receive these patients.”
“I’ll man the radios and meet you down there as soon as I get relief,” she said. I nodded and ran down to the clinic. I frantically tried to get as much of the hemorrhage control supplies, pain medications, trauma sheers and other supplies into my pockets as I could. I set up the oxygen, opened the pharmacy, and got IV bags ready, put on my scrub top and gloves and waited by the door with my handheld radio.
Five minutes later I began to hear gunshots. I looked up and saw them heading for the gate, heavily engaged in a firefight. The next thing I knew, I saw the first HMMWV round the corner with people yelling at me about the wounded patient they were carrying. It was an Aussie who had been shot in the leg and the buttocks.
“Offload him to the ground in front of the clinic so I can evaluate his wounds!” I instructed. I cut off his clothes, assessed his level of consciousness and pain and noted he had minimal blood loss. I determined he was stable enough to hand over to the Aussie medic, Will, who took control of the patient with the utmost confidence. Will would later prove to be an amazing asset during the whole ordeal.
By the time Will had taken over the patient the rest of the trucks were coming through the gate. They all had patients to unload, and what I thought was going to be four patients soon turned into thirteen! There were nine Australian causalities, two interpreters, Jay and then Eric. Eric had minor wounds and was able to wait until everyone else was addressed, which turned out to be a blessing because as the TACP he was heavily involved in talking to the incoming aircraft on the radio.
The most serious injury in front of me was the Aussie with the gunshot wound to the abdomen. Another soldier had been shot in the thigh and lower leg; another soldier had severe shrapnel wounds to the face, chest, and arms, another with a gunshot wound to the arm and leg. It was complete and utter chaos. As I continued to see the patients and triage the new arrivals, I realized what resources I had. I was, as a Physician Assistant, the most senior provider, Will was the most senior medic, and Hal and Becky were trained and ready to go.
All of the uninjured men offered to help in whatever ways they could. Will thankfully had much experience in this type of combat situation and was able to help me manage the chaos. I knew I would need to delegate a lot of the treatment to the medics and oversee the situation ensuring everyone remained stable and that all of the potential complications with trauma patients were avoided. I had to think about pain management, avoiding narcotic overdose, hypothermia, volume loss, prevention of infection by initiating antibiotics and constant reassessment of stability, just to name a few.
As I worked from patient-to-patient, Curtis came up behind me and placed his hand on my shoulder and whispered in my ear, “Jenn, I need to tell you… we have a friendly KIA.”
I felt chills run down my spine, but I couldn’t stop working, I couldn’t let myself digest the reality that one of our own had been killed. I suppressed everything I was feeling and simply said, “Ok,” and continued working on the men in front of me. I finally got to Jay, who thankfully was stable and when I saw him he instantly smiled. “Don’t worry, I am fine,” he said.
“Jay, are you sure? How’s your pain?”
“I’m ok, but please, get this fucking ‘Screw the Taliban’ shirt off of me!”
I couldn’t help but smile at him, remembering how he was bragging about it the night before. I promptly cut the shirt off.
“Do you want me to get rid of it?” I asked.
“No!” he insisted, “Just leave it with me here.” He pointed to his side.
“Ok Jay,” I agreed and left it by his side as he requested. I needed to see that he was ok; it gave me the strength to press through. Once all of the patients I was seeing outside the clinic were stable I found Curtis and mustered up the courage to ask him who the KIA was.
“Who was it Curtis?”
He looked at me with sadness in his eyes and said, “Jenn…it’s Rod.”
I felt a lump forming in my throat and my eyes tearing up. Not Rod! My friend! He sits outside with Jacko every night I run the track cheering me on! He laughs and jokes with me and Becky when we get homesick. I just talked to him that morning at shift change. Now he’s dead? NO! Not him…not my friend.
I stared off blankly in a state of shock, my thoughts saturated with the voices of the men I had revered as the most impressive fighters I’d ever seen now screaming helplessly in pain and agony in the background. I felt myself losing it, and immediately turned my focus to the situation at hand. I still had patients inside I hadn’t seen yet. I had to keep it together. I walked into the clinic and saw Johnny, the Aussie that had been so eager to learn the medical world was now lying on the stretcher in the first treatment bay. Just two days earlier he was standing in that same room learning some basic medical techniques from me and the other medics, now he was a patient with two gunshot wounds to the leg. He was screaming and breathing rapidly and heavily due to his pain.
“Hang on Johnny! You’re going to be ok,” I tried.
“It hurts so fucking bad!” he cried.
“Here’s some morphine, it should help. I need you to calm your breathing ok?”
“I’m trying, I’m trying.”
The medication started to take effect in a few short minutes and he was stabilized. “You guys watch him and keep a close eye on his vital signs,” I instructed to the men standing next to him. I walked to the back to evaluate the rest of the patients Becky and Hal were working on. I saw someone lying on the next stretcher that looked like Sola, an interpreter, but I barely recognized him. His face was covered in blood and bandages. He had been shot in the face and also suffered from shrapnel wounds. As I was treating him, I dropped a bandage on the floor. As I looked down to see where it landed, I noticed both of my shoes were soaked in the blood of these men. I thought to myself, Keep working, Jenn. I was about to go to the next bay once Sola was attended to, but as I was walking out I looked on the other side of him and saw a stretcher on the ground with a body on it covered by a blanket. I knew it was Rod. I felt I had to pull the blanket back, perhaps for some sort of confirmation he was really gone. Once I lifted the blanket, I couldn’t help but notice how peaceful he looked. His feet were crossed and his eyes were closed and he appeared as if he were taking a nap. I could have pretended that was what he was doing if it wasn’t for the pool of blood behind his head. He was killed by a shot to the back of the head. I was consumed with a deep sadness for my friend.
I heard voices coming out of the next bay and snapped out of it and hurried into the next room. The patient was Hanifi, my friend and interpreter, who just days before told me the horrible story about his brothers being shot in the head by the Ta
liban. Now here he was, lying on a stretcher with a gunshot wound to the face. “Hanifi!! Are you ok?” I yelled. Becky had been in the room with him and was tending to his wounds.
“Yes, my sister! I just have a headache,” he replied. He was so sweet and I couldn’t stop telling him how proud of him I was. Thankfully, his wound was a through-and-through shot to the cheeks and he was stable.
“Becky, keep a close watch on his mouth and the bleeding, he could choke on the blood.” She had already thought of that and was standing next to him with suction ready should she need it.
“I got it,” she said, and she did.
We had to keep the entire group of patients stable until they could all be evacuated out, unfortunately only three-to-four patients could fit on the helicopters at one time, which meant we would be spending hours with these soldiers until they were safely on their way. I continued to bounce from patient to patient, which forced me to keep walking past Rod, and at times I had to actually step over him. Each time I saw him I had to pull myself together. I had to witness the process of getting him into a body bag; from stripping his clothes off, collecting his personal effects he had with him, to getting the actual bag in the room and finally placing him in it. I saw it all.
It took an hour before the first helicopter arrived. Sola was slotted to be on the first bird out, but at the last minute he was bumped from the flight. As time continued to pass, I grew deeply concerned for him. I figured he had maxillofacial fractures (fractures to the facial bones) and his airway could be compromised at any moment. I put him on oxygen and insisted his vital signs be monitored every five minutes, hoping to avoid intubation if possible. My concern and hopes to avoid intubation were due to the unknown timeframe of the next bird to get him out of there, not to mention the limited supply of Rapid Sequence Intubation (RSI) medications we had and his overall well-being. I had no idea what the extent of his injuries were, but if I had to stick a tube down his throat I was risking pushing a piece of fractured bone that could have broken loose down his airway in the process. Several of the workers on the firebase, who were local nationals and his friends, were standing by him, desperately wanting to help in whatever way they could, constantly changing out his bandages and cleaning the blood from the area around him.
166 Days: My Journey Through The Darkness Page 17