by Dave Hnida
This time when the medics sprinted out, they sprinted back in, pushing a stretcher occupied by an Iraqi policeman spurting blood in all directions. And the medics were doing CPR. Shit. My surgeons had left. The anesthesia people were busy and nowhere to be seen.
I went to Alpha bay and took my place at the head of the stretcher as the medics jostled into their assigned areas around the wounded soldier. It quickly became a contest to see who wouldn’t puke first. He had no jaw. It was gone. Blown off. Yet he was still alive. There was a collective swallow of bile as we all kicked into our personal auto modes. I had seconds to get an airway in to help this poor guy breathe. Blindly probing with my finger, bubbles soon appeared from the middle of the bloody mass of unrecognizable flesh, and I found what used to be a mouth.
“Guys, I think we’ve got one good shot at this. Get me some suction. Hold him steady now.” In went the airway tube—sliding smoothly along my finger, down the throat, and into the windpipe. Pure luck.
A medic grabbed my stethoscope and listened to the lungs.
“Good breath sounds both sides, sir. Very nice.”
The medics got their IV lines in and poured in fluids and blood. X-ray came and shot a series of films. We watched as his blood pressure climbed and the patient began to stabilize. He might actually have a chance.
Now I asked for more details. “Who is this guy?”
The chief nurse answered, “Iraqi police.”
“What’s the story?”
“No clue.”
I wanted to get him to a reconstructive specialist before something went wrong and he tanked on us, and told the chief nurse, “What do you say we get Balad on the line and spin up a bird to get this guy on the road? Time to say hi and goodbye.”
Twenty minutes later the “Man Without a Face” was on his way. Odds were the docs at Balad would jigsaw-graft back together a human face. I’d seen their work and it was good. Our time with the patient was just twenty-eight minutes, and we’d never see him or his new face again.
As the medics swabbed the blood from the floor, I snuck out to sneak a peek at our kid in the ICU. Rick and Bernard were hovering like nervous parents.
Rick was somber. “Look at that blood. Still leaking. Pressure is dropping. We’ve gotta go back in, Bernard.”
Bernard stood staring at the bandage that was soaking red. “You’re right man. Need a hand?”
“Twenty, if you’ve got them.”
Rick looked up, saw me at the foot of the bed, and said, “Dave, we could use you, too.”
I answered quickly, “I’m in. Let me get someone to cover
the ER.”
I paged Mike to see if he could take over for a few hours. While I waited, it was back to work seeing patients. Fortunately, there weren’t many waiting, which was unusual, and those who were waiting had problems just like the ones I typically saw back home. One guy who strained his back lifting a bag of something, another with a headache, then one other with chest pain. The one with chest pain was only twenty-two years old, so I wasn’t too worried about heart problems. Nonetheless, I had the medics do the million-dollar workup: EKG, chest X-ray, lab work, the whole nine yards.
The headache guy was simple. A migraine, which was typical for guys working in 130-degree temperatures and not getting enough fluids. He needed a little pain medication to take the edge off and a lot of IV fluids to refill his tank.
As I worked my way to the next stretcher to see the patient with back pain, the train pulled in to the station, filled with a group of soldiers who had hit a small IED an hour before. Nothing too serious at first glance, but they all needed to be checked and cleared before being sent back to duty. There were five of them, so that was going to take some time.
I told one of the medics to tell the guy with back pain it might be a few minutes before I could see him.
The young specialist stammered, “But, sir, he’s a sir.”
Puzzled, I asked, “Meaning … ?”
He continued to stammer. “A colonel. And he says he’s in a hurry. All he wants is some Vicodin.”
With sprouting irritation, I quickly responded, “Tell the colonel to take a number. I don’t give narcotics without an exam. And I need to see the IED guys before anybody else.”
“He’s really pissed, sir.”
I could feel myself getting hot.
“Then give him a urinal.”
We now had a full house and I was squirming for Mike to show up so I could hustle over to surgery in time. I made my way down the rows of stretchers once more.
The IED guys weren’t in too bad shape; some ringing ears, a couple of headaches, and one bloodied eardrum whose owner couldn’t hear very well. As I looked at the ruptured eardrum with my otoscope, I was blasted by a shouting voice less than an inch away from my face.
“I AM FINE, SIR. JUST A LITTLE HEADACHE. MY EAR HURTS BUT NOT TOO BAD.”
Fighting the need to shout back, I evenly replied, “Okay, you don’t have to yell. I can hear you just fine, even if you can’t hear me very well.”
“WHAT DID YOU SAY?”
“I said we captured Osama, the war is over, and we can all go home now.”
“I’M FINE, SIR. JUST A LITTLE HEADACHE. MY EAR HURTS BUT NOT TOO BAD.”
That clinched it. My young ruptured eardrum bought himself a night in our medical hotel.
Looking into his confused eyes I said, “Son, welcome to Paradise General Hospital. You will be our guest for the night and you will not go back to duty until you can hear every single syllable I utter.”
For good measure, I wrote it all down for him to read. He was going to be fine, but he wasn’t going anywhere until we were sure he was fine. Too many concussions and head injuries had been missed or ignored, and none of us wanted a soldier to carry home the scourge of a hidden brain injury. When it came to IED blasts, we were cautious to the max, even if it pissed off commanders who were shorthanded on troops to send out on missions.
My motherly ways were rudely interrupted by a whining screech from a couple of stretches down the line.
“I need someone here NOW!”
The asshole colonel.
I took my time strolling to his stretcher. As I pulled back the curtain, I told myself to be calm.
“Yes, Colonel, what can I do for you?”
“I need to get back to my office and get some work done. I don’t need to be wasting my time sitting here waiting all day,” he barked.
“Well, sir, maybe we can get the official war referees to call a time-out,” I responded calmly, “you know, take a little break from the game so we can all catch up. Maybe we can make a phone call or something to the people in charge.”
His face turned bright red and the veins on his forehead took on a dangerously explosive appearance.
“Wise guy, huh? MAJOR.”
I now answered through gritted teeth, “No, doctor-guy, COLONEL. And I’ve got five guys who hit an IED in line ahead of you. And I know your back had a fight with your duffel bag, but they get to go first. Rule of the hospital. Rule of my ER.”
He continued to push me to the edge with a sternly toned, “Well, hustle it up. I don’t have all day.”
Bowing at the waist, I quickly backed away from the stretcher.
“Yessir, yessir, yes—sir.”
I would now go sweep the sidewalks and take out the trash before I’d examine him. Important rule: Never piss off the staff of an emergency room, or any medical office for that matter. It made me wonder what this self-important desk jockey would think about our young trooper who was slowly dying, one drop at a time. The one whose blood still stained my boots.
As I walked away cursing under my breath, Bernard came in.
“We’re in a holding pattern. Bill is sticking a rod in some guy’s tibia and then has to clean up a wound graft. Dude says he’s hurrying.”
I shook my head and pictured the steady drip from the unknown leak in the kid’s neck.
“All right—just let m
e know. I’ll be here. How’s the kid doing?”
“Sinking. I think Rick is taking this one hard. Man, we’re all taking this one hard. Even the Angels are hovering extra close. Shit, that leak is going to do the kid in. He’s going to die no matter what, but we’ve got to try something.”
Die no matter what. Damn, I didn’t need Bernard to confirm what I already believed.
I looked over at the clock. Eleven A.M. here, which meant the middle of the night back home. Was his wife up? She had to have gotten word by now. I thought about what went through her mind as the pair of soldiers came to her front door to give her the news her husband was critically wounded. She probably didn’t want to open the door because she knew why soldiers in dress uniforms travel in pairs to the homes of soldiers. The neighbors watch in sadness, yet are secretly relieved the soldiers passed by their houses.
She had no idea about us, a group of doctors—strangers thousands of miles away, feeling crushed by the pressure of fighting a battle destiny told us we would lose. We couldn’t eat, couldn’t sleep, and couldn’t get our minds off her husband. I wonder if she knew how much we really cared? How the Angels hover around his bed, talking to him about his beautiful children, and making sure he is comfortable? And what about those kids? They’d never see their dad again, but they didn’t know it yet. The waiting, that dreaded and powerless unknown, is one of the greatest tortures a soul can ever know.
Once again, I flashed back to Littleton. The night of the shootings, scores of parents were herded to a nearby elementary school, waiting as the authorities sorted through long lists of missing students. Who was found at a friend’s or neighbor’s house, who was wounded and in the hospital, and who wasn’t on either list. Those not on a list were still lying in the school. Vibrant teens who left for school that morning, like any morning, now lifeless under desks and tables. The frightened look in the eyes of a parent waiting for news, but dreading it.
What did the eyes of our soldier’s wife look like? Sleepless, red, and tear-stained, filled with dread and anxiety as she waited for word that lay in our helpless hands. Seven thousand miles away and we couldn’t comfort her, couldn’t reassure her, couldn’t hold her hand and tell her we were going to try somehow to make everything right. The questions and images racing through my exhausted mind were making me nuts.
Just then, Mike came strolling in and saved me from myself.
“Sorry, Dave, I was out running when my pager went off. Where do you need me?”
I gave him the colonel. Begged him to take the colonel, just to get the guy out of the ER. He was a bad vibe for all of us. In the meantime, I took off to check out the rest of the IED guys, while the medics went to work on a couple of new arrivals: a bellyache from desert-induced constipation and a badly cut hand belonging to some guy from the motor pool. The cases were quickies the medics could handle, and I could just sign off after a swift double-check of their work.
I shot a quick glance at the clock once again—twenty more minutes had disappeared. I fast-walked to the ICU to check the kid. The Angels surrounded his bed, doing busywork as they waited for the OR to open up, while I tried to look at the big picture so I wouldn’t see the family picture. Things weren’t pretty. Blood pressure continuing to drop, and blood coming out as fast as we could transfuse it in. Logic told us to call it quits, but we couldn’t. If we didn’t pull out every single stop, every sleeve-hidden trick, and then invent a few more, we’d never be able to look in a mirror again. It all boiled down to the simple matter of why we were here and why we practiced the way we did: if it were our son or daughter in that bed, we would want everything possible done. Everything. As I turned to leave, I saw a tear trickle down the cheek of the head nurse.
I walked back into the ER, knowing I had to pull myself together. There were other patients to be seen, and if any of them were my son or daughter, I would want the doctor caring for them without distraction.
The tests on the young chest pain patient were all normal. It was a minor-league pulled muscle, but he needed some major-league convincing. With shaking hands and darting eyes, he begged for reassurance. “Are you sure it ain’t my heart? My dad had a heart attack last year. I’m afraid to go to sleep.”
I held up a copy of the EKG and lab tests.
“Son, since I am thirty years older than you, I wish I had your heart. It’s perfectly fine and your pipes are wide open and unclogged.”
He continued to jitter. “Are you sure, really sure?”
Just then, Bernard came strolling over from the desk where he was killing time and listening to this whole conversation. He gently reached over and pushed on the sore chest muscle.
“OW! Je-sus!” The kid jumped from the pain.
With the face of a wise sage delivering bad news, Bernard looked straight into the young soldier’s eyes. “You either pulled a muscle or you’ve got a classic case of Updog Syndrome.”
The now wide-eyed kid almost screamed, “What’s Updog?”
Bernard calmly replied, “Nothin’, dawg. What’s up witch you?”
It took a couple of seconds for the joke to click, but as the soldier saw Bernard cackle his way back to the desk and me standing with a big grin, he realized we weren’t bullshitting him about his heart. A mild tranquilizer for a night or two of nonfrightening sleep, and he would be fine.
In the background during all of this came a bunch of grunting and wheezing noises. Mike was putting the colonel through a thorough and grueling exam. That meant lots of rapid-fire bending, twisting, squatting, and lifting. Now that the exam was finished, all Mike thought the office commando needed was some ibuprofen and he would be fine. Obviously, that didn’t sit well with the Vicodin-seeking brass-hole. So after talking to Mike, I decided I would give the colonel three little Vicodin, for nighttime use only. (We do not want to mask the pain, sir, and remember you need to be thinking clearly when you are doing all that paperwork.)
On his way out, the colonel and I almost collided as I was heading to check more X-rays.
“Say, Doc, I didn’t mean to come off too hard on you there, you know what it’s like when you’re hurting. Tempers get a little short. Wondering if I could catch a favor from you, though.”
Shit, he wanted more than three Vicodin.
“I’ve got some leave coming up. The pain pills might make me a little constipated plus me and the girlfriend are planning on meeting up back home for a little R and R, if you know what I mean …”
Home. We’ve got this wounded kid we want to get to back home and he sure isn’t going for a little fun.
“… and I was wondering if you could give me something to loosen me up … Plus maybe a few Viagras to make the weekened a little more, you know, action-packed.”
Viagra? You think we have Viagra in the pharmacy in the middle of Iraq? Why in hell’s name would we stock Viagra in a fucking war zone?
With a solemn look I answered, “Sorry, sir, I don’t have everything you need for your trip but I do have something that might help get things moving. We don’t carry any name brands but we do have a generic, it’s called docusate. Take one in the morning and by nighttime, things will be functioning just fine. Guaranteed.”
He winked at me. “Thanks, Doc. Let’s make this our little secret, okay?”
I winked back. “Okay, sir. It’s definitely a secret.”
The real secret is that docusate is one of the most effective stool softeners known to medicine.
One of the medics interrupted my little vision of the colonel’s toilet vacation. Time to head to the OR. Stat. When I got there, Rick and Bernard had already scrubbed in and were heading to the operating table. A quick-moving Rick looked back over his shoulder, “Dave, hustle and wash up. Kill the germs but don’t stay for the funeral, we’ve got to move it.”
A few cursory scrubs of the hands and I was in the room, watching the staff turn our kid onto his stomach so we could get at the back of his oozing neck. His face still looked young and at peace, but his vital si
gns told a different story. Blood pressure in the toilet. Rapid and irregular heartbeat. Hypothermic. Not only oozing from the neck, but now the leg, arm, and abdomen. A classic case of trauma shock. Irreversible. He would never leave the OR alive.
We usually boomed some Rolling Stones or Led Zeppelin when we worked, but today’s OR was quiet. Just our low murmurs and the beeping of the monitors. The overheated OR caused steam to swallow us, fogging goggles and glasses, and filling our gloves with sweat. Looking up, we saw a crowd of noses pressed to the plastic windows of the door. By now, everyone in the hospital knew we had a young GI who was ready to die. I wondered how many knew he had a wife and two little kids.
My job was simple. Hold retractors and suction blood as fast as it flowed, opening a clear field of vision for Rick and Bernard to pull off some surgical miracle. And it would need to be a miracle. The leak was somewhere deep at the base of the skull, right next to the top vertebra. There had to be a small blood vessel in there with a microscopic tear. But even if we found it, there wasn’t any way to tie it off—the space was so narrow, you couldn’t fit a baby’s finger in there, let alone that of an adult.
We spoke sparingly, all thinking the same thing. This kid was not going to die on us. Plain and simple. We had to get him home to see his family again. My mind added its own thought to theirs: this was not going to be like Columbine.
One hour turned into two, then three. I wondered, How was this kid hanging on? Bad question because as soon as the thought zipped through my brain, the rhythmic beep of the cardiac monitor went into the steady screech of cardiac arrest. We ripped the surgical drapes off, spun the kid over to get at his chest, and then hit him with the paddles.
One shock didn’t do anything. Neither did the second. But the third was the charm. We had bought another chance.
Spinning him back, Rick and Bernard went on meticulously dissecting tissue away to try to find some angle to get at the leak. More hours passed. The noses stayed pressed to the windows. And we changed our gloves twice, spilling what seemed like buckets of sweat onto the floor. Blood continued its steady drip onto our boots. At a critical point when Bernard was carefully trying to work around a small nerve, the OR suddenly shook from the force of a rocket landing just outside the gate. The scalpel jerked against a nearby artery, slicing it in two, and sending a pulsating geyser of blood onto our masks and protective glasses. Temporarily blinded, we froze in fear, not daring to move with sharp instruments in our hands. Coolly, Bernard gently wiped clear a narrow window on his goggles with a sterile gauze while placing a finger on the jagged edges of the spurting vessel. His skills as a cardiac surgeon gave him the dexterity of a concert pianist; stabilizing the separated edges of the artery with one hand, he tied off the bleeding with the invisibly flying fingers of the other. A huge sigh of relief trapped itself inside my mask.