Combat Doctor

by Marc Dauphin

  I looked at my watch: forty minutes had passed since my Oh shit moment. You can say what you want, but I think we were pretty good. I suppose it wasn’t through lack of practice. I gave a few final orders and wended my way back to the TOC to find out about those U.S. servicemen, the victims of the suicide bomber.

  “They’ve sent them all to Tarin Kowt,” Brian told me. I raised my eyebrows. That wasn’t necessarily good. Tarin Kowt’s blood supply was a lot smaller than ours. And they didn’t have as much personnel as we did. They were a Role 2 and had only one OR. Oh well, no sense in worrying; we’d find out soon enough.

  “Oh, and the Australians are here for you.”

  Damn! I had forgotten about those TV reporters. They were the last thing I needed right at that moment. I sighed. I would have to collaborate with them. Those were my orders and I understood them: the whole world needed to know what we are doing there. I nodded to Brian and walked out into the hallway.

  This was probably taken after having resusc’ed another bunch of casualties. Hence, the adrenalin-induced smile. In the background, Julie updates the status board, and Rob, clipboard in hand, ensures that the trauma bays are replenished.

  The Australians looked like any other TV crew, except I had to pay close attention to what they were saying. Nothing as bad as the New Zealanders, but still, some words did need to be repeated in my head before I understood them. I was supposed to be “Rye low vritt,” as in, “You rye low vritt” before I finally understand that I was all over it.

  I quickly shook their hands and told them a bit about the hospital and what we did there, and about the situation we were currently dealing with, and what we were expecting, and …

  But I was talking too fast. The adrenalin still had me going a hundred miles an hour. Ah, what the heck, I think, why not let them dive in right away?

  “Follow me,” I said a little too curtly, and led them on down the hallway. They’d been briefed about the Afghans’ faces not showing up on their report, and respecting the privacy of the patients, and they looked like a good bunch. Besides, I was way too busy and tired to micro-manage them. If they screwed up, they’d be the last to be allowed in again. So, in the trauma bays, I just lost myself in my work and completely forgot about the Aussies.

  Okay, the mother was saveable. Probably. But she needed an operation to remove some shrapnel from her brain. I had been right.

  The kid in 3 had passed away. Burn-Face in 4 had much less than 50 percent burns, so he was a go. He was in the OR, taking the place of his cousin who had just died. The kid in 2 was coming out of the OR and would be replaced by the howler in 6. Then 5 and the mother could go in. As I was reviewing all this info with Julie in front of the board, I was conscious of being filmed, but I sent the info to the back of my brain.

  Brian came in the trauma bays to tell me that the Americans were going to be transferred in about 1700.

  “Okay. How many?”

  “Two Alphas, one Bravo, and four Charlies.”

  Good. It was a lot better than I had anticipated. I turned to Julie. “Okay, the mother for sure, and maybe one of the two kids, either the one in 2 or Burn-Face in 4 will need an ICU bed. We’re doing really good, Julie.”

  She just smiled that tired, kind smile where the eyes reveal the exhaustion. We were breaking — no, pulverizing — all records for the hospital. At that time we were one of the busiest trauma hospitals in the world. At least, that’s what my American surgeons told me. And they’d worked at the Shock Trauma Center in Maryland. Well, if we were going to do the work, we may as well get the credit for it.

  At that moment, Burn-Face was coming out of the OR. The Dutch anaesthetist’s assistant was carrying him, clearly showing the left arm stump with its fresh bandage. At least the boy was alive. The Aussie camera crew were all over him.

  “ICU?” I asked the anaesthetist’s assistant. He shook his head and was about to speak when I interrupted him. “Yeah,” I say. “Stable as a rock, I know.”

  In spite of the sadness he was carrying, he just grinned back at me. When we were running on adrenalin, we were all like that: we’d been so scared to lose our patients that we’d all be elated when we saved them, in spite of what they’d lost. That was the main difference between us and Landstuhl, in Germany. In Landstuhl you had time to focus on the losses. At KAF, we focused on what we’d saved.

  I’d have to ask Linda about that one. Linda had been a nurse in Geilenkirchen, Germany, in 2007. She and I were the only ones who had had the chance to work both in Landstuhl and in Afghanistan. Linda, for nine months in Afghanistan and five in Landstuhl; yours truly for nine in Landstuhl and six in Kandahar.2

  My work was done, at least the clinical MD work. I still had the “OC of the hospital” work, as in, Do I have enough blood? Are there enough beds? And what about that battle going on in the northwest? Did I tell you I was a worrier?

  I made my way back to my office, leaving the Aussies to film to their heart’s content, but under Dave’s supervision. I read the emails from my family. I was happy to hear from them. My son, especially. He announced that his wife, who was pregnant, was carrying a boy, and enclosed a photograph of the ultrasound. Numbed, I printed it out and hung it up on the wall of my office. If people could hang up the pictures of their kids, this old guy could do the same with his first grandkid. As I answered his email, I tried to find the words to convey some of the emotions I was feeling for my distant family, but the little Afghan boys kept popping up in my head. It’s time we got the hell out of here. Only two more months to go. Hang in.

  My stomach reminded me that, since that Danish at 0730, I hadn’t had any food or drink. I slugged down a bottle of water, and then made myself a couple of those 99-cent-a-pack dehydrated noodles, the ones where you take in a week’s salt ration in one shot. I stirred in some of the Chinese hot sauce that one of the PAD clerks liked, and ate voraciously.

  At 1645, I made my way to the TOC.

  “ETA still 1700,” Brian informed me.

  The phone rang, and Brian passed it to me. It was Tarin Kowt. They had their hands full. They were nice guys, and although I’d never met him, the major in charge up there and me, we got along well. We had the same can-do attitude. Once, when we were really hard-pressed, he offered to take some patients off me. I appreciated the gesture, but we didn’t send guys forward, only back.

  He was calling me to give me a rundown on his suicide-bomber guys: two with messed-up legs and one with a messed-up face. He ran through all the surgery they’d just finished, and I took some notes. Roger that, and thanks for the call.

  I hung up and Brian gave me that wry smile that showed me he was unhappy about something.

  “What, Brian?”

  “RC South are sending us an Afghan soldier who got shot in the head.”

  Shit.

  “No problem, Brian. They can’t send him anywhere else. We’re the only ones with a neurosurgeon.” Besides, head cases are not very complicated. They bleed a lot initially, but if you save them, they stop bleeding. They won’t run the blood bank down. It’s the leg cases that killed our blood supply. Those and the pelvises. And the penetrating chests.

  Okay. So let’s review this: seven U.S. servicemen, of which two are leg cases and one a face case. Then the others who will have to have some CT scans, depending on what they looked like.

  The phone rang again and Brian got that look. Not again. This time it was Qalat. They had a helicopter pilot who had crashed and two of his passengers. Two of them had head injuries and needed neurosurgical consultation. What could I say? Send them along.

  I was starting to have too many incoming. So I wrote all the patients down on my hand. That way, I wouldn’t lose track of them. I made my way back to the trauma bays, which had been restocked. I didn’t need to supervise that. Sergeant H, the ward master, was “eye low vritt.”

  Julie was off shift, and Jimmy was supervisor for the night. (Jimmy’s also from 52 Field Amb in Sherbrooke — didn’t I tell you
? We’re taking over the world.) I quickly went over the incoming as he filled up the board. We were expecting eleven patients from three different places. I hoped they would stagger the arrivals, because we only had eight trauma bays.

  Well, there goes the party. It was Saturday, and the staff had organized a tropical-themed party. I wasn’t expecting to go anyway; I had just hoped some of my people could attend.

  I looked at my watch: 1715. They were late. I made my way outside. The sun was still high. The unloading staff had already assembled, but they were restless. The Australian TV crew were standing a little ways away, respectful of our need to talk among ourselves. They seemed like nice people, and I wandered over to chat.

  Brian came out the back door of the hospital. His shift was almost over. “RC South have some more they want to send us,” he announced. Geez! I know we can stretch, but …

  Seeing my look of starting-to-feel-the-pressure, he added the bad news quickly: “Bastion’s CT has conked out again.”

  Damn! That was really bad. Bastion is that large British Role 3 to the north of us. They handled half of RC South’s casualties. But with no CT, everything was going to come to us.

  “Did they say for how long they were going to be out?”

  Brian shook his head. “They didn’t know.”

  All this time, the Australian was filming me. I just shrugged. There wasn’t a lot I could do. I excused myself and headed back inside.

  Everything was ready. All trauma bays manned, and both ORs were finishing their cases and would soon be free. Captain B walked toward me with a half smoked, unlit cigar in his hand. I shook my head. “Still not landed yet.” Then I point to the board before adding, “And on top of that, Bastion’s CT is down again.”

  He pursed his lips and nodded. He already knew. News travelled fast. Jimmy walked up. “I bet you their CT is fine and they just wanted to take a rest,” he said in heavily French-accented English.

  Somehow that made me smile. “Now, now, let’s not be un-Christian,” I said.

  Everybody grinned.

  “Hey, Major, you’re wanted at the TOC.”

  Probably to tell us that they’re not coming right away.

  I glanced outside. The sun was lower; they had better hurry if they wanted to be here before nightfall.

  At the TOC, more bad news. Three more incoming: one guy with a stroke, another one shot in the gut, and they were piggybacking another ANA soldier who had shot himself in the foot. What was with these guys?

  We were up to fourteen incoming. I quickly added the three to the list on my hand. There were six Alphas at most, so we could handle them. I still had three or four docs or PAs in Primary Care. They could handle the Charlies while I waited outside with the Bravos. That was one good thing about Afghanistan: it didn’t rain in the summer, so you could hold your patients outside in the balmy thirty-seven-degree evenings.

  I made my way to the back door again, pausing by the board to bring Jimmy the bad news. He just shrugged. He was right. No sense in complaining. Nobody’d listen anyway. Outside, everybody was starting to get nervous, like horses before a race, although they hid it well. But I knew them well enough to be able to tell. A little ways off, some of the U.S. Army guys were throwing a football, and they were pretty good at it. The Australian reporter made her way over to me.

  “Three more,” I told her. “That’s fourteen altogether.”

  Triaging in the resuscitation room and making sense out of chaos, discussing cases and priorities with USN Captain Don Bennett, the chief of surgery. We have to process all these casualties in sixty minutes or less.

  I pointed to my hand and sighed. She wanted to film my hand. I shrugged. These Australians are crazy. Why would they be interested in my hand?

  “Could you walk us through the patients you’re expecting?” she asked.

  Why not? So I started enumerating as I pointed to each “line” I had written on the back of my left hand: “Victim of a suicide bomber. This one too. This one too …” I repeated that seven times, then went through the other ones: “Shot in the head, shot in the foot, shot in the gut …”

  She interrupted me: “Why do you write them on your hand?”

  That’s a silly question. Because I keep losing my clipboards, that’s all.

  Then I guess the tension was getting to me too, because I answered: “Well, they don’t issue us with notepads. It’s the Canadian government, you see …”

  But then I couldn’t hold it back anymore, and I burst out laughing. Little did I know that that quote would make its way around the world. There goes my promotion.

  Oh well, c’est comme ça …

  Then the PAD clerk (Salsa, remember?) walked up to me. “Sir, you’re wanted at the TOC. There’s been an IED right by FOB Wilson and they have some casualties. Bad ones.”

  Well, it was Linda, out there at Wilson. She’d probably have them all stabilized. But I was getting overwhelmed. I choked back a string of French expletives, or, if I did verbalize them, the Australians were kind enough not to put them in their newscast.

  I walked to the TOC as quickly as I could (never, ever run), fully conscious of the thump-thumping of a helo in the distance, and thinking, Here we go, people, rock ‘n’ roll!

  The Taco was John, an American with a neat drawl. He was from Tennessee, and his descriptions of that state were so nice that I made myself the promise that I was going to go there after I returned home. At that moment, John did not look pleased.

  “What do we got?” I fired at him. (Hey, I’m allowed to use bad grammar. I’m French, remember?)

  “Two kids, pretty bad, and two ANA soldiers, status unknown. They had stopped by a culvert to inspect it for IEDs when the bad guys blew it up. And the kids, well, it was a family who had stopped there to get a drink.”

  What a dumb place to stop for a drink, I thought. And then I thought about them drinking that brown water. No wonder they were resistant to all those germs. They drank them by the gallon.

  “ETA?”

  John looked as if he’d like to be somewhere else. “They’re incoming as we speak.”

  Holy sweet effing … What’s the matter with RC South? Don’t they know we’re expecting fourteen already? This is too much for English expletives.

  “Tabarnak! Y sont malades, ces osties-là.”

  I grabbed the phone and punched in the number for RC South med ops. The duty officer answered, and before he could say anything else, I belted out at him “Aren’t you guys aware that, before those four from Wilson, we were expecting fourteen, of which six are Alphas?”

  He wasn’t.

  “What the hell is the matter with you guys? Don’t you talk to each other?” Then, before he could answer, I said, “You’ve got to divert those choppers to the ANA hospital. They’ll keep them stable, and then, if they need us, they can transfer them to us by road.”

  The voice at the other end was apologetic, as the RC South duty officer informed me that it was too late.

  “Ah, just forget about it,” I said, and hung up.

  “Tabarnak!” I muttered again, then walked out of the TOC, trying to compose myself. The staff was going to need me as cool as a cucumber. And our task force surgeon was going to have to mend fences with RC(S) once more.

  When I got to the back door, the first ambulance was already arriving. There was a pair of helos on the ground, and one hovering above those two, like an angry hornet.

  The rest was just a blur of broken bodies, quick decisions, trauma teams emptying and re-stocking bays, casualties being wheeled to the CT, to the OR, to the ICU, lab techs bringing blood, more blood, always blood, blood flowing off stretchers, blood being transfused, blood being brought by the lab techs, blood spurting from a wound, people cleaning bloody floors, and helicopters, always more helicopters with patients dripping blood. Drip, drip, drip, off the stretchers. And then there were the people dressed in crazy Hawaiian clothes walking in from the party. Well, Marc, you wanted to play M*A*S*H when you
were eighteen, and sitting in that movie theatre eating popcorn with your girlfriend, dreaming about being a hero in a tropical shirt like those Hollywood types. Be careful what you wish for in the future, because this time, you sure as hell got it.

  One vision sticks in my mind: an ambulance with four walking (heavily limping) wounded U.S. Army soldiers — the Charlies from that morning’s suicide bomber. I was just triaging them to make sure they could all go to Primary Care to complete their once-over. One of them was grinning, happy to have escaped alive. On his neck there was a two by two inch white bandage, the kind they tape in the crook of your elbow when you get poked for blood. It was just held there, on the side of his throat, by one piece of tape.

  “What’s that?” I asked.

  “Oh, just a little hole in my neck, doc,” he answered without losing his grin.

  “In there, let’s go,” I said as I pulled him toward the trauma bays. His grin left him instantly.

  A hole in the neck is a time bomb. It could have nicked the carotid or the jugular and the slow leak can suddenly turn into a tidal wave of blood, compressing the airway and stopping all blood flow to and from the brain. This had to be addressed immediately.

  Inside, I grabbed a TTL. “Get Captain B,” I said as I shoved the kid on a stretcher. Ten minutes later, as I walked by the bay in which Captain B and the vascular surgeon have just finished ultrasounding the soldier’s neck, they both shake their heads at my unasked question.

  “No shrapnel in the neck, Major Dauphin. Vessels look okay.”

  Good. But where is the shrapnel? I let the boy go back to Primary Care with the proviso that he is to come back in to get a chest X-ray and a CT as soon as we’ve finished with the actively bleeding patients.

  And all the while, I was dimly conscious of the Australians just filming away, yet staying out of the way of rickshaws and stretchers moving to and fro.