by Marc Dauphin
Well, there was a pause then, as the general looked into my eyes without releasing my hand. Realizing that maybe, just maybe, I had uttered one wisecrack too many, I held his gaze and refrained from giving in to my suddenly difficult-to-restrain urge to swallow. Then, slowly, he broke into a wide grin and clapped me on the shoulder.
The next day the general was back into our lines to talk to us about the future. It was a privilege to hear strategic stuff straight from the top. The last thing General Lessard told us was to tell everybody what we were doing there. “When you get home, tell them all that you did.”
Well, mon général, here it is.
Head “Injury”
We had an understanding with Mirwaïs Hospital, the civilian hospital in Kandahar City. The hospital did its best, but the whole country was a mess and so too were its hospitals. The only ones that were half decent were the Afghan Army ones. And even the Afghan Army hospitals fought among themselves for specialists. So if you were an Afghan intensivist, for example, you’d better not unpack your suitcase.
Anyway, the civilian hospital was short of everything, not the least of which was ventilators. So if we had a vented patient, it was understood that we couldn’t transfer him to Mirwaïs. But they, in turn, couldn’t intubate their patients, as they had no means to keep them vented once intubated. So you can imagine the problems with their head traumas. Those who could breathe on their own survived — for a little while, at least. Then, if they were still alive after thirty-six or forty-eight hours, Mirwaïs would ask us for a CT scan. At first my staff was upset by this.
“You have to intubate them if their GCS is eight or less.”
“But this trauma happened two days ago! It’s no use intubating them now that the damage is done.”
“What the hell good is it going to do to perform a CT scan on a patient if we’re not going to intubate him?”
And so on. It took me a while to understand this myself, but, once I did, everything was as clear as … well, nothing is really clear in Afghanistan. The way I saw it was that Mirwaïs did their best with the means they had. If they thought a CT would help to explain the patient’s condition to the family, so be it. We would provide the CT and the neurosurgical consultation. If the patient needed an operation, we would perform it if we had the time and space. In exchange, Mirwaïs accepted our transfers, no questions asked. Martin, our neurosurgeon, had absolutely no problem with that arrangement. He had worked in some pretty tough places before. Places where medical resources were very primitive. In such places, you adapted your practice to the local conditions. Ask anybody who’s ever cared for people in developing countries.
So one day a woman came to us after telephone arrangements had been made with Mirwaïs: “I send you patient who has been hit by rock on head. She is unconscious and needs CT scan please.” Sure, no problem. Send her on.
She was a younger woman. They all looked old, but her breasts were ready to burst with milk, so she was obviously of child-bearing age. When they brought her in, she was wheeled into one of the trauma bays. The personnel were all agitated. “Why weren’t we made aware that this woman was coming to us?” It’s a good thing that I happened by, because they would have intubated her in less than three minutes. They were that good.
“Hold it! Hold it, gang!” I said as I walked into the bay. “This lady is sent to us from Mirwaïs for a CT scan only. It’s not a transfer. We are not to intubate her as they have no means of venting her once intubated.”
That’s when I usually get the “Why the hell are we CT-ing her anyway, if we’re going to let her die?” Because after having been un-intubated for thirty-six or forty-eight hours with a GCS of less than six, she would have no chance to live. Even if we intubated her, kept her there, and fed her for months, she was still going to end up the same way, with bed sores and everything. We were just not equipped for that. We were good for the survivable ones, the ones who we intubated, operated on (or not), then woke up after two or three days. There was no chronic care. We didn’t provide that, and neither did the Afghans.
I’ve got no other answer than that. It’s just the way of the country. We couldn’t take in all the civilian head traumas they got. We’d have been overwhelmed in three days. What with their driving habits, and piling into the backs of pickup trucks and the trunks of cars and all that. So Mirwaïs did its thing for civilians, and we did ours for soldiers. And if we happened to be in a position to help the civilians, we did. But sometimes it was too late to help.
C’est comme ça.
I have invented a character for a novel (yeah, I write novels, but in French), who explains it this way: The lions are all sleeping under the baobab tree. All day long they snooze as thousands and thousands of antelopes, gnus, giraffes, and zebras walk by unmolested. Then, at the end of the afternoon, the lions wake up, stretch, and figure they’re hungry, so they look at all the lunch walking by, select one prey, and kill it off. The moral of it all is that you can’t save all the zebras.
C’est comme ça.
They checked this lady over for obvious and easy things to fix. She had a GCS of about four to six, and she had apparently been like that for thirty-six hours. Prognosis: not good. Okay people, we CT her and see if we can do anything to help. If not, that’s all.
She was accompanied by the Afghan amb driver and a small, humble young man who looked as if he’d like to disappear into the floor. Apparently it was her husband. The story was that her twelve-year-old son had whacked her on the head with a rock. Well, her face was all swollen, so it did make sense.
But when we looked at the CT, we couldn’t believe what we were seeing. Not one of the bones in her head or her face was intact. This woman had been hit repeatedly on the head, and from all directions. The left side was caved in. So was the right. And so was the top. And so was her face. I’d never seen anything like it. We couldn’t understand it.
Facial fractures are classified according to a scale designed by some guy called Lefort. A simple fracture is a Lefort 1, and so on, all the way up to three, the maximum. Well, this was a Lefort 57, according to that scale.
“What can the police do about this?”
“Yeah, somebody’s been at her with a baseball bat or something.”
What could the police do? Good question. The police could hardly survive in that country. They didn’t have time for a domestic dispute. Still, somehow, I couldn’t imagine that humble little hand-wringing guy beating her up like that. Neither could I imagine a twelve-year-old doing it, even the most delinquent.… Well, I suppose we do have delinquents capable of doing that back home. I’ve watched twelve seasons of NYPD Blue, and yeah, we have those kind of sick people back home, too.
Somehow, I couldn’t help thinking about my ancestor. The first Dauphin had arrived in Quebec City in the early 1600s and had married one of these brides-by-mail-order — a Fille du Roy. My parents, who are genealogists, have found this guy’s original wedding contract, complete with the “X” for a signature at the bottom of the page. My dad had also found a contract made a few years later in which their neighbour agreed to pay that first Dauphin family a certain amount of money if the wife died. She had apparently gotten into an argument with that neighbour over something, and he had beaten her to within an inch of death. My ancestor’s name was Marie Morin. And I couldn’t help thinking about her when I was looking at this poor woman. She had also been beaten within an inch of death. Well, more like within a millimetre. But why?
I didn’t figure out what had happened to that woman until I got back home and Rick sent me a grisly video. At first I didn’t want to look at it, and I left it for a few days before getting the courage to open it. The video showed the lapidation of a woman. In certain countries (let’s try to be politically correct here, and not affix any label) they throw stones at a woman until she dies. For adultery, for example, even if the “adultery” was in fact a rape. Even if a man sees the face of a woman it is considered by some very primitive societies to be
adultery. No wonder that woman in the back of the amb had been trying to cover her face while her baby was bleeding. She could always make another kid, but if a neighbour accused her of showing her face to us men, especially infidel men, she could lose her life. And in a very unpleasant way, too.
And that’s what the video showed. Except in this case they didn’t throw stones at the woman. But they did drop a cement block on her head. In addition to that, the men in the video were gathered all around her and seemed to be kicking her. Just a bunch of stupid yahoos venting some frustration by kicking some poor woman in a country where it’s permitted. Until the idiot slams the cement block on her head from about four feet up. Like I said, it took me about three days to get up enough courage to watch that video, but once I did, I understood what had happened to that poor Afghan woman months before. They had lapidated her. Kicked her, stoned her, then left her for dead. On the video, you see a bunch of those idiots filming the scene with their cellphones as they’re kicking her.
As a matter of fact, it’s probably what had happened to that other woman, at the FOB, when the men had stopped to borrow a shovel.
For weeks after that, I tried to fight the rage inside. But every time I calmed down, I kept thinking about how backward some cultures can be. Then, slowly, I started thinking about the witches they’d burned in our country. Admittedly, it was a few hundred years back. Still, you suffer a heck of a lot longer when you’re being slowly burned to death than when some idiot heaves a cement block and crushes your skull. Yeah, I know, we stopped doing that four hundred years ago. So some Afghans are four hundred years behind us socially.
That was one good reason to be there, to try to prevent that kind of stuff from happening.
Then again, maybe I’m full of it.
C’est comme ça.
Darn Pilots
Darn pilots. Some of them, as soon as they walk away from their flying machines, act like sex-crazed eleven-year-olds. Yes, I know they have testosterone too. I also know that individualism and some spontaneity is professionally encouraged in them, but still, it can be a pain. Like those two Canadian idiots who came around to the hospital in Wainwright on some pretext or other, all smart and sexy in those flight suits and those fancy sunglasses, to ogle and flirt with the ladies, and as a half-joke, to ask me if they could have a private massage from two of my nurses. I had an impulse to send them Rob and Jimmy. They were nurses.
Rob was six foot three and almost as wide, with shoulders like James Caan. (And if you don’t know who James Caan is, well, I am getting old.) Jimmy was a good six feet tall, big and strong; a nice, calm defenceman, the kind you’d like to have playing on your team. Smooth and unhurried, he saw the whole play before it happened. Did I tell you that, after his daughters and his wife, what Jimmy thought about the most was the Montreal Canadiens? Canadiens fans are all like that: passionate and proud. I used to hate them when such a thing as the Quebec Nordiques existed. (I did tell you I feel ancient, didn’t I?)
Then there was Rémi. He was also a nurse. Although not an immense guy, he was taaaall, probably six-five or so, and he had these huge, bony hands. And Shrek was a nurse, too. His real name was Aaron. He once tried to teach me how to twist my fist in such a way that, when I hit a guy in the liver, I’d tear that organ to shreds and the guy would bleed to death. (Yeah, I’ve seen torn livers, and they do bleed like you wouldn’t believe.) That’s not to say Aaron was aggressive. He was just prepared for all the bad that lay out there. On his days off Shrek would help train the Special Forces dogs. The guys would wrap him up in one of those thick suits and he would bait the dogs, letting them bite him, and swinging them around once they did. Since he was so big and tall, the suits were sometimes a little too short for him, and the dogs would miss the suit at the edges. Shrek would come back with a few holes in the skin of his wrists and ankles, the kind of holes where the edges are bluish from all that pressure from the dog’s teeth. He just laughed it off.
Darn pilots. I bet you if Shrek gave them a massage they’d remember him.
Then, there was Troy, a.k.a. “Monster Boy.” Technically, being a med tech, he wasn’t a nurse. But those pilots wouldn’t have known the difference. Monster Boy was huuuge. Bigger even than Shrek. Taller than Rémi. And he had the voice to go with it, too. Yeah, fellows, step right this way, Monster Boy and Shrek will give you a massage to remember.
Darn pilots.
It was out of the goodness of their hearts that they did it. Some illiterate idiot had just come along and blown himself up in some God-forsaken dusty little town. You know, the kind of ignoramus that believes those criminals when they tell him that if he blows himself up for the Jihad he’ll have a few dozen virgins in heaven. Those guys must be really deprived to believe stuff like that. Well, anyway, this poor fellow had completely missed the army convoy that had driven right past him, and, when he finally did blow himself up, he caught one of those Afghan taxis. You know, the ones where they pile up ten people inside, plus the women and children in the trunk? Well, they say he killed a bunch of his fellow citizens. Plus himself, of course.
At that time, we were really busy. I mean, we were the busiest that hospital had ever been in its history. Later on, of course, we got much, much busier, and handled that with (some) ease. But at that time, we thought we just couldn’t handle those extra patients, and since RC South had phoned to ask if we could take on those civilians who hadn’t been outright killed by Mister Hopeful, I answered that they should send those casualties to our neighbours at the ANA hospital. You see, as I’ve mentioned before, civilians were a pain for us. We fixed them up, but until they were close to 100 percent healed, we couldn’t send them away because there was no one to care for them. The civilian hospital in Kandahar had no advanced care whatsoever. I know, in a cold-hearted way, that that’s the standard of care in Afghanistan; but still, it was a shame to save somebody just to have them die because of negligent (non-existent) nursing and medical care. Especially a child. So civilians stayed on and on with us, and took up a bed that a soldier might need at any moment. Did I tell you this was a military hospital? Anyway, RC South agreed with me and said they’d send the patients to KRMH, the ANA hospital next door.
I think it was the pilot who decided to divert to us. They did that once in a while when their medic would tell them the patient was not doing well. Because, unlike us, at the ANA hospital the landing pad was not right next to the hospital, and, in those days, the ambulance was not there waiting for the chopper when it landed. In the Afghan Army, it used to go like this: first land the chopper, then call the hospital, then the hospital guy calls the ambulance crew, then the ambulance crew finishes watching their Indian soap opera, then they start up their amb, then they drive up to the chopper. They didn’t have the same sense of urgency that we did. They believed, like we did, in Inch’Allah (if God wills it), except that they hadn’t quite mastered the “first help yourselves” part. Ah well, who am I to impose my Western views on them?
Anyway, the helo pilot, in a fit of Mother Theresa-ism, decided to divert to us, which, in retrospect, is fine with me, except that we weren’t expecting anybody. Fortunately, it was morning so I did have a lot of staff on hand. The girls’ trauma team was even in their bay, practising airways. Well the Five-Foot-Two Crew, like any trauma team, could turn around in a jiffy. When those patients came in, they just matter-of-factly dumped the mannequin from their stretcher to the floor and replaced it with the little girl I sent them. She was so tiny that it was fitting that the Five-Foot-Two Crew should take her.
In the next bay, her older brother was howling in protest at whatever Mister Lonely had done to him. Also, I’m sure, in reaction to the needles we were sticking into him. (One good thing about children is that they yell readily. That way you know for sure that they don’t have any airway problems.) Unfortunately, that was not the case with his little sister. Boy, it sure was a quiet trauma bay, what with that little one as silent as if she were asleep, and the girls not saying
a word. Not that they were that affected, but only that they had gotten to a point where they didn’t need to talk. Everybody knew what everyone else was doing.
The little girl looked to be about one year old, which meant she was probably three. Lines went in okay. She was quickly intubated. She didn’t look like she had any major injuries: no blood or anything, nice pulse, nice BP, great sats, just peaceful, as if she was taking a nap. Well, a nap with a big old white tube sticking out of her mouth, another one up her nose, and two IVs out of her arms that is. So she was the first one off to CT.
I was the most worried about the adult who came in with them, because he had a bunch of shrapnel in his thorax, and the chest tubes they’d put in him were draining quite a lot of blood. From outside the bay, it looked as if somebody was putting blood into his venous lines and it was coming straight out of the chest tubes. Sort of like one of those closed-circuit things we used to put up in our college physics lab.
So if that little girl needed to go to the OR for some neurosurgical intervention, and this guy to the other OR for a chest exploration, that didn’t leave me a lot of leeway if the other kid had a surgical problem too. What if I was using all three of my ORs and then some soldiers came in who also needed surgery real fast?
Did I tell you this was a military hospital? Damn those Mother-Theresa pilots.
So at the same time that the guy went to OR 1 (he told us he was the taxi driver and didn’t have a clue who his clients were — great! How are we supposed to figure it out?), the little girl came out of the CT. So, while the howling boy went next to the CT, we bunched up to the screen, all silent and with half-open mouths, like a bunch of kids looking at the newest Harry Potter teaser. The radiologist was pulling up the pictures, clicking away wildly as he changed the contrast, the brightness, then again the contrast, then scrolling up and down so that the pictures flipped from one to the next almost like a movie.