I was going to blog this week about the team’s ingenuity in discovering you can bake a cake in the Operating Room autoclave (medical instrument sterilizer), but too much has happened that I would rather talk about. **WARNING**, there are graphic descriptions of injuries to follow.
Some of you may have heard about the recent helicopter crash that happened very early this past Monday morning. There was even a small story on Yahoo about it. Here is a link:
When we are not in the FST building we carry radios so that we can be contacted should we get notice about a patient(s). I was awakened at 0100 on Monday with the following call, “Teams 1 and 2 to the FST, 14 patients incoming – 2 urgent surgical, 12 routine”. My room is about 50 feet from the FST so I was the first one there. When I arrived, I asked the duty corpsman what happened and he tells me there was a helicopter crash 6 miles from our FOB. Now I’m thinking, how could there have been a helo crash and only 2 of the casualties are urgent? In my short experience here I have come to realize what is reported to us about the incoming casualties and what actually arrives are usually two different things. So, I’m thinking the worst. About 30 minutes after I got out of bed the casualties began arriving. We only received 13 of those 14; one of the Afghan interpreters came on the helo, but refused treatment claiming he had no injuries. We ended up transferring 4 of them to the Role 3 in Kandahar for further definitive treatment and other studies we were unable to provide at the FST. Everyone on our team was surprised there weren’t more serious injuries other than some closed head injuries and broken bones. They were all very fortunate. The rest of our patients last week were not as lucky.
We had our first death the following day. An ANA soldier suffered a gunshot wound to the head and right shoulder. He came to us with a blood pressure and electrical activity on the ECG monitor, but no pulse. We worked on him for about 30 minutes – even performing an emergency thoracotomy with cardiac massage (cut his chest open and squeezed his heart) in the trauma bay (never a good sign) – but were unable to resuscitate him. When we removed the dressing from his head to assess his wound I saw the worst injury I had EVER seen in 15 years of nursing – the top of his skull was shattered with brain and blood oozing out. I discovered “ever” doesn’t last all that long here. Unfortunately, I witnessed more devastating injuries the following day.
Wednesday, 31 March 2010 was probably the most challenging, and physically and emotionally draining day of my life. Several of our team members were eating lunch at about 1100 when we got a call on the radio about patients coming to the FST. 4 ANA soldiers were injured in an IED blast (Improvised Explosive Device – if you are not familiar, you can Google it, they are heinous instruments of war). We were getting 3 of them; the other was dead on arrival. The three we got suffered various blunt trauma injuries, all with traumatic brain injuries or TBI (a fancy new term for concussions of various degrees). The most seriously injured suffered 5 fractures in his left leg – femur, tibia, fibula, talus and crushed calcaneous – and his right leg had a fractured talus and dislocated ankle. He was in the OR for about 3 hours. This was NOT the injury I mentioned above – I wish it was.
Not long after he came out of the OR the phone rang. There was another IED blast in nearby Qalat. We were going to be getting 4 injured Afghan children – yes, children. 4 boys, brothers and cousins aged 8-14, were herding their sheep when they “tripped” an IED. Two of them were severely injured and unconscious. The other two had only minor injuries – minor for Afghanistan. One of the severely injured boys had multiple shrapnel wounds to all 4 of his extremities and face. The other had traumatic amputations of both arms just below the elbows and his left lower extremity – though not amputated - was mangled. He also had complex facial lacerations and a right eye injury. After a lengthy resuscitation, he was taken to the OR where his arm wounds were cleaned and dressed and his left leg was amputated above the knee. After further examination of his eye, it may not be able to be saved. The two young boys were transferred to the Role 3 in Kandahar at about 1100 p.m. I just went through 12 hours of “somewhat” organized chaos and it seemed like 30 minutes.
I, like most of the rest of the surgical team here with me, thought I had a pretty clear idea of the types of injuries I would encounter during this deployment. I even told Judi that I wasn’t really concerned about the injuries I would probably see – I thought I could handle them. I was more worried about the potential injuries I might suffer. I’m not so sure about that now. One thing I am sure of is that I don’t think the Navy could have selected 20 better, more qualified people for this mission. What I described above does not truly capture the volume and acuity of injured patients we treated this week and our team did it without missing a beat. I was going to post a picture of our group later on in the deployment, but I can’t think of a better time than now. I’ve only known them for a few months, but I learned more about their character in 12 hours on 31 March 2010 than I think I ever will about anyone...EVER.
If you wonder how a person who just went through what I described above unwinds, I can tell you. He picks up his cell phone, walks outside under the stars, calls his beautiful wife and listens to her tell him a funny story about how she tried to outsmart their dog by hiding a baby aspirin in shredded chicken only to get schooled by him when he spit it out onto the floor. It’s that simple. Thanks for being there Judi! I love you!!!
p.s. remember, you can click on the photos to enlarge them.
Me with two of the Afghan boys while the other two were in the Operating Room
The NAVY Forward Surgical Team
Front Row Left to Right; HMCS Pietro Martone (Senior Enlisted Leader), HM2 Shamika Wilson (Leading Petty Officer, Surgical Tech), LCDR Chris Coetzee (Orthopedic Physician Assistant), LCDR Robbie Ladd (Nurse Anesthetist), LCDR Sue Howell (Critical Care Nurse), LT Shannan Cook (Perioperative Nurse), HM2 Patrick Malveda (X-Ray Tech), HM2 Tommy Turtle (ER Corpsman), LCDR Sharese White (Orthopedic Surgeon), CDR Charlie Godinez (Trauma Surgeon and OIC).
Back Row Left to Right; LCDR John Eckenrode (ER Nurse), HM3 Kevin Hines (Surgical Tech), HN John Hitchcock (ER Corpsman), HM3 Hasan Hafiz (ER Corpsman), CDR Hank Zielinsky (Trauma Surgeon), LT Shane Lawson (Nurse Anesthetist), HM2 Gavendra Rampertaap (ER Corpsman), CDR Cheuk Hong (Trauma Surgeon),, HM2 Alonzo Shields (Surgical Tech), HN Anthony Funk (ER Corpsman).