the real deal...

posted by: emilie

tomorrow will be 3 weeks since i offically arrived at my new duty station. it has been a relatively eventful 3 weeks, with the initial attack on the post, the emergency ruptured ectopic pregnancy, and the earthquake. but until tonight i hadn't really, truly felt the effect of being at war. i'm hoping that it will be therapeutic somehow to write about it. i'm hoping that it will help me to never forget what these incredibly brave americans have sacrificed. i hope that when i feel frustrated with medicine, and being in the army, and dealing with difficult patients i can think about the fact that all of the school and the training helped me prepare for this moment...and i can remember that today i actually helped people.

I work in the Aid Station. we normally see the minor stuff...coughs, cold, runny noses and sprained ankles. The neighboring building is the FST (Forward Surgical Team). That is where all the big trauma goes. They often get 1 or 2 patients at a time who were involved in blasts, or gunshots.

Tonight while i was seeing my usual "sick call" patients one of the nurses ran over to ask if i could come to the FST. They were expecting 5 severely injured soldiers, and needed every available hand. I told all the coughers and sneezers to come back in the morning, and ran over to the FST. We recieved a radio message that said we had 11 minutes until the casualities would arrive.

The FST is a well-oiled machine. The Colonel in charge (a general surgeon) quickly assigned each of us to a bed. The sickest patient would be attended by the anesthesia provider and the general surgeon. The next 2 would go to the two orthopedic surgeons, the 4th would go to the trauma-trained physician's assistant, and i would get #5. We each gathered around our stations and started getting our equipment together.

It tends to be the trend that the trauma we receive is not quite as severe as we anticipate, and so i expected a few broken bones and that kind of thing. When they brought the first guy in i knew it was going to be the real deal. He was young...early 20's...and a big guy. the medics were struggling to get the stretcher in to the building. He was completely unresponsive, and his tibia was literally sticking out of his leg at a 45 degree angle. The team quickly intubated him and started getting to work to identify his wounds and stop the bleeding.

After that the stretchers kept coming, and every young soldier was in critical condition. Apparently the enemy had mounted an IED (bomb) to the bottom of their vehicle while it was stopped, and when it detonated it demolished the vehicle (which is incredibly rare...usually the roadside bombs barely make a dent in our big, sturdy tanks).

The soldier that ended up on my table was fortunatley at least alert. A very proficient medic had applied a tourniquet to his leg to stop the hemorrhage from the wound that was created when his tibia tore through his skin. His other leg was also grossly disfigured, but at least no bones were sticking out. He remained stable while i found his various injuries and cared for them, and in the long run i think he will do just fine (After a lengthy recovery).

After i stabilized my patient i checked to see how i could help with the 4 other soldiers who were more critically injured. I spent the evening doing whatever i could....i bagged each of the intubated patients while the surgeons worked to figure out who needed immediate surgery. there was not much i could do to help, but i prayed for each man as i squeezed the bag every 3 seconds. I helped with some minor surgical procedures, and bandaged up injuries that were so gruesome i can't even write about them. Every once in awhile i would look around at these soldiers and choke back tears when i thought about their families who were about to recieve terrible news.

when i walked over to the aid station to get some meds from our pharmacy i saw a line of guys standing outside the aid station, and wrapping nearly all the way around it. I suddenly got very anxious that all these guys had been injured as well, but when i asked the medic she told me they were the "walking blood bank" that was activated to provide whole blood for the casualties. I had to duck into the pharmacy as my eyes filled with tears when i realized that all of these guys were pitching in to help save the injured soldiers. Their blood would literally be taken directly from their bodies, and administered to the soldiers in the building next door. (for the non-medical type this is incredibly rare...usually the blood gets drawn and then screened, and then filtered and separated into various components. in the non-war scenario it is almost never indicated to give blood directly from one person to another)

I've seen some sad things in the 5 years since i graduated from medical school. I have certainly become numb to many of the situations that we face as physicians. but tonight it was unbelievably real. unbelievably sad.

as i am completing this post there is an announcement over the intercom for soldiers with O neg blood to report to the Aid station immediately. this is 6 hours following the blast, which means that the injured men have not yet been stabilized. please take a moment to say a prayer for these brave warriors and their families. if they make it through tonight, they still have a long road ahead of them.