Genesis 50:20


Genesis 50:20 - You intended to harm me, but God intended it for good to accomplish what is now being done, the saving of many lives.

Thursday, January 12, 2012

Random...the home stretch





Here are a few random shots .... home is coming soon!!! Praise GOD!

Monday, December 26, 2011

Seasons Greatings

Hey there everyone!

I just wanted to say thank you to all of you who have sent me care packages for Christmas. The weather had been bad recently so a lot of the mail had got stuck in Kandahar, but today I got a bunch of boxes from friends and family. Its like a late Christmas. I was busy in my room this morning opening all these boxes filled with thoughtful gifts and cards. I love you all.

Christmas here was good. I tried to pack as much in as I could. I played the piano and sang at the Christmas Eve service at the Chapel (see the pic below). I stayed up all night on Christmas Eve and manned the TOC so that the people who normally do could have a night off. I called home. Then the next morning (Christmas Day), again I played for the praise and worship team for both the 11 AM service and the 9AM Service and I preached at the 11 AM service. Then I crashed for a few hours. Then I woke up and manned the TOC again all night on Christmas night. Needless to say, by Monday morning I was exausted. But I felt that I had given all I could so that Christmas could be special even in Afghanistan.

Merry Christmas everyone and may God bless all of us as we seek His will this coming year.

Friday, December 16, 2011

The Christmas Season

It can be hard sometimes to get in the mood of the holiday season when you are surrounded by rocks and dirt and can only wear a uniform. But I am not letting those factors get in the way of me celebrating this awesome Christmas season. In fact I have never been geographically closer during the holiday season to where it all went down 2000 years ago. So thank you to all of you that sent care packages for Christmas. From candy canes, stockings, baby Christmas trees, fudge, truffles, gum drops, Christmas Coffee, and the like it has all served to brighten my days and the days of my fellow tent mates. So here are a few shots of the Christmas joy around my Middle East World.... I love you all.


Tuesday, December 6, 2011

Meaning


Here I sit at half past 2 in the morning, listening to the playlist on my sister’s blog. Tears come to my eyes as I listen to the music. Aim so blessed. I look over the pictures on her blog and see the smiles and the kids and warm embraces. The family that I grew up in is now grown. We are scattered all over the globe. Christmas will be different this year. I see the smiles of my own kids in my mind. Life has taken the innocence of a little boy and in its place left sweet memories of growing up. Now I see the wonder of innocence in the eyes of my own son and daughter. And I pray that I can be as good a parent to them as were my parents to me. I dream about my family at night. I can hear my wife’s voice. What did I do to deserve such abundant blessings? Life is frighteningly short. From swaddling to crawling to walking to running and falling it all passes quickly. This war reminds me that some things are worth dying for. But some die too soon; life slipping through my hands and my heart. Like a broken glass, Lord, fill me.

Monday, October 17, 2011

Resuscitation

Well the last 24hrs was a blur. It was a peaceful Sunday night and I was just about to change out of my multicam uniform and into my flannel PJ pants and T-shirt when there was a pounding at our tent door. My tent mate opened the door and one of our young specialists was at the door. “Hey, there is a GSW coming in from the gate. It’s an Afghan who was shot in the chest,” immediately came out of the young soldier as the tent door swung open. “Great” sarcastically mumbled my anesthesia buddy from the room next to mine. “Hey Weaver…did you hear that”, I called out as I reluctantly put my multicam pants back on. “Yep,” replied the sleepy voice of my anesthesia buddy.

As I walked out of my tent, there were a few of the new soldiers that had just arrived to the FOB to relieve some of the guys that had been here for 360 days, walking around. “You ready?” I asked them. “Ready for what?” they replied. “GSW to the chest in 15 minutes” I answered. They had only been on the FOB for one full day and they had never deployed before. Their eyes were as big as saucers as we all headed over to the hospital.

As I walked in to the hospital, my best friend out here (the orthopod), asked if I had heard about the trauma coming in. I told him what I had heard and went to the ER to get the trauma bay and medics ready.

The medics were in their place and I, as I always do, began running through a mock scenario of what we were about to see. I ask them “if…fill in the blank… happens, what will you do” type questions. It’s like a little warm up to get them thinking in the right direction.

Before long, the patient is being unloaded from the field ambulance (a modified humvee) and brought into the trauma bay. He is soaked in blood. Blood is dripping from his blood drenched pants, which were the only thing he was wearing at this time. The translator immediately starts peppering this 35yo guy with questions to get an assessment of how “with it” he is and if he has any medical problems. The patient is barely conscious and his vital signs reveal that he is about 10 minutes from crossing over to the other side….so to speak.

The medics get IV’s in place and draw blood work, while the rest of the team quickly evaluates the patient like a NASCAR pit crew. There is a large exit wound about the size of a kiwi in the middle of his right clavicle. Blood is welling up in this cavity like someone had left a water fountain running with a clogged drain. We shove a large curlex roll into the hole and I let the team know that we need to be in the OR now.

I head back to the OR to talk to my head scrub tech (who also happens to be in a Bible study with me) and let him know that we are going to need the major vascular set open and possibly the thoracotomy set too. He calmly says, “No problem,” and continues to get the sets opened, counted and ready.

Justin, my ortho friend, asks if I will need him to help. “Yeah, that would be nice.” I let him know. And we both go back to scrub our hands. By the time that we are ready, the patient is ready too.

Long story short, we repair the lacerated subclavian vein, tie off some bleeding smaller arteries, and get him out of the OR to continue warming and resuscitating the patient. And he does great. The next day we take the breathing tube out and send him to a local Afghan hospital at 4:30 in the afternoon. That night I only slept 3 hours. It’s amazing what is involved in one small word….resuscitate.

In human physiology, resuscitation happens at the cellular level, and it has to do with oxygen delivery. Each cell in the human body needs oxygen to live. People breathe in oxygen and it gets transferred in the lungs to a certain kind of molecule in the blood. The blood carries the oxygen to the cells through smaller and smaller blood vessels until the vessels are so small that the blood can only pass in a single file line. When the blood cells travel by tissue cells that have low oxygen levels, the blood cells release the oxygen that they have stored in them to tissue cells that are literally suffocating.

The ultimate reason people die when they get shot is because a bunch of cells are suffocated due to lack of oxygen delivery. Now how does that happen? Well given the above information, if you don’t have one (or enough) of the following, you can’t deliver oxygen to the cells: oxygen, blood, functioning lungs (basically I spent all night “tweaking” these three variables to optimize oxygen delivery to this Afghan’s cells). Interestingly, if only a few cells die from lack of oxygen, the body can “deal with it” and make some new cells. But at a certain point, or at a certain number of cells, the body can no longer compensate for the amount of tissue that died, and the whole body dies too.

Now I know that Paul didn’t know all this when he wrote Romans 12 or I Corinthians 12. But I know that God did. You can have a greater understanding of God by looking at “His Image”… namely, by looking at human physiology. It is no coincidence that the Greek word for the third person of the Trinity is pneuma (πνευμα), "breath, motile air, spirit". Where there is no pneuma, there is no life! Where there is no Spirit of God you cannot have life; and where there is no oxygen or breathing, you cannot have life. Furthermore, where there is no blood, there is no life. Without Christ’s blood we cannot have eternal life.
Now an important distinction to point out is the difference between resuscitation, and resurrection. I am not in the professional business of resurrection (although there have been a few times in my life when I witnessed this happen in the OR or ICU….truly miraculous). But I more frequently deal with resuscitation. Resurrection is going from dead to alive. Whereas resuscitation, a tough word to spell if you do not know the Latin roots behind it, comes from the Latin root word cito, citare, citavi, citatum—to set in motion, rouse, excite, hence, to resuscitate is to ‘set (one) in motion again.

I spent the last 11 years learning how to physically resuscitate a human. I need to be as passionate and effective at spiritual resuscitation. One person who is great at spiritual resuscitation is my mother. She is like a DeBakey, or Mayo, or Hopkins of spiritual resuscitation. Spiritual resuscitation involves focusing people on the person of Jesus Christ and through prayer and Biblical teaching getting them to “breathe” again. Let’s hope we all “get this skill set down” before the final board exam… it’s expected of us.

Monday, October 10, 2011

Things I Miss

By far the hardest part of deployment is being away from my family:
Bath time
Movies on the couch with Kari after the kids are asleep
BBQ steak
Swimming with the kids in the backyard
"Exploring" the neighborhood with the kids
Bedtime stories with Ian
Coming home after work and Ian running to hug me as he raises his arms to have me pick him up
Watching Diego with Ian and Audrey
But most of all I miss the love of my life and anything we do together...I love you Kari





Wednesday, September 28, 2011

Angels Crying

Today was an exhausting day. I woke up to after staying up way too late to go over to the clinic and see some follow-up patients. These patients were Afghan army soldiers that we had taken care of after they were shot by the Taliban in the legs and abdomen two months ago. They were doing well. After fixing their intra-abdominal wounds, we had put external fixators on to stabilize the fractures and sent them for definitive surgery at a local afghan hospital. We found out later that they don’t have any capability at that hospital to do the definitive surgery that they need. Instead that hospital took them in, collected the money from the government to take care of them and after they were “stable” they got discharged from the hospital. The problem is that the hospital does nothing for the external fixators. They just leave them on! And then we see them back at 2-3 months after the accident and our eyes were like saucers to see the ex-fixes still on. The fractures don’t heal very well. But they are slowly healing. The ex-fix is not supposed to be the definitive surgery for these types of fractures.

Anyway, we were seeing these follow-up patients when the radio started blasting that there had been an IED explosion and 4 afghan locals were wounded. About twenty minutes later, they were coming out of the back of the Field Litter Ambulance… two kids, two adults. The first one out the door is an older female…she’s dead. The next one out is a stretcher with two kids on it. The kids were so small that they were laying with one head at one end of the stretcher and the other kids head at the other end of the stretcher and their feet didn’t even meet in the middle. There was a boy and a girl. The girl was about 5 and barely over 20kg. She was trying to roll over to one side but not crying or moaning. She had huge black eyes and abrasions over her face and head. Her left arm and leg are bent in ways that God did not intend. The little boy…a little smaller than the girl was crying (thank God for crying…it means that the airway and lungs are intact). I was almost as happy to hear that little boy cry as I was to hear my own boy first cry when they pulled him through the c-section incision when he was born.

I went busily to work on the little girl. ABC. A…airway; she was unconscious and could not protect her own airway if she were to vomit. She needed to be intubated (a breathing tube placed in her mouth and down into her trachea to prevent her from suffocating). The anesthesia providers went to work and easily intubated her. Next…. B ….breathing; they squeezed the ambu bag and her little chest didn’t rise, but we could hear breath sounds on both sides. Her O2 saturation was low but had come up slightly. We got a chest x-ray that revealed the problem ….she had air outside her lung that was collapsing her lung on the left. I placed a chest tube to release that air and that helped things a little bit. But still she had low O2 saturation…..think, think, think, what could be doing this. The x-ray showed that the tube was in good position and the repeat x-ray after we had put the chest tube in showed that the air was evacuated but what was I missing…..why was her O2 saturation so low……well her stomach was full of air, so we put a tube through her mouth into her stomach to relieve that air which helped, but she still had low O2.

I looked at the chest x ray one more time and thought about the mechanism of injury, then it hit me….pulmonary contusion! She had sustained a huge blast from the IED. That blast basically slammed her lungs into her chest wall causing huge bruising on the inside of her lungs. The only way to get more oxygen to the lungs was to increase the pressure of O2 in the airways. This can’t be accomplished with a non-cuffed endotracheal tube. We needed a cuffed endotracheal tube so that we could make a seal around the inside of the air way and thereby increase the pressure of the O2 in the airways. We did this and BINGO she started to get better…at least in regard to the breathing part.

A….dealt with. B….dealing with but improving. C…circulation. It is amazing how God makes little kids. During this whole event, her blood pressure was pretty steady and even appropriately high to help perfuse blood to her badly injured brain. Still I add a central line to the left subclavian vein to the mix to give us a fighting chance to be able to resuscitate this little girl.

Now how about the brain… What was I to do with the head injury? Clearly she had a horrible head injury evidenced by her “raccoon eyes” and non-reactive right pupil. I gave her a dose of mannitol that helps lower pressure on the brain but she needs more than that. She basically needs a neurosurgeon RIGHT NOW. In the US she would already be in the OR….not here. So we call the nearest neurosurgeon.
The response I get is chilling…no neurosurgical intervention for Afghan locals that come in to the ER with a GCS of 8 or less. That is the Clinical Practice Guideline (CPG) in theater.

The words hit me like a ton of bricks. The neurosurgeon on the other end is actually someone I know from back home in the states. He says he will take her if I think that the head injury is the only thing that’s wrong. He wants to help, but it has to be an isolated head trauma.

I wish she only had an isolated head trauma. I put the phone down and take another look at her. For the first time in the hour that we have had her, her vital signs look stable. I look at the repeated Chest x-ray. She has one of the worst pulmonary contusions that I have ever seen. She has blood coming out of her lungs and into the ET tube from the bad contusions. She has a broken arm and a broken leg. This is the opposite of isolated head trauma. I grab the phone again and with a frog in my throat I tell him thanks, but she is not an isolated head trauma. He again says sorry. I say, “I know”. And we hang up.

So now I have stabilized her but her brain will continue to build up pressure until it no longer functions, and I can’t do anything about that.
So now I check on the other two patients that are alive. The little boy is doing fine. He is crying and the nurses are taking care of him like he is their child. There is something remarkable about seeing an American nurse holding and caring for a child like that. It is as if they temporarily adopt the child as their own. But he is doing fine. He is just a bit bruised and cut up but he will be fine. The last patient is a 35yo woman who is 9 months pregnant. The baby seems to be doing fine, although all we can check is fetal heart tones which are appropriate for gestational age. But the lady has a bad contusion on her head and had lost consciousness at the time of the blast. She has a closed head injury and needs a CT scan to make sure she doesn’t also have a intracranial bleed like the little girl.
The people in charge of arranging medivac flights get the next call. We let them know that we have two category alpha patients that need medivac to the local Afghani military hospital. I am not going to let the little girl die in this hospital. I feel strongly that the Afghan people need to see and treat the consequences of the IEDs that their own people are making. Despite some push back from the transportation arrangers, my friend that oversees them arranges that both the pregnant woman and the girl get sent to the Afghan military hospital. I know full well that the woman will be OK, but the little girl will die in about 12 hours. I just hope that the parents, if they are still alive, will be able to be there before she dies.
After a few minutes, the flight medics show up and the sound of blackhawks preparing for takeoff fills the trauma bay. We package up the patients, securing all the lines and take them out the door on stretchers and load them on the blackhawks. A few minutes later, they are out of site on their way up north.
I sit outside behind the ER exhausted. I sit for a while and reflect on the situation that just presented itself to me, while picking up little stones and throwing them at a coke can that had missed the trash can. I was a confused mixture of tired, angry, sad, and relieved. I was proud of what the team accomplished. We had stabilized 3 very sick patients and got them transported. We fulfilled our mission. But ultimately we can’t do what the little girl needed. I reason with myself that even in the US this girl with her head injury and her pulmonary contusion (not to mention the broken arm and leg) would have been “touch and go” for a while. She might not have made it even in the US, let alone out here in 2nd century Afghanistan. My stomach starts to growl and I head over to my tent to meet my buddies for dinner.
After dinner, I went walking through the hospital when the commander walked up to me and said that the Special Forces guys have a detainee that they need to have medically cleared before they send him for interrogation. So we lock off the back of the ER (the same room those hours before we fought to keep the little girl alive) and in walks a young man in a blindfold with a security escort. I look this 22 year old over and get a complete history and physical examination. He is perfectly healthy. He even smiles at me while I check his cranial nerves.
Just then the Special Forces SSG says, “I heard you guys were busy today.” “How’d you hear that?” I asked. “This is the guy that planted the IED” He coldly responded. Just then my blood boiled. This arrogant 22 y.o. punk that smiled at me just killed 16 of his own people including that little girl. The story that the Special Forces gave me was that the bomb had been planted for an Afghan army convoy that was supposed to go over that route today. Instead the convoy delayed a day and four cars packed with local Afghanis, headed to an engagement party for a couple that was getting married in a few weeks chose that route. That explains the little dress that the girl was wearing that kept raining sparkly sequence onto the stretcher as we cut her clothes off.
What a backward country. “We all, like sheep, have gone astray, each of us had turned to his own way; and the Lord has laid on him the iniquity of us all.” Isaiah 53:6. We all need a shepherd. Look what we are doing to each other.