Reflecting On February

In like a lion out like a lion, no lambs here. The 1st entry on the blog for February was trauma and the last is trauma. We were sitting out by a makeshift fire pit listening to the crackling of a modest sized bon fire under a full moonlit night, while smoking some cigars. My thoughts drifted up to the heavens as I watched the sparks float into the blackness of a starry sky. I remembered many nights doing the same thing but over a certain prairie of northeastern Colorado.

We talked and laughed around the fire unhindered by the normal drone of aircraft coming and going. But this evening the ebb and flow of the traffic was low and thus we were even able to bring out some portable speakers and listen to some music. The breadth of the topics casually covered was staggering and before I knew it, several hours had passed and the majority of the world around us had gone to sleep. Our laughter cut the silence of our sleepy little area of the world and we all felt a warm glow akin to the fire that had now died down to embers.

As our eyelids started to feel heavy and the folding chairs began to get folded in for the night; as the hiss of water filled the air when coals were doused with water, a particularly cruel sound punctuated the now dark night. Small arms fire. Hmmm. This was followed by the other familiar sound, athis time emanating from my hip…beep, beep, beep, beep. Sure enough, “Trauma to EMT…ETA NOW” read the glowing display from the pager on my hip. I guess I am not going to bed now, I’ll just have to store that warm glowing feeling away for now and switch gears. And with that I headed for the back door of the EMT.

As dawn broke, I exited that same back door of the EMT. Having helped repair a femoral artery and vein, thankful that his buddies knew how to use a tourniquet, thankful that my CHU has blackout shades, thankful that I have great colleagues here, thankful that this isn’t every night, thankful that the PX has plenty of socks so I can throw these blood stained ones away. But most of all I’m thankful that this soldier won’t lose his leg, whether he knew that was a possibility or not. I hope he realizes his medic saved his life with that darn tourniquet.

As I drifted off to sleep, I could see those sparks floating into the sky from the night before…who knew February would hold such diversity.

Battle Rhythm

The roar of helicopters and planes go by unnoticed, and the ¾ mile walk to the DFAC seems right next door. Morning meeting and workout schedules are set. The new normal has come. And yet every day there seems to be one, two, or a few things that make one realize that this is not normal. Back home, when I left the house, I just left the house. Now when I leave, I need to keep in mind, “How fast could I get back if I needed to,” or “will they be able to find me if a mass cal came in?”
This morning was punctuated by two separate explosions shaking the CHU’s. Each time an explosion is heard, it seems one has to make a decision, “Will I let the enemy defeat my spirit, or will I live victoriously?” Victory itself takes on a whole new meaning here. Last Sunday I went to a new church service. One of the scriptures that was read dealt with God knowing our coming and our going. Here when you go outside “the wire”, your life is at stake. So as we all recited that God knows our coming and going, we were affirming that God would be in control of our very lives while we lay everything on the line. The Bible is very much a survival guide here.
I am still of the conviction that I, like David as he faced Goliath, am a servant of the most high God who upholds my right hand and triumphs over my enemies. Whom shall I fear!

Tosca

The other night I did a neck dissection on a working dog that had been shot through her neck. She did well and by that night was playing with her squeaky chew toy, and wagging her tail.
The familiar feel of petting a dog, brought a little piece of home to Iraq. On top of that, my heart was grateful to God that this Gunnery Sgt was going to be OK.
I love dogs and I love operating. I am thankful that God allowed me to combine the two. And I didn't even have to go to vet school:)
I guess this is another example of a treasure God had in store for me from the beginning.

"Don't Forget The Past"

There are so many small moments that God can use to effect a person. I learned quickly that if one is not looking and listening for Him, complacency creeps into every corner of one’s life. Every day, on the walk to the dining facility I pass by an old building and a large bunker. I never pay any attention to these two structures, save there use as landmarks as to how many more mud puddles I have to dodge until I can eat. However, for some reason today I looked at the old building and thought it looked vaguely familiar.
A long time ago in a very small town in northern Colorado, there was a bank. This bank must have been a source of security and point of pride for the rural community of farmers that frequented this little bank. This bank brought respectability to the town and validation that these farmers were not forgotten from the rest of the world. These farmer’s investments, whether in land, stock, or equipment were just as valuable as any in the big city. And so this little bank remained as a landmark through the years, long after the town had moved and the people migrated to better land.
As a child I remember exploring around this old bank. Now destroyed, the only standing part of the town is the vault of the bank. My imagination vividly painted scenes of what this old vault must experienced as it stood alone on the prairie of northern Colorado.
Twenty years later, with my M16 and dressed in ACU’s I turn around and look straight at this old building I have passed by many times before and find myself transported back to that old bank. God whispers, “Don’t forget the past.” Here I am in a town in northern Iraq imagining what this old building has seen in its lifetime. What amazing things have taken place on this very soil. I can’t fathom what Jonah must have felt as God told him, “You have been concerned about this vine, though you did not tend it or make it grow. It sprang up overnight and died overnight. But Nineveh has more than a hundred and twenty thousand people who cannot tell their right hand from their left, and many cattle as well. Should I not be concerned about that great city?” Jonah 4:10-11.
This great city needs the Lord now as they did then. I’m reminded of that every day 5 times a day: Once two hours before sunrise, once at dawn, once at noon, once at sunset, and finally two hours after the sun goes down. As God shines over me, may the impression I leave be greater than the person I am.
What a great old building.

Settling In

The mud of Ninevah. Every street here looks like this one.

An Evening On Call

Trauma pager goes off and everybody drops what they are doing to assemble to receive the patient. Standing around waiting while conflicting reports float around as to what the injuries are. Then the sound of the helicopters can be heard. Moments later the techs run out to get the injured. Not just one but two soldiers…the team splits into two teams to evaluate our new patients simultaneously. I take the more critically injured. Over the moans and cursing, the team efficiently goes to work like a racing pit crew, each with their own task as I assess whether or not the patient needs to be rushed to the OR, now …later…or ICU.
The other team leader comes over to me to let me know the condition of the other patient. I give a few instructions and advice, then back to my patient. “Get him to the scanner” I say in as calm a voice as I can muster. Blood pressure, heart rate, breath sounds, O2 sats, all change from moment to moment. Good one moment, crappy the next. I turn to SPC T and say, “Have the blood bank get 4 Units ready for when we get back”. Off he goes. They load him on the scanner and after working through a few “kinks” in the system (sucking up valuable time) the whur of the CT machine reveals the images that bring great relief to me…No intraabdominal bleeding, but, the back is shattered. “How can this guy still be moving his legs” I think to myself. I send up quick prayer thanking God for the use of his legs and plead with him that we don’t make things worse in all the transfers he will need until that back gets fixed in Germany.
“Where’s the blood” I ask slightly annoyed that there is no blood waiting for us as we pull back into the trauma bay. “It’l be here in 10 minutes, “ I hear from some random voice behind the frenzy of activity. “ I asked for it 20min ago, it should be hear by now”, I think to myself.
“His pressure is dropping and now we don’t have IV access” the nurse says with a sarcastic smile, knowing that Murphy’s Law always strikes in the trauma bay. “Get me a central line kit!” I say to one of the internist that desperately wants to help but stands there like a man standing by a raging river afraid of where the current would take him if he were to jump in. “What size gloves?” the nurse says. “Seven and a half” I respond without thinking about it. Less than 2 minutes later the central line is in just below the clavicle sutured and dressed. Another prayer of thanks goes up, as the FP doc pats me on the back and says, “Nice job with that line.”
The blood arrives and is slammed in. His pressure rapidly responds….back to normal. Thank you GOD!!!
“Let’s get him to the ICU and get him warm, and get a CXR to check that central line.” I say as I step back to let the pit crew do their thing. Moments later they are on their way with the young patient to the ICU. I look at the chest xray…the moment of truth…is it in the right place….did I drop the lung…nope! Thanks again GOD.
I walk over to the bedside of the other patient and am given the report from the other team leader. Sounds like he is fine. “Can you admit him?” I ask the other doc. “Sure,” he responds.
In the ICU the nurses are getting his repeat labs and cleaning the patient up. “Seems like his stable for now,” I think to myself and go over to the desk and start documenting. The hour goes by punctuated by little requests here and there for miscellaneous orders. I check the patient and the labs. “More blood, he needs more blood” I think to myself and let the nurse know that he is going to need more blood. 10min later the blood is there and being transfused. The pain medication is kicking in and the patient is comfortable. Time to fill out the medivac request and get the helicopters coming. After all the paperwork, the word back is, “It’ll be 3 hrs. till they get here.” Time to sleep. I stop by the ICU to let them know to page me when they pack him up for the flight.
0500hrs I get the page and I put my fleece jacket on over my scrubs and go to the ICU. I walk in to see the patients brigade commander at the bedside. I introduce myself and summarize the situation for him. He thanks me and we all go out to the flight line to get him on “the bird”. I watch and pray as they load him. The commander says, “Keep up the good work” then turns and walks away, leaving me alone to watch the helicopter take off. One last prayer for safety for them and that I did all the right things. I look at my watch, 0855. I turn around and walk to church alone.
This is how things can be for me.