Authors: Dave Hnida
Just then, Mike came strolling in and saved me from myself.
“Sorry, Dave, I was out running when my pager went off. Where do you need me?”
I gave him the colonel. Begged him to take the colonel, just to get the guy out of the ER. He was a bad vibe for all of us. In the meantime, I took off to check out the rest of the IED guys, while the medics went to work on a couple of new arrivals: a bellyache from desert-induced constipation and a badly cut hand belonging to some guy from the motor pool. The cases were quickies the medics could handle, and I could just sign off after a swift double-check of their work.
I shot a quick glance at the clock once againâtwenty more minutes had disappeared. I fast-walked to the ICU to check the kid. The Angels surrounded his bed, doing busywork as they waited for the OR to open up, while I tried to look at the big picture so I wouldn't see the family picture. Things weren't pretty. Blood pressure continuing to drop, and blood coming out as fast as we could transfuse it in. Logic told us to call it quits, but we couldn't. If we didn't pull out
every single stop, every sleeve-hidden trick, and then invent a few more, we'd never be able to look in a mirror again. It all boiled down to the simple matter of why we were here and why we practiced the way we did: if it were our son or daughter in that bed, we would want everything possible done. Everything. As I turned to leave, I saw a tear trickle down the cheek of the head nurse.
I walked back into the ER, knowing I had to pull myself together. There were other patients to be seen, and if any of them were my son or daughter, I would want the doctor caring for them without distraction.
The tests on the young chest pain patient were all normal. It was a minor-league pulled muscle, but he needed some major-league convincing. With shaking hands and darting eyes, he begged for reassurance. “Are you sure it ain't my heart? My dad had a heart attack last year. I'm afraid to go to sleep.”
I held up a copy of the EKG and lab tests.
“Son, since I am thirty years older than you, I wish I had your heart. It's perfectly fine and your pipes are wide open and unclogged.”
He continued to jitter. “Are you sure, really sure?”
Just then, Bernard came strolling over from the desk where he was killing time and listening to this whole conversation. He gently reached over and pushed on the sore chest muscle.
“OW! Je-sus!” The kid jumped from the pain.
With the face of a wise sage delivering bad news, Bernard looked straight into the young soldier's eyes. “You either pulled a muscle or you've got a classic case of Updog Syndrome.”
The now wide-eyed kid almost screamed, “What's Updog?”
Bernard calmly replied, “Nothin', dawg. What's up witch you?”
It took a couple of seconds for the joke to click, but as the soldier saw Bernard cackle his way back to the desk and me standing with a big grin, he realized we weren't bullshitting him about his heart. A mild tranquilizer for a night or two of nonfrightening sleep, and he would be fine.
In the background during all of this came a bunch of grunting and wheezing noises. Mike was putting the colonel through a thorough and grueling exam. That meant lots of rapid-fire bending, twisting, squatting, and lifting. Now that the exam was finished, all Mike thought the office commando needed was some ibuprofen and he would be fine. Obviously, that didn't sit well with the Vicodin-seeking brass-hole. So after talking to Mike, I decided I would give the colonel three little Vicodin, for nighttime use only. (We do not want to mask the pain, sir, and remember you need to be thinking clearly when you are doing all that paperwork.)
On his way out, the colonel and I almost collided as I was heading to check more X-rays.
“Say, Doc, I didn't mean to come off too hard on you there, you know what it's like when you're hurting. Tempers get a little short. Wondering if I could catch a favor from you, though.”
Shit, he wanted more than three Vicodin.
“I've got some leave coming up. The pain pills might make me a little constipated plus me and the girlfriend are planning on meeting up back home for a little R and R, if you know what I mean ⦔
Home. We've got this wounded kid we want to get to back home and he sure isn't going for a little fun.
“⦠and I was wondering if you could give me something to loosen me up ⦠Plus maybe a few Viagras to make the weekened a little more, you know, action-packed.”
Viagra? You think we have Viagra in the pharmacy in the middle of Iraq? Why in hell's name would we stock Viagra in a fucking war zone?
With a solemn look I answered, “Sorry, sir, I don't have everything you need for your trip but I do have something that might help get things moving. We don't carry any name brands but we do have a generic, it's called docusate. Take one in the morning and by nighttime, things will be functioning just fine. Guaranteed.”
He winked at me. “Thanks, Doc. Let's make this our little secret,
okay?”
I winked back. “Okay, sir. It's definitely a secret.”
The real secret is that docusate is one of the most effective stool softeners known to medicine.
One of the medics interrupted my little vision of the colonel's toilet vacation. Time to head to the OR. Stat. When I got there, Rick and Bernard had already scrubbed in and were heading to the operating table. A quick-moving Rick looked back over his shoulder, “Dave, hustle and wash up. Kill the germs but don't stay for the funeral, we've got to move it.”
A few cursory scrubs of the hands and I was in the room, watching the staff turn our kid onto his stomach so we could get at the back of his oozing neck. His face still looked young and at peace, but his vital signs told a different story. Blood pressure in the toilet. Rapid and irregular heartbeat. Hypothermic. Not only oozing from the neck, but now the leg, arm, and abdomen. A classic case of trauma shock. Irreversible. He would never leave the OR alive.
We usually boomed some Rolling Stones or Led Zeppelin when we worked, but today's OR was quiet. Just our low murmurs and the beeping of the monitors. The overheated OR caused steam to swallow us, fogging goggles and glasses, and filling our gloves with sweat. Looking up, we saw a crowd of noses pressed to the plastic windows of the door. By now, everyone in the hospital knew we had a young GI who was ready to die. I wondered how many knew he had a wife and two little kids.
My job was simple. Hold retractors and suction blood as fast as it flowed, opening a clear field of vision for Rick and Bernard to pull off some surgical miracle. And it would need to be a miracle. The leak was somewhere deep at the base of the skull, right next to the top vertebra. There had to be a small blood vessel in there with a microscopic tear. But even if we found it, there wasn't any way to tie it offâthe space was so narrow, you couldn't fit a baby's finger in there, let alone that of an adult.
We spoke sparingly, all thinking the same thing. This kid was not going to die on us. Plain and simple. We had to get him home to see his family again. My mind added its own thought to theirs: this was not going to be like Columbine.
One hour turned into two, then three. I wondered, How was this kid hanging on? Bad question because as soon as the thought zipped through my brain, the rhythmic beep of the cardiac monitor went into the steady screech of cardiac arrest. We ripped the surgical drapes off, spun the kid over to get at his chest, and then hit him with the paddles.
One shock didn't do anything. Neither did the second. But the third was the charm. We had bought another chance.
Spinning him back, Rick and Bernard went on meticulously dissecting tissue away to try to find some angle to get at the leak. More hours passed. The noses stayed pressed to the windows. And we changed our gloves twice, spilling what seemed like buckets of sweat onto the floor. Blood continued its steady drip onto our boots. At a critical point when Bernard was carefully trying to work around a small nerve, the OR suddenly shook from the force of a rocket landing just outside the gate. The scalpel jerked against a nearby artery, slicing it in two, and sending a pulsating geyser of blood onto our masks and protective glasses. Temporarily blinded, we froze in fear, not daring to move with sharp instruments in our hands. Coolly, Bernard gently wiped clear a narrow window on his goggles with a sterile gauze while placing a finger on the jagged edges of the spurting vessel. His skills as a cardiac surgeon gave him the dexterity of a concert pianist; stabilizing the separated edges of the artery with one hand, he tied off the bleeding with the invisibly flying fingers of the other. A huge sigh of relief trapped itself inside my mask.
Five and a half hours and yet another cardiac arrest into the surgery, Bernard and Rick saw daylight. An artery smaller than the narrow lead of a mechanical pencil, almost completely hidden behind a piece of glistening white neck bone. Pulsing away lifeblood second by second, there was no way to clamp or tie off the leaking vessel. Then
you could almost see the simultaneous light bulbs go on in Rick and Bernard. Bone wax. A few pennies' worth of cheaply manufactured material made from beeswax. The guys cautiously wedged in a small piece, then another, and the oozing gradually ⦠slowly ⦠stopped.
Blood pressure went up. Pulse rate slowed. Bingo.
“Let's get out of here real fast, guys,” Rick whispered, as if the evil artery might hear him and start bleeding again.
It wasn't a home run, but at least the kid was still in the game. Realistically, the outlook was bleak. He had brain damage, some paralysis, and was still on life support. But at least we might be able to get him back to the States where some of the super-docs could do more than we could in our little tent hospital in the middle of the desert. Back home, his wife and loved ones had no idea of the miracle that Bernard and Rick had just performed.
We trudged together in the dark to midnight chow, no words between us, just the sand-filled wind in our faces. I thought about the three of us, strangers who by chance volunteered for the exact same deployment, were randomly placed in the same CSH in Iraq, and formed an unspoken brotherhood when we scrubbed in for our first case together. Tonight it all came together for the one case that needed a miracle. We had given it all we had ⦠together.
At one minute after midnight we heard, then saw, the nightly plane to America. Our guy was on his way.
Rick finally broke the silence.
“You know why I didn't want to quit? The picture of his wife and kids. I don't know if you guys saw it, but every time I wanted to just let this guy go peacefully, I saw that picture.”
Bernard broke in. “Man, you saw it, too? I thought we were screwed. Then that picture kept on showing up in my head. It was a miracle we found that bleeder.”
My smile was invisible in the dark.
With my mind on his family, as well as my own, I wondered aloud, “I just hope we did the right thing. You know, that it was worth
it. I hope she's okay ⦠and the kids, too.”
Still thinking, I paused for a second. “I don't know. Maybe we went too far.”
But we hadn't. At the same time that the plane from our CSH was taking off for home, a small group in America was getting ready for their own trip. The U.S. Army was flying the family of our wounded soldier to a hospital where they would see their husband and dad once more. We had succeeded in keeping him alive for an important, final family reunion. They now had a chance to say goodbye.
Several days later, they turned off his life support and the family donated his organs to others in need. And we suited back up into our mental armor, waiting to see who we would work on next.
I
T SEEMED LIKE
I had already lived a lifetime of war in the course of a few short weeks. Though I tried to call home regularly, there often wasn't the time or desire to get into the details of life. Most often a call consisted of simply reassuring the person on the other end of the line that all was well. One evening after another eighteen-hour day, I finally had the time to drop an e-mail with a few extra details of life in Paradise.
From: [email protected]
Sent: 06/22/07 23:08
To: [email protected]
Hi Guys,
We've got a little break in the action, so I thought I'd drop a quick note. Man, what a few weeks. We've got Internet in the phone tent right next to the ER so I can just run over and type a few syllables when we hit a lull. The
computer crawls so slowly, I think it operates on hamsters running on a little wheelâso this e-mail will probably take an hour to write and send. Our phone/e-mail tent is not only convenient, it's off limits to anyone but hospital personnel and better yet, free.
As I wrote the kids about the Internet, I thought about our first day in camp when we were almost snookered into buying Internet for our room. For a couple hundred bucks a month, we could sit in the luxury of our quarters rather than wait in line. A couple of guys took the hook and signed upâbut it turned out their service is slower than the phone tent and is always breaking down. The guys peddling the service are pricks; it seems someone is always trying to make a quick buck during a war and we docs rotating through must have a “Sucker” sign stuck to our backs.
I went back to writing, trying to hurry before the next chopper delivered some business.
But remember, all of our phone calls can be tapped and our e-mails read, so there's a lot I can't say or write.
In reality, there were bundles of things I wanted to tell them, but there were simply too many thoughts, as well as things I simply didn't want them to know.
Things have been steady but not too crazy. I run a trauma team in the ER and am the first doctor the patients see when they are flown in.
And I always pray I won't be the last face they will ever see. The haunting thought keeps me up at night. My biggest fear is having an overload of wounded come in, then having to pick the most critical and decide to let him die because he'd take too much time and
resources from the others.