Authors: Dave Hnida
I
LOOK AT
the second hand as it sweeps around the face of the clock on the dull green wall.
It took nine minutes from front door to OR for my patient. Nine minutes where I became a short story in this soldier's life. I realized he probably wouldn't remember me and we would never meet again.
Our surgeons fixed his internal injuriesâincluding putting a lifesaving clamp on his large bleeding vessel. A CAT scan after surgery had good news: no shrapnel in the brain. He was stable enough to fly to Balad to have his face repaired, then on to Germany for further surgery. Then home.
By this time in our rotation, cases like this were taking on the feel of routine. Businesslike with a sprinkling of adrenaline-filled panic thrown in for flavor. I was drained but once again thankful for the medics and nurses who mentally pushed me to get the job done. They were my heroes. And heroes to the soldiers they saved.
We had no time to wring the sweat from our uniformsâanother bird flew in about an hour laterâno warningâit just dropped from the
sky with more wounded. Our medics had just wrung out their blood-soaked mops from swabbing the floor when we heard the incoming blades beating the air. The day had just begun.
L
IKE ANY HOSPITAL
, the pace at Paradise could vary from crazy busy to sluggish slow. On the busy ones, we didn't have time to pee, while on slow shifts the medics fought boredom by staging scorpion-versus-camel-spider fights, or by watching slasher movies that drew belly laughs for the fake blood splashing across the screen. A few of the females, and even a couple of males, had taken up knitting and crochet. Instead of war souvenirs, they'd bring home scarves and blankets. You also needed to look both ways before crossing the ER to avoid being run over by the NASCAR-like wheelchair races.
By mid-July, business was on the upswing, with a steady flow of patients and even a few periods where our operating rooms had been open around the clock. I had been designated the official “shit magnet” for the weeks before, the term for the doctor who had the highest number of trauma cases when on duty. It was better than being designated “007”âas in licensed to kill. Make a mistake and you were called Dr. Bond until someone else fouled up and stole the title. Fortunately, our mistakes seemed few and minorâand no patients had suffered from our work. Nonetheless, I didn't want to be introduced
as: Bond, Dave Bond.
Our wards get full, then empty as patients are flown to Germany or, if Iraqi, discharged into the local medical systemâa health care nightmare we call the kennels. The wards quickly refill and the cycle repeats itself.
Though the majority of patients we'd get were the wounded, I was surprised at the number of everyday medical problems similar to what we saw day to day in the States. Overall, 77 percent of soldiers evacuated to Germany or the United States had noncombat problems that bought them a one-way ticket out of the war. Bad backs, high blood pressure, and bum knees beat shrapnel as the chief reasons combat commanders had trouble keeping their units filled with warm bodies. As a full-service hospital with an oversized welcome mat, we also took care of a lot of contractors. They also had bosses who growled when we had to pull their workers off the schedule because of an ache, pain, or something more serious.
There had been a regular flow of patients with appendicitis, several each week, as well as a steady stream of kidney stones. Both problems were probably due to the searing heat and the fact it was nearly impossible to swill the ten to fifteen big bottles of water needed to head off dehydration, especially for the soldiers who went outside the wire in full battle gear. Migraines were another big-ticket item as well as, of all things, heart attacks. It was the rare soldier who had a heart problem, usually it was overweight contractors in their forties and fifties who smoked like chimneys and ate like pigs at the trough.
Then again, a number of the soldiers we saw would also easily qualify for the cover of
Weight Watchers
. The food here sucked, but there was plenty of it, especially cakes and pies, so that average ten-and-a-half-pound weight gain made the weight control program one of the busiest in the war zone.
Sundays were the worst days in the ER. The sick call clinic was closed, so in addition to the combat trauma that landed on our
helipad, we got the pain-in-the-ass stuff. And this day, Sunday, I drew the short scalpel, and got to juggle IEDs with constipation. And listen to a bunch of contractors who suffered from “Acute Ambien Deficiency” plead for piles of the precious sleeping pills.
It was a far cry from a day filled with the adrenaline-pumping pressure of trauma casesânot that we wanted trauma cases but the routine had become torture. So we broke up the monotony of the Sunday routine by making the diagnosis with the fortune-telling Magic 8-Ball. When a soldier asked when they'd feel better, we broke out the ball, gave it a shake, and hoped it didn't return an answer of “Outlook not so good.” In that case, we were forced to shake, and shake, and shake again until we got an answer that eased anxiety. And for the stubborn “Ask again later,” all we could say was: go to sick call tomorrow if you want a look into your future.
Another tactic was to use libido in place of drugs to affect a cure. Think of it as alternative medicine in a war zone. Nonmedicinally natural. For a male with a nonserious case of “something that won't kill you,” we pulled out the latest edition of the New England Patriots cheerleader calendar for a curative leaf-through; the females got the NYC Firemen of the Year, bare-chested edition. Or we simply pulled out a picture of Bernard.
But this day, before commuting the quarter mile to work, I had my weekly business meeting during breakfast with Rick. Basically, it was a time for two grumpy old men to clear the air and start the week on a fresh footing.
Rick had the first item on the agenda.
“You know, I think you curse too much. So the least you can do is give my virginal ears some peace on the Lord's day.”
I rolled my eyes.
“What the hell are you talking about? You curse, too.”
“But not on Sundays.”
“Bullshit.”
“How about âmale cattle manure' instead? It would make God
happy.”
I almost spit out my coffee.
“I'm sure God is really worried about my language. And I'm really sure God wants me to say stupid stuff like âmale cattle manure.'”
Rick gave me a serious look. “I bet you can't do it. In fact, I will give you twenty bucks if you can get through your shift without cursing. However, if you fail, you owe me a dollar a curse. Plus, you can forget about lunch.”
“You're on. Today. Only.”
“Thanks, Dave.”
“You bet ⦠penis cranium.”
He did the verbal translation and gave me a nasty scowl.
“Okay, Dave, your turn to moan. How did I bother you this week?”
“You're ugly.”
With that final insult, I grabbed my tray and raced out the chow hall to face my day of hell, or in this case, let's call it “heck.”
I walked in just as the medics were throwing out the first patient of the day. It was a soldier who said his back had been sore for a month. The medic absentmindedly rolled a pencil off the desk. Sergeant Sore Back easily bent over to pick it up. A nice gesture that determined his prescription: You can wait. Go to sick call tomorrow.
The next guy wanted to quit smoking. A surefire ticket to better health in a war zone. The chief medic asks for his cigarettes, which are then thrown on the floor and stomped on. “Don't buy any more before sick call tomorrow.”
Our third winner said he had a painful nostril.
“I have a sore inside my nose that's been there for three weeks and I can't get it to go away.”
“How did the sore get there?”
“I was picking my nose. And every time I pick my nose it gets sorer.”
“Well, here's the latest clinical research on a cure: stop picking
your nose. Now get out.”
Sounds brutal but there was a good reason to keep the not-very- urgent cases from causing a traffic jam in our ER: we needed to keep our stretchers open for the more serious cases that showed up with little warning. Within minutes, the radioman stuck his head in and confirmed that “Please come back tomorrow” was indeed a wise policy.
“Business coming. One urgent on a litter. Burns from blast. Estimate fifteen mikes.”
Mikes-minutes-months-millenniums. I lived in a world of mil-speak and secret codes. I chuckled. This must be Gerry's idea of heaven. Then I quickly felt bad when I realized there was a wounded human on the other end of that chuckle.
Twelve mikes later, the medics rolled in our patient. From a distance, he didn't look so hot. He had a tube in his throat and the medics were bent at 90-degree angles over the stretcher as it squeaked rapidly across the cracked linoleum.
We did some quick calculations: burns over 60 percent of his body. Not good. Singed mustache and soot around the mouthâ
inhalation injuries to the lungs. He'd also suffered blast injuries: some of his bones were pointing north, others south. I gently pulled on his arm to open a path to wiggle my stethoscope onto his chest. The skin from elbow to wrist pulled off in one long solid pieceâlike a glove being removed. I was afraid to tug on anything else for fear it would just slide off into my hands.
I took my time with a portable ultrasound, his belly was becoming increasingly firm and tight, and the scan confirmed blood leaking inside the abdominal cavity as the reason why.
The complexity of his wounds swallowed a chunk of time. From exam to X-rays to treatment, it took close to a half an hour before I
was ready to turn the patient over to Ian. I was glad he'd drawn the surgical on-call straw for the day. He'd need to find, then fix, the source of the bleeding in his abdomenâI suspected a chunk of shrapnel plowed its way into something important. But Ian was also the best guy we
had in burn care, so he'd start removing the worst of the crisp tissue, then repeat the process over the next few days.
Then Bill would have his turn, setting and straightening crooked bones. Finally, our internist would fiddle with the respirator to find the right settings that would push needed air into the scorched lungs. That, and finding the right antibiotics to protect a now fragile body from infection.
I actually thought the guy would make it ⦠if he were an American. But he was an Iraqi soldier, so even if we saved him today, he'd be transferred to an Iraqi hospital where the care was so bad the odds pointed to a quick death.
As he was wheeled to surgery, the doors to the ER were roped open to let in fresh air. Blood has a sticky sweet smellâoften more nauseating to see than smellâbut the odor of a bad burn is something else. It attacks the nose and throat and won't let go. It attaches itself to your nostrils, and at times, like today, leaves a horrible taste in your mouth. No amount of brushing or gargling can cleanse away the bitter tang of charred human flesh.
Now that our Iraqi soldier was gone, we screeched from bedlam to boredom. The next few hours morphed into a blenderized mix of the routine: ingrown toenails, infected bug bites, a slip and fall in the shower that resulted in a nasty gash to the back of the headâa wound easily and quickly stapled together, to the surprise of the soldier who owned the head.
“You're going to do what to my head?”
“Staple it,” I answered.
“What do you mean staple it?”
“What I said. Staples. Little metal things that attach piles of papers. Make believe the cut on your head is a loose pile of papers. We're going to staple the papers back together.”
“No you're not.”
Snap. Snap. Snap. Snap.
“Just did. If you need any further assistance with cuts, wounds,
stationery, or office supplies, please remember we're here. And by all means, tell your friends. Thanks for shopping with us.”
I looked up in time to see Rick standing over by the nurse's desk. There were murmurs and whispers floating in the area.
“No, sir, he hasn't said one dirty word all day.”
“Y'all sure? He's got a potty mouth.”
“Clean, sir. He's got the tongue of an angel today.”
I strolled over toward the buzzing and glared at Rick.
“We've got a special on staples today. Need any? Like on your lips?”
“How's your day, Dave?” he said with an innocent look.
“Just swell. I'm swell. Having a peachy day. Dad-gum it, things just couldn't get better.”
“Okay, buddy, here's your lunch for the day. Just remember, I've got spies everywhere.”
I was famished. The second he left, I popped open the Styrofoam container and unwrapped my noontime fare. Chili with onions. Turkey on white with onions. Chips with artificial onion dip. A piece of cake with sliced onions on top. I hate onions. Despise onions. In my world, a weapon of mass destruction was an onion bomb.
“You motherâ” I skidded to a stop, looked up, and saw eager eyes peering my way.
“âof blessed Jesus our Lord. What a saint. He brought me an appetizer, main course, and dessert. What a pal.”
Disappointment rose across the room. Thought they had me. What was this, a conspiracy? I thought the medics were on my side! I bet Reutlinger had promised them a slice of the winning bet if I slipped and blasphemed.
My thoughts of killing Rick were interrupted by the bang and whoosh of the opening door. It was another radio message.
“Badblood is giving us a heads-up on a big one. Sounds like up to fifteen wounded coming in.”
All heads jerked up. “How many?” gets asked by several of us
simultaneously. One-fiver is the repeated answer.
I swung my boots off my makeshift desk and looked over at Major Boutin, the head nurse of the day.
“Roger, that's a ton. We need every live body to get over here. Or at least give everybody a heads-up.”