Christmas Day 2009 was my first exposure to how life would be for the next 6 months here at Bagram. I had arrived the previous day and had settled into my living quarters. I made my way over to the hospital for morning rounds which start at 0630. In medicine, ,making "rounds" means many things. Generally, it means that you are going around seeing your patients in the hopsital. Rounds at Craig Joint Theater Hospital was unlike anything I had ever seen in my career. First off, most of the professional staff was present. Getting a couple dozen doctors from various specialties all together at the same time is unheard of at most hospitals. Then, I was introduced to "The Trauma Czar". This position is held by someone trained in trauma surgery. l will call him the TC.
It was apparent from the very first moment that the TC was a dictator when it came to patient care here. He ruled with an iron fist. Rounds would start off with a review of recent x-rays, proceed to the Intensive Care Unit (ICU), then finish up in the Intensive Care Ward(ICW). The TC was in complete control the entire time. Doctors who were experienced and competent would report an update on each patient. Ultimately, the TC would decide on a plan of care. Often this would involve him telling various surgeons and doctors what they needed to do. This is not a common practice at a normal hospital. I was shocked to see this happening. Doctors have big egos and plenty of pride. Being told what to do is a major slap in the face. The TC did not care at all about hurting anyone's feelings. You had to have thick skin around this man. After all, there is no crying at a military trauma hospital in the middle of a war zone dammit! Why did the TC act this way? Months later I came to understand that he felt 100% responsible for every patient that came through our doors. Whether this was self imposed pressure or whether it was reality is debatable.
The TC was perhaps even more authoritative in the trauma bay, aka the "Trauma Hot Box" (THB). Our trauma patients would be brought into the ER and then were assessed in the THB. A plethora of people would be present at these resuscitations. Often, the TC would tell everyone to, "Shut up, be quiet, and do your job". Another signature statement was, "If you are not needed here, GET OUT!" When a patient was unstable and needed interventions right away, the TC would step up his game even higher. Orders were barked out firmly such as, "Transfuse a six pack of platelets NOW" or "Put in a right chest tube NOW." In time everyone knew their job in the THB. There was very little ambiguity. This was definitely a good thing because few of us had ever seen anything like the horrifying injuries that we see here routinely.
The TC was an equal opportunity offender. It did not matter if you were a full bird colonel or an airman first class. If the TC thought you did something wrong, he would be in your face. The TC was a major, the same rank that I was promoted to just a month ago. In many ways, to see him going off on colonels was highly amusing. I could never pull that off like he did. It was refreshing to a certain degree. In this situation, experience and training trumped rank and time in service. That's appropriate considering that the stakes here are so high. We are in the business of saving life, limb, and eyesight.
My description of the TC probably makes him seem like a first class you know what. But, I think it is important to realize what was motivating this man. Simply stated, the TC's primary goal was providing world class health care. He wanted to do what was right for the patient. He treated all the patients the same whether they were an American general or a young Afghan policemen. Human life is the same across the board, right? The TC also took into account what was the best thing for the military. For example, if a soldier wanted to stay here in Afghanistan (a clear sign to me of insanity) but he could not do his job due to an injury, well, he was on the way home. The TC angered a lot of people by doing this, but in the end it is the right thing to do. After all, what happens when the person with a bad back comes under mortar fire and cannot get to a bunker fast enough? Is it okay to send someone back to duty who needs mind altering medications to numb pain? These are difficult questions. But, the TC made the answer clear. If there was any doubt at all, the patient was getting on a plane out of Afghanistan.
I worked with this TC for 20 weeks. I came to understand a lot of things about him. One morning he took a few minutes to go out of his way to thank me and my colleague Mike Greene for our work in the hospital. It was sincere. He felt we worked hard for the right reasons. We simply wanted to do what was best for our patients even if it was not easy. That's why I think the TC respected us. And, his dedication to the patients and our country is why I respect him. About 10 days ago the TC left Afghanistan and was replaced by another trauma surgeon. The TC is now home in Texas enjoying life. He is probably spending a lot of time on his boat which he talked about frequently. He is back at home with his family where he deserves to be. If the TC ever reads this, I want him to know one thing. Thank you Dr. John Bini for all that you did every day here.
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