There is a very important room at Craig Joint Theater Hospital here at Bagram. It's called The Trauma Hot Box. It's located in the ER. It is equipped with 6 patient beds, 4 ventilators, racks of supplies for procedures, 2 crash carts for cardiac/respiratory arrest, and anything else you can think of that might be needed for critical patients. The most unique thing about this room is its temperture... it is kept at a toasty 95 degrees. Why you ask? Well, there is a well known fact in medicine that warm trauma patients do better than cold ones. So, here at Bagram we do eveything we can to help our patients even if it makes the staff all hot and bothered. Of course, we have rules about that too. Clearly posted on the the door of The Trauma Hot Box is a sign that says:
1. You do not speak about The Trauma Hot Box.
2. No complaining.
3. No gawking outside the window.
4. No passing of gas.
The Trauma Hot Box was used to its full capacity on Easter Sunday. As I slept off my night shift, waves of new trauma patients arrived throughout the day. We were only getting warmed up on what was dubbed "Sunday Bloody Sunday". I arrived at work at 1900 hours and at 1905 a "Level 2 Trauma" was called over the loud speaker. This is when a large bolus of patients is due to arrive which will exceed the capabilities of the in hospital staff. Most of the doctors and nurses are paged to come to the hospital. What happened next can best be described as controlled chaos. The medical evacuation teams brought in severely injured Americans one by one. Each bed in The Trauma Hot Box was manned by 2 doctors, a nurse, and 2 technicians. I happened to be teamed with our vascular surgeon on this night. We first unhooked our patient from the vast amount of equipment attached to the stretcher. Then, we moved him over to our bed. Next, we began a systematic examination of him from head to toe. I started at the head and our vascular surgeon began at his feet. We called out our findings as we progessed. The same scenario was playing out in the other 5 beds in The Trauma Hot Box. "The pupils are equal and reactive bilaterally"... "The pedal pulses are strong on the right"... "Lungs are clear. Heart is regular"... "No wounds noted on the head"... you get the picture. Simultaneously, the technicians drew blood, obtained vital signs, and placed the proper monitors onto the patient. In the corner of the room, the pharmacist was dolling out medications and the lab was busy running tests on the blood samples.
Our particular soldier had a large bandage on his right leg. We tested the blood pressure in his ankle versus his arm. It was normal. Thus, he was unlikely to have any major bleeding in the leg. He also had gaping wounds of his scrotum and his left leg. This made sense given the mechanism of the injury. The floor of his vehicle was blown upward which smashed his legs when an Improvised Explosive Device (IED) went off as they drove down the street. Luckily, our patient was completely awake and aware of the situation. His brain was spared any trauma. Next, we rolled the patient onto his side to look at his back. The spine was palpated and a finger (gloved of course) was inserted into his rectum much to his dismay. Welcome to Bagram!
Having done our head to toe exam, he was now ready for x rays. The radiology technicians rolled in their portable machine. Multiple x rays were taken of all the possible problem areas. This took several minutes as the patient needed proper positioning and such. We are able to view the X rays right then and there on the portable machine looking for obvious problems. As soon as all the X rays were done, our patient was ready for the CT Scanner. We "packaged" him up by unhooking the monitors, connecting the oxygen to a tank, replacing the bandages on his legs, and covering him with blankets. He was now ready for transport. We wheeled him down to the radiology suite, moved him onto the scanner, then sat back as the radiology technicians programmed the machine to obtain images of the patient from his skull to his pelvis. This is called a "Pan Scan" which pretty much everyone gets who is involved in an explosion. We use technology to the extreme here.
My patient that night was taken to the operating room shortly after finishing his scans. This is also pretty much a standard procedure at Bagram. Within several hours he was admitted to the hospital in stable condition. He had a full on trauma assessment, was surgerized, and now was ready to move on to his next stop in Germany. There was a happy ending for this patient. Barring any unforeseen complications, he would keep both legs and walk again someday in the not too distant future. As for the other 5 patients who came through The Trauma Hot Box that night, some did well and some not well. On this Easter Sunday, we did our best and I guess that is all you can ask. In the end, The Trauma Hot Box was in disarray with bloody bandages all over the floor and medical equipment scattered around the room. The cleaning crew quickly entered to get The Trauma Hot Box ready for the inevitable next round of casualties.
Tuesday, April 6, 2010
Saturday, April 3, 2010
Combat Dining In
Deployments do not have to be only work and misery. Just like anything else in life, it is what you make of it. There is some fun going on here at Bagram. During the month of March, all the doctors grew mustaches. The other day we had the final judging. I am NOT proud to say that I finished third in the "Nice Try" category. One of our orthopedic surgeons took the prize for the sleaziest while an emergency room doctor won the most majestic mustache. A good time was had by all especially at the final judging when several people showed up in outrageous costumes.
Last week we had another fun event called "Combat Dining In". It was based on a traditional military event that military organizations will have back home about once a year. I had only gone to one of these "Dining In" events in my whole career and that was 10 years ago during my officer training. Of course, this involves a dinner but that is just a small part of it. The main entertainment of the night revolves around "The Grog". This is a disgusting, horrifying, putrid concoction of juices, solids, and other toxic substances. Various people are called to drink "The Grog" in front of the crowd to punish them all in good fun. So after months of planning, the medical personnel gathered for the first ever "Combat Dining In" here at Bagram.
The event started with the traditional brewing of the grog. A large pale with a reddish broth was front and center. Several duty sections from the hospital were called forward to make their contribution. From the ward where I work, we poured in a foley bag full of "urine" and a pleura vac filled with "serosanginous discharge". The folks from the dietary division added "feces" from a colostomy bag along with some "vomit". The intensive care ward contributed a suction container full of "pus". The gynecology clinic did some stirring of the grog with a well used speculum of course. Alas, the grog was ready for consumption.
The first people to drink the grog were our commanders. In order to have the privelege of dowing a glass of this foul substance, the victim had to make his or her way through a combat obstacle course as the entire crowd pummeled him or her with water balloons and super soakers. After low crawling under a barrier and then coming to attention, a salute was made to the head table. Then, a glass of grog was held high for a toast "To the Grog". Drinking commenced often resulting in rhythmic wretching as the particpant tried to ingest the "The Grog". Finally, the cup was placed on the head before one final salute was given. After our commanders were tortured several times over with this process, a whole slew of people were called to "The Grog". I was spared. By the end, the dining hall was an absolute mess. The floor was soaked, uniformes were covered in grog, and water balloons were everywhere.
We military folk are strange I know. In the end, "Combat Dining In" was a huge success. We were all able to have some laughs and for a short time forget about the insanity surrounding us. That's a good night on deployment in my book.
Last week we had another fun event called "Combat Dining In". It was based on a traditional military event that military organizations will have back home about once a year. I had only gone to one of these "Dining In" events in my whole career and that was 10 years ago during my officer training. Of course, this involves a dinner but that is just a small part of it. The main entertainment of the night revolves around "The Grog". This is a disgusting, horrifying, putrid concoction of juices, solids, and other toxic substances. Various people are called to drink "The Grog" in front of the crowd to punish them all in good fun. So after months of planning, the medical personnel gathered for the first ever "Combat Dining In" here at Bagram.
The event started with the traditional brewing of the grog. A large pale with a reddish broth was front and center. Several duty sections from the hospital were called forward to make their contribution. From the ward where I work, we poured in a foley bag full of "urine" and a pleura vac filled with "serosanginous discharge". The folks from the dietary division added "feces" from a colostomy bag along with some "vomit". The intensive care ward contributed a suction container full of "pus". The gynecology clinic did some stirring of the grog with a well used speculum of course. Alas, the grog was ready for consumption.
The first people to drink the grog were our commanders. In order to have the privelege of dowing a glass of this foul substance, the victim had to make his or her way through a combat obstacle course as the entire crowd pummeled him or her with water balloons and super soakers. After low crawling under a barrier and then coming to attention, a salute was made to the head table. Then, a glass of grog was held high for a toast "To the Grog". Drinking commenced often resulting in rhythmic wretching as the particpant tried to ingest the "The Grog". Finally, the cup was placed on the head before one final salute was given. After our commanders were tortured several times over with this process, a whole slew of people were called to "The Grog". I was spared. By the end, the dining hall was an absolute mess. The floor was soaked, uniformes were covered in grog, and water balloons were everywhere.
We military folk are strange I know. In the end, "Combat Dining In" was a huge success. We were all able to have some laughs and for a short time forget about the insanity surrounding us. That's a good night on deployment in my book.
Tuesday, March 30, 2010
Not for the Faint of Heart
Rumors began flying early in the day about a visit from a "DV". Much of our staff was asked to show up at 1900 hours for a trip to the flight line. I was scheduled to work that night, so I was exempt. I asked the question, "What is a DV anyway?" Of course, that would be distinguished visitor you moron Hayes! Someone said it might be an actor from "The Sopranos". Big deal. Maybe it would be Jessica Simpson coming. Now that would be something... NOT! I came into work at 2000 hours for the night shift and the rumors were still rampant. The latest was that it was someone very important coming, perhaps the President.
We began making preparations for the visit. The hospital ward is usually overrun with Afghan patients. We were asked to move many of these patients to other rooms so that all the Americans were in one area. We had 5 patients involved in IED blasts who were strategically placed at the front of the ward. At this point, we were told that several patients would be receiving purple hearts. One of the patients was laying there in bed with head phones on in a pair of red and white stripped boxer shorts. I asked him kindly to please PUT SOME PANTS ON BOY! As the time of the visit came closer, the tension rose. Word was out that only those who were on duty would be allowed in the patient care areas. Because of this, a dozen or so doctors were locked into the doctor's lounge (aka "doc box") and asked to turn the video games off RIGHT AWAY. The room was guarded by an armed airman. How dare those doctors want to see this DV!
THERE I WAS, standing in the middle of the ward when the secret service guys began pouring into the hospital. The sheer size of these men was unbelievable. One of them was easily 6 feet 8 inches tall weighing 300 pounds. He reminded me of Mr. Incredible from the cartoon. Then, around the corner came the President himself! He began shaking hands with our medical technicians and nurses. He thanked each person for their service. I was standing next to one of our orthopedic surgeons. The president shook one last hand and I nervously asked myself if I should introduce myself as Dr. Hayes or Captain Hayes. It did not matter. In one quick instant, the President turned and proceeded directly towards the patients. I was staring at the back of his presidential bomber jacket. Oh, so close!
The room was called to order and we stood at attention as 2 young soldiers were awarded purple hearts for being wounded in combat. It gave me goose bumps. What else is there to say? The President continued to shake hands. He made his way over to my friend who is a nurse and they had a nice, brief conversation. (little did the President know that my friend is practically a card carrying member of the Tea Party!) In the meantime, the White House Chief of Staff approached myself and the orthopedic surgeon. He asked us where we were stationed, how long we had been at Bagram, and what it was like here. The orthopedic surgeon informed him that he had performed over 700 surgeries at Bagram in his 2 tours here.
The entourage moved on to the Intensive Care Unit. Two U.S. soldiers were patients there. Our trauma surgeon lead the President into the room. The rest of the visitors stayed outside. It was simply the President, the surgeon, and the nurse together with the patients. One of the patients had severely broken legs with large iron devices called external fixators holding the bones in place. He was not on a breathing machine and probably was able to grasp the enormity of the situation. The President awarded him the much deserved purple heart. The other patient was in critical condition. He had lost all four limbs in an IED explosion and also had much of his pelvis destroyed. He was one of the most severely injured patients any of us had ever seen. His ventilator was hissing away as the President leaned in to offer some words to him. The purple heart was laid on his torso. On his way out of the hospital, the President asked out loud to our medical commader, "How do you do what you do every day?" Many of us have asked ourselves that same question often here. After all, the realities of war are not for the faint of heart.
We began making preparations for the visit. The hospital ward is usually overrun with Afghan patients. We were asked to move many of these patients to other rooms so that all the Americans were in one area. We had 5 patients involved in IED blasts who were strategically placed at the front of the ward. At this point, we were told that several patients would be receiving purple hearts. One of the patients was laying there in bed with head phones on in a pair of red and white stripped boxer shorts. I asked him kindly to please PUT SOME PANTS ON BOY! As the time of the visit came closer, the tension rose. Word was out that only those who were on duty would be allowed in the patient care areas. Because of this, a dozen or so doctors were locked into the doctor's lounge (aka "doc box") and asked to turn the video games off RIGHT AWAY. The room was guarded by an armed airman. How dare those doctors want to see this DV!
THERE I WAS, standing in the middle of the ward when the secret service guys began pouring into the hospital. The sheer size of these men was unbelievable. One of them was easily 6 feet 8 inches tall weighing 300 pounds. He reminded me of Mr. Incredible from the cartoon. Then, around the corner came the President himself! He began shaking hands with our medical technicians and nurses. He thanked each person for their service. I was standing next to one of our orthopedic surgeons. The president shook one last hand and I nervously asked myself if I should introduce myself as Dr. Hayes or Captain Hayes. It did not matter. In one quick instant, the President turned and proceeded directly towards the patients. I was staring at the back of his presidential bomber jacket. Oh, so close!
The room was called to order and we stood at attention as 2 young soldiers were awarded purple hearts for being wounded in combat. It gave me goose bumps. What else is there to say? The President continued to shake hands. He made his way over to my friend who is a nurse and they had a nice, brief conversation. (little did the President know that my friend is practically a card carrying member of the Tea Party!) In the meantime, the White House Chief of Staff approached myself and the orthopedic surgeon. He asked us where we were stationed, how long we had been at Bagram, and what it was like here. The orthopedic surgeon informed him that he had performed over 700 surgeries at Bagram in his 2 tours here.
The entourage moved on to the Intensive Care Unit. Two U.S. soldiers were patients there. Our trauma surgeon lead the President into the room. The rest of the visitors stayed outside. It was simply the President, the surgeon, and the nurse together with the patients. One of the patients had severely broken legs with large iron devices called external fixators holding the bones in place. He was not on a breathing machine and probably was able to grasp the enormity of the situation. The President awarded him the much deserved purple heart. The other patient was in critical condition. He had lost all four limbs in an IED explosion and also had much of his pelvis destroyed. He was one of the most severely injured patients any of us had ever seen. His ventilator was hissing away as the President leaned in to offer some words to him. The purple heart was laid on his torso. On his way out of the hospital, the President asked out loud to our medical commader, "How do you do what you do every day?" Many of us have asked ourselves that same question often here. After all, the realities of war are not for the faint of heart.
Wednesday, March 24, 2010
Life, Limb, or Eyesight
This past Saturday morning presented one of the most difficult situations that I have faced as a doctor. I was on call here in Afghanistan taking care of 4 patients with eyesight emergencies.
2 of my patients had already lost a left eye due to trauma, but both were having a very hard time excepting this fact. And, 2 of my patients had conditions that were seriously threatening eyesight in the left eye. Yes that's correct, I had 4 patients all with major trauma to their left eye. It's weird how in medicine you will see a cluster of similar conditions presenting at the same time. 2 of the patients had lost the left eye in blast injuries earlier in the week. Each day when I saw these patients they would ask me when the vision would come back in the left eye. I had to inform them that they no longer had a left eye. Saturday morning was no different. They asked about it, and I tried to be compassionate in my reply. Clearly, time is necessary for the reality of these devastating injuries to sink in and solidify.
The other two patients were even more challenging. One was a U.S. marine who had sustained facial trauma during an IED blast while he was riding in the turret as the gunner on a convoy. The butt of his machine gun slammed into his face. His check bone and eye socket were shattered into pieces. The soft structures of the eye were under enormous pressure. Our eye surgeon took him to surgery and repaired what he could. Now the issue was all the inflammation surrounding the eye. The decision was made to try the patient on high doses of steroids to calm this inflammation down. I wrote an order for whopping doses of solu-medrol (1 gram bolus then 250 mg every 6 hours for 3 days). Time would be needed for see if this would work. After about 36 hours at Bagram, the patient was flown to Landstuhl in Germany. I probably will never know if this marine will see out of that eye again. There are just too many patients to try to follow up on what happens to them. You have to move on to the next patient in crisis.
The 4th patient was the most difficult case. He was an Afghan who works an interpreter for the British Marines. Their camp came came under attack with mortars. The patient was peppered with shrapnel to his right side sustaining some relatively minor flesh wounds. However, somehow shrapnel also flew into his left eye. He was taken to surgery and a very improbable condition was diagnosed. He had a partial retinal detachment from the trauma. This is an absolute eye emergency. The retina is a very specialized structure. It is so specialized that very few eye doctors in the world operate on it. The condition needs a retina specialist. The U.S. Air Force does not currently have a retina specialist. There may not even be a retina specialist in the entire middle east trained to western standards. We were in a bind to say the least. Many phone calls were made. Because of a plethora of factors including world politics, we had no options other than to treat him here at Bagram.
The patient was beside himself. He understood fully that his eyesight was very much at risk and the clock was ticking. For several hours on Saturday morning, he approached me time and time again asking me questions that I could not answer. I was trying to provide care to all the patients on the ward, but really the situation with this one patient was absolutely killing me. It was tearing me up. I was actually nauseated for the entire morning. I knew that in the United States this patient would get surgery and retain his vision for sure. But, that would not happen here which to me was a very bitter pill to swallow. Our eye doctor looked into options. He did not have the proper equipment here to even attempt a retina surgery. The patient's vision was 20/300 at this point, legally blind in that eye. The decision was made to try a series of laser treatments in hopes that the retina would re-attach itself. It was a long shot. Our eye doctor lasered his retina approximately a thousand times I was told. At that point, it was a waiting game. The patient stayed in the hospital for the next 4 days while his flesh wounds healed up, but of course we were all focused on his left eye. 3 days ago he had a repeat eye exam. His vision was now 20/30 in his left eye with correction. Wow! Perhaps he would see again well with glasses. Yesterday he had another eye exam.... 20/20 without correction!!! Unbelievable. The eye doctor was amazed. I was so relieved. The patient was ecstatic. His gratitude was infectious. He had us all sign a T-shirt for him so that he could remember the names of everyone that cared for him here. It was corny but 100% sincere.
To me, the restoration of his vision during his 5 day stay here was a minor miracle. We often talk about the triad of life, limb and eyesight when triaging trauma patients. When any of these three are in danger, we go to heroic lengths and do everything humanly possible. However, in this case I think the most important intervention was divine.
2 of my patients had already lost a left eye due to trauma, but both were having a very hard time excepting this fact. And, 2 of my patients had conditions that were seriously threatening eyesight in the left eye. Yes that's correct, I had 4 patients all with major trauma to their left eye. It's weird how in medicine you will see a cluster of similar conditions presenting at the same time. 2 of the patients had lost the left eye in blast injuries earlier in the week. Each day when I saw these patients they would ask me when the vision would come back in the left eye. I had to inform them that they no longer had a left eye. Saturday morning was no different. They asked about it, and I tried to be compassionate in my reply. Clearly, time is necessary for the reality of these devastating injuries to sink in and solidify.
The other two patients were even more challenging. One was a U.S. marine who had sustained facial trauma during an IED blast while he was riding in the turret as the gunner on a convoy. The butt of his machine gun slammed into his face. His check bone and eye socket were shattered into pieces. The soft structures of the eye were under enormous pressure. Our eye surgeon took him to surgery and repaired what he could. Now the issue was all the inflammation surrounding the eye. The decision was made to try the patient on high doses of steroids to calm this inflammation down. I wrote an order for whopping doses of solu-medrol (1 gram bolus then 250 mg every 6 hours for 3 days). Time would be needed for see if this would work. After about 36 hours at Bagram, the patient was flown to Landstuhl in Germany. I probably will never know if this marine will see out of that eye again. There are just too many patients to try to follow up on what happens to them. You have to move on to the next patient in crisis.
The 4th patient was the most difficult case. He was an Afghan who works an interpreter for the British Marines. Their camp came came under attack with mortars. The patient was peppered with shrapnel to his right side sustaining some relatively minor flesh wounds. However, somehow shrapnel also flew into his left eye. He was taken to surgery and a very improbable condition was diagnosed. He had a partial retinal detachment from the trauma. This is an absolute eye emergency. The retina is a very specialized structure. It is so specialized that very few eye doctors in the world operate on it. The condition needs a retina specialist. The U.S. Air Force does not currently have a retina specialist. There may not even be a retina specialist in the entire middle east trained to western standards. We were in a bind to say the least. Many phone calls were made. Because of a plethora of factors including world politics, we had no options other than to treat him here at Bagram.
The patient was beside himself. He understood fully that his eyesight was very much at risk and the clock was ticking. For several hours on Saturday morning, he approached me time and time again asking me questions that I could not answer. I was trying to provide care to all the patients on the ward, but really the situation with this one patient was absolutely killing me. It was tearing me up. I was actually nauseated for the entire morning. I knew that in the United States this patient would get surgery and retain his vision for sure. But, that would not happen here which to me was a very bitter pill to swallow. Our eye doctor looked into options. He did not have the proper equipment here to even attempt a retina surgery. The patient's vision was 20/300 at this point, legally blind in that eye. The decision was made to try a series of laser treatments in hopes that the retina would re-attach itself. It was a long shot. Our eye doctor lasered his retina approximately a thousand times I was told. At that point, it was a waiting game. The patient stayed in the hospital for the next 4 days while his flesh wounds healed up, but of course we were all focused on his left eye. 3 days ago he had a repeat eye exam. His vision was now 20/30 in his left eye with correction. Wow! Perhaps he would see again well with glasses. Yesterday he had another eye exam.... 20/20 without correction!!! Unbelievable. The eye doctor was amazed. I was so relieved. The patient was ecstatic. His gratitude was infectious. He had us all sign a T-shirt for him so that he could remember the names of everyone that cared for him here. It was corny but 100% sincere.
To me, the restoration of his vision during his 5 day stay here was a minor miracle. We often talk about the triad of life, limb and eyesight when triaging trauma patients. When any of these three are in danger, we go to heroic lengths and do everything humanly possible. However, in this case I think the most important intervention was divine.
Sunday, March 21, 2010
The Faces of Terrorism
In three months here at Bagram, I have taken care of my fair share of patients that we call "enemies of peace" or EOP's. These of course are our patients who are suspected terrorists. They are often our most challenging patients for both medical and psychosocial reasons. There is one thing that is obvious to anyone who lays eyes on the EOP's. In short, these guys are some of the sorriest looking dudes you ever want to see! It seems hard to believe that 125 pound weaklings are the heart of the Taliban. They are illiterate people with little education. Their bodies are emaciated, basically just skin and bones. Of course, this all worsens after they have been shot up and spend days to weeks in the hospital. They will often refuse to eat or talk. It is not uncommon for them to be disoriented with extremely questionable mentation. This is certainly expected in the EOP's who have been shot in the head. Nobody expects those guys to be normal again. One of them was so out of his mind that he would incessantly bang his head up against the iron bars of his external fixator which was holding his mangled arm together. He had stitches all over his head resembling train tracks. It was not a pretty sight. Actually, it was disturbing to me to see him day after day.
Until the other day I had not seen an EOP that was intimidating in the least. We as Americans picture terrorists as shady, unsavory characters of middle eastern descent. Without a doubt, these EOP's are unsavory. But this is so because they are so malnourished, weak, and discheveled. Many of them look like they could be on a commerical for a world hunger organization. And yet we are struggling in this war against the Taliban and Al Queda. I think that speaks volumes to the fact that this war is very complicated. It is clear that the F-16's that take off all night long from Bagram are not going to take down the Taliban. Technology is not the answer. Brute military force is not the answer. After all, IED's made simply from fertilizer are used to take out our million dollar, giant vehicles called MRAP's (Mine Resistant Ambush Protected). We are fighting an enemy that has been brainwashed into believing radical islam. That's a powerful force.
Today I met a young medic who works at the "detainment facility" , aka the prison. He was very disillusioned. He could not understand why the prisoners were getting top notch medical care. The prisoners get all kinds of medications there. Have you heard of Nexium? Yes it's true, we are treating heartburn in our prisoners with the "purple pill"! (Good for the pharmaceutical industry I guess) He went on to say that he could not understand why these prisoners were being held for years. If nothing else, the cost of doing this is mind boggling. I did not have any good answers for the young medic except to say that his concerns are valid and that I have similar concerns. I am trying to make sense of it myself.
Until the other day I had not seen an EOP that was intimidating in the least. We as Americans picture terrorists as shady, unsavory characters of middle eastern descent. Without a doubt, these EOP's are unsavory. But this is so because they are so malnourished, weak, and discheveled. Many of them look like they could be on a commerical for a world hunger organization. And yet we are struggling in this war against the Taliban and Al Queda. I think that speaks volumes to the fact that this war is very complicated. It is clear that the F-16's that take off all night long from Bagram are not going to take down the Taliban. Technology is not the answer. Brute military force is not the answer. After all, IED's made simply from fertilizer are used to take out our million dollar, giant vehicles called MRAP's (Mine Resistant Ambush Protected). We are fighting an enemy that has been brainwashed into believing radical islam. That's a powerful force.
Today I met a young medic who works at the "detainment facility" , aka the prison. He was very disillusioned. He could not understand why the prisoners were getting top notch medical care. The prisoners get all kinds of medications there. Have you heard of Nexium? Yes it's true, we are treating heartburn in our prisoners with the "purple pill"! (Good for the pharmaceutical industry I guess) He went on to say that he could not understand why these prisoners were being held for years. If nothing else, the cost of doing this is mind boggling. I did not have any good answers for the young medic except to say that his concerns are valid and that I have similar concerns. I am trying to make sense of it myself.
Wednesday, March 17, 2010
Hospital Happenings
Happy St. Patrick's Day! It was a good day here at Bagram. We were able to enjoy the irish holiday as much as possible half a world away from home. My sister Mary sent me a kelly green felt golfer's cap (like the ones Payne Stewart wears) which I wore at work. It was a hit. I even wore it while working on a chest tube procedure. I figured that I needed the luck of the irish on that one! The nurses had green beeds, top hats, and crowns. It was fun. We made the best of it. And, I was able to have some pretty good corned beef and cabbage over at the chow hall. Perhaps the funniest moment was when I attempted to explain the significance of St. Patrick's Day to a patient from India. I told him that St. Patrick drove the snakes out of Ireland, then admitted that I really did not know if that was true. We googled it of course. Wikipedia says it's all a myth, but deep down I want to believe it.
Another fun thing we are doing is "Mustache March". It is a contest that frequently goes on during deployments. Here at Bagram, all of the doctors are growing mustaches. At the end of the month, there will be prizes. Cash will be given out for the sleaziest, the cheesiest, and the most pre-pubescent mustaches. 17 days into it, I am a little surprised with mine. The hair is almost all blond and it is not nearly as thick as I expected. Nevertheless, I kind of like it. I feel like my brother Pat back in the eighties or something.
March of course brings the college basketball tournament. We are all excited for March Madness. Our brackets were turned into today for our pool among the professional medical staff. I have Ohio State winning it all. It's a long shot, but I figure that you have to choose a long shot to run away with first place. We'll see. The games will be on during the middle of the night here, so we'll have to watch highlights and tape delayed games.
Of course all of these "happenings" are simply a distraction from the job at hand. The mission goes on every hour of every day. The hospital has been and will continue to be extremely busy. We have seen over twice as many trauma patients this year as we did last year at this time. It seems that the stream of blown up soldiers (mostly Afghans) is never ending. Each day we have to do our best to deal it and whatever fun distractions we can find helps to keep us all sane.
Another fun thing we are doing is "Mustache March". It is a contest that frequently goes on during deployments. Here at Bagram, all of the doctors are growing mustaches. At the end of the month, there will be prizes. Cash will be given out for the sleaziest, the cheesiest, and the most pre-pubescent mustaches. 17 days into it, I am a little surprised with mine. The hair is almost all blond and it is not nearly as thick as I expected. Nevertheless, I kind of like it. I feel like my brother Pat back in the eighties or something.
March of course brings the college basketball tournament. We are all excited for March Madness. Our brackets were turned into today for our pool among the professional medical staff. I have Ohio State winning it all. It's a long shot, but I figure that you have to choose a long shot to run away with first place. We'll see. The games will be on during the middle of the night here, so we'll have to watch highlights and tape delayed games.
Of course all of these "happenings" are simply a distraction from the job at hand. The mission goes on every hour of every day. The hospital has been and will continue to be extremely busy. We have seen over twice as many trauma patients this year as we did last year at this time. It seems that the stream of blown up soldiers (mostly Afghans) is never ending. Each day we have to do our best to deal it and whatever fun distractions we can find helps to keep us all sane.
Friday, March 12, 2010
My Favorite Patients
Happy Friday Ya'll!!! Today is a good day. I worked this morning and now I am off for the rest of the day. My colleague Dr. Greene is manning the ward. Tomorrow I will do the same for him so that he can also have a little mental health time. My recent posts have been perhaps a little negative and maybe too intense as well. Today I'd like to write about my favorite patients so far here at Bagram. Hopefully, this will lighten it up a bit.
The first patient was a heavily muscled U.S. Air Force member of Korean descent. I am not exaggerating about the muscle. He was so pumped up that his arms would not even come close to resting at his sides due to severely hypertrophied latisimus dorsi muscles bilaterally. We'll call him Sergeant Strong. He came to the hospital for abdominal pain and was found to have what is know as an ileus. This is when your bowels just stop moving. We do not know why he developed it, perhaps too many clean and jerks. The treatment involves putting a tube through the nose down into the stomach (NG tube) to suck out the gastric contents. Also, there is no eating or drinking for several days for "bowel rest". So, Sergant Strong had a tube jammed down his nose/throat and was not allowed to eat. He went along with it for a while, but pretty soon he got antsy and started walking the ward. Picture a pumped up Korean dude with a tube in his nose (which makes you talk all nasally) walking around the hospital in his Air Force physical training gear ... it was priceless. He came up to the nurses station and asked, "Can I have some roast beef?" Heck no!!! But, this was a legitimate question considering Sergant Strong eats over 5,000 calories a day in support of his weight lifting habit. He starts the day with 6 hard boiled eggs for pete's sake. That's a lot of protein! Anyway, Sergant Strong was a very good sport about it all and eventually things started working again for him. We brought him 2 hard boiled eggs for breakfast and he was elated. I discharged him from the hospital on quarters (barracks restriction) with gym priveleges for 72 hours. Keeping him away from his weights any longer seemed cruel and unusual to me. Rumor has it Sergeant Strong place third in the Bagram Air Field bench press competition last week.
Another great patient was a Greek officer who was medically evacuated to Bagram from a NATO base in Kabul. He had been playing an intense game of basketball and apparently went in for a slam dunk. Unfortunately, he lost control of his body, came crashing down, and slammed his head against the basket's supporting pole. He was knocked out for 30 minutes. Wow. We'll call him Captain Crash. In the Bagram ER he had a Head CT Scan done which looked okay. But, he was not doing so well physically, so I was asked to admit him to the hospital. Upon examination, I found a burly Greek man stripped down to his boxer briefs who was minimally responsive. I jammed my knuckles into Captain Crash's sternum and he barely responded. We admitted him to the ward. Six hours later, he was still very drowsy and was not making much sense at all even to the Greek doctor that came along to him. We had a heck of a time getting this mountain of a man into a wheel chair. Another Head CT Scan was done. This one revealed bleeding into the brain in multiple areas. He actually had scattered Subdural, Intracerebral, and Subarachnoid Hemorrhages for all you medical folks out there. I was astounded. Our neurosurgeon was consulted. Luckily, Captain Crash did not need surgery. He would likely get better without any intervention. We continued to watch him closely administering large amounts of morphine for his killer headache. Slowly but surely, Captain Crash came around. The only Greek doctor in Afghanistan stayed by his bedside the entire time. Two days later, Captain Crash was functioning normally despite a persistent giant headache. He actually spoke excellent English and I learned that he was an engineer. He was a heck of a nice guy. As we wheeled him off the hospital ward, he thanked us all profusely for his medical care. The greek military reacted quickly arranging for him to be picked up in Germany. We loaded him on a plane and sent him back home for further recovery. I am sure he is doing well back in his beloved homeland of Greece right now.
Sergeant Strong and Captain Crash were great patients. These are the type of patients that make medicine fun. Both cases ended up with happy endings. My hope is that experiences like these will keep me engaged and excited about practicing medicine for the rest of my career.
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