Something to read: Bagram ER Doc
This is a new blog, but the writer is very good (I think he’s written other ones before). He’s an ER Doc in Bagram, Afghanistan treating military casualties. A lot of the events he writes about, you don’t hear about in the news much anymore, but from the sounds of it, there are still some pretty awful things going on over there. I respect how he is able to deal with the chaotic situations that always seems to arise, but still maintain that compassion for his patients. Below is one of my favorite posts.
The page came just as I was heading to the hospital. It read the ED’s phone number, not 911. That was good news. However, getting a page was concerning, as I had only gotten 3 since arriving. I quickly grabbed my bag and headed in. As I headed to the hospital, I caught a glimpse of Mike, one of the nurses, heading in. I caught up with him. They had sent a runner for him since he did not have pager. We arrived just before casualties. There had been a suicide bombing and they were flying the critically ill patients in now. The KIAs would be flown in later. We had about 10 minutes to prepare for the group of 6 patients with an unknown number to follow. I quickly assigned teams, prepared the Belmont, readied the emergency blood for transfusion, and quieted the room. With a small crew, we had 25 staff in the room for all six patients. We had seen this many before, but not recently.
They could not fit all the patients on the 2 Blackhawk helicopters, so they flew in a tactical C-130. Before patients came into the trauma by, a flight surgeon gave us a grief, frenetic report, out of breath from running into the ED, and jumbled with his thoughts. The first patient rolled in, hypotensive, recieveing two vasopressors to keep his blood pressure up. In trauma when blood pressure is low, we rarely give medicine to raise blood pressure, we use blood, thus this was an ominous sign. We assessed him quickly and moved him from the NATO liter to the bed. He had a small hole in his head and tubes in his chest. He was unresponsive and not moving. Before we started his full assessment we started 4 units of blood and hypertonic saline to shrink his brain. Using the bedside ultrasound, we did detect abdominal bleeding or a collapsed lung. As we stabilized him and prepared him for the CT scanner, the next patient came in, then the next, until we had all 6 in the room. Three others had severe wounds and fragmentation from the blast but were more stable than the first. We quickly assessed the others as they came in. As I looked around, the resuscitations were running smoothly and efficiently, a sign that this team had been here many months.
We dressed the wounds, splinted the fractures, and took everyone through the CT scanner. As the dust settled, one patient had a nonsurvivable head injury and would be flown to Germany quickly. Another 3 filled the ORs for abdominal surgery and limb explorations. The last two were stable. One patient was crying and anxious, dealing with the concussion, mild PTSD, and acute grief reaction. The chaplain, his commander, and one of the empathetic technicians tried to calm him. The sixth patient was the medic, who had only a mild concussion. He gave me the details of the bombing.
All 18 soldiers were in a conference room when an Afghan soldier entered the room. He detected the ANA was wrong side of the room, but did not take notice until the ANA moved to the middle of the room and then stopped. He pulled two cords, said “something about Allah”, and the medic ducked behind the table. He heard “a firecracker” and saw smoke. He readied his weapon and was about to stand when a loud explosion went off. He stood up to fire, and he saw nothing but dust, blood, and debris. He looked around. Many were injured. The rest of the details were from two other less injured who arrived 4 hours later. The medic did not tell us the details of what he had done. 18 people were in the room, 6 died immediately, 3 were minimally injured, and the remaining 9 were saved due to the medic’s calm demeanor and brave acts. He acted solely to triage each injured soldier, set up a collection point, placed tourniquets, decompressed collapsed lungs, and reassured the others. He was the only medic there. He radioed in for support and saved the lives of at least 6 patients.
Of course the medic’s version of his heroic acts was terse and muted. He just recollected the events of the bombing and the rest was a blur. His colorful description of the bomber was unvarnished. As we completed his care, we allowed his commander and his soldiers to chat with him. His commander, a Colonel, quickly assessed his heroic act and planned to decorate him. Four hours later, two more concussed patients flew in. The medic was there to great the patients, take care of them, and offer non-medical support and kinship.
That night we sat on the roof of the hospital. The rain had kept the remaining 3 injured from flying in immediately, but they would arrive in an hour. In the far distance the mountainous landscape was ominous over the flight line. We smoked our cigars and recollected the day, as the temperature dropped. A C-130 had landed and two troops walked to meet it. There is only one time this happens, the fallen comrade ceremony. In the distance, the soldiers lined up behind the open back door of the C-130. Six modified Humvee’s pulled up. Everyone on the flight line snapped to attention as the vehicles pulled up behind the C-130, and one by one and the bodies of the fallen soldiers were unloaded. The memorial service was completed two hours earlier, and in a few hours these fallen comrades would fly home – six soldiers the heroic medic could not save.