I find that more often than not, I am listening to my sister's music while I am writing. Her music inspires me and she is one of my many heros. If you, my reader, has never had the opportunity to listen to her music, you should check her out on Facebook and see what you are missing.
The past 48 hours have encompassed some of the lowest moments and the highest highs of my deployment. I share these experiences so that you can see the contrast and see what I have experienced and hopefully draw some lessons of your own.
It began Thursday morning with casualties arriving around 0430, after a brief interlude for lunch (that was considerate of the Taliban), there was a particular soldier who arrived to my team in extremis after sustaining an extremely severe injury. (You can tell how sick they are by how hard the helicopter lands. They nearly broke their landing gear.) He arrived and coded in the ATLS area (Advanced Trauma Life Support), we were able to get a heart beat back and after consultation with our neurosurgeon in Bagram we decided that his only chance was to aerovac him to Bagram where he would need to undergo massive brain surgery. At this point his chances of survival were slim, but we loaded him on a helicopter in a desperate attempt to save him. Due to his tenuous condition, I and my CRNA (anesthesiologist) flew with him. Three minutes into the 25 minute flight, his heart stopped again, we coded him again. I did chest compressions for the next 22 minutes until arriving at the ER in Bagram where he was pronounced dead. I resolved that I was not going to call him during the flight, and we would get him to Bagram. We did everything we could do, it just wasn't enough.
Upon return to Shank, I just didn't want to talk to anyone. I just wanted to be alone with my thoughts and my own prayers. I think of the mother, the father, and wife and children who lost their Dad. I could only pray that the Lord would let this guy know that I did everything I could. I reaffirmed my testimony that our Lord and Savior descended below all things, so that he would know how to succor his children in need. It wasn't the soldier who needed his aid, but it was the physician who needed healing at that moment.
I finally got to bed around midnight and an hour later we started taking casualties again. We were busy all night and I was able to get back to sleep around 0600. After a few hours of sleep, we were told that there were more casualties. There were three soldiers coming in, all with gun shot wounds. One was quickly deteriorating and the other two appeared stable. My partners took the severely wounded one while I would take care of the other two. Of my two, one was stable and the other had a nasty femur fracture.
After looking at their x-rays, I ran into a chaplain. The chaplain asked me if I was Major McMullin? "Yeah", I replied. "Are you a Mormon Elder?", he asked. "Uh, yeah". He proceeded to tell me that one of the soldiers under my care was a Mormon and wanted a priesthood blessing from a Mormon Elder. It was the one who was minimally injured. However, he was the one who watched two of his buddies die and performed life saving care for the one soldier now in the operating room. This soldier had been stationed at a remote location and was the only Mormon on his post. So there in the middle of the ICU and amidst the chaos, I was able to give my patient a priesthood blessing. It was a very spiritual experience. After the dust and chaos settled down a bit, the local serviceman's group leader and I were able to administer the sacrament to him. I will never forget how grateful he was to get that priesthood blessing, and how grateful I was that I was worthy to place my hands on this faithful brother's head and pronounce a blessing from his Father in Heaven upon him. I rededicated myself to always living worthily to be able at a moments notice, be an instrument in the hand's of the Lord to do bless his children.
That evening as I sat by his bedside, we talked about Captain Moroni from the Book of Mormon. Who led his people during a time of war against the Lamanites. How was it that they were able to maintain their spirituality during that time of strife? To such a degree that Mormon was able to decree that "there never was a happier time among the people of Nephi..." (Alma 50:23). We talked about Moroni (the son of Mormon) who witness the destruction of his people. Many times we overlook that this likely included brothers, sisters, maybe a spouse and children. Yet, he was able to carry on and perform the important work that the Lord had for him. The Book of Mormon was written by warriors.
This experience was one of the highs of the past several weeks, and it really helped me overcome the sadness from the previous night to be able to serve this brother. (There is your hint to the answer for my previous question.) I am so grateful for this opportunity.
There are some things you can control and other things which are just not in your hands. This is an observation on both of your examples. I think it is very important to make peace with the fact that your role is sometimes just to be a signpost along someone else's mortal journey. I suspect that as this conflict continues to heat up you will find yourself in these same situations again... and perhaps even more frequently. Staying focused and intense when the time calls for it is good, but I also hope you are doing things to let off some steam. You are are still early in this game.
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ReplyDeleteI would like to read a little about your living and working conditions. You alluded that you have a CT scanner available. Are there other high-tech toys that you have out in the middle of nowhere? Are there other circumstances where you have to work with primitive tools or conditions? Art's question about withdrawal of care is interesting too. How do you handle consent issues when there is obviously no contactable family around and you have to decide something semi-electively for an unconscious soldier (ie limb salvage vs amputation)?
Brian - Those are good questions. I will try to post some pictures of where we are living. To describe our FOB as a mining town is about the most descriptive way I can think of. This area is in a huge transition right now. We live in an area of the FOB that is kind of forgotten about. The build up and movement is to the south of us where they are starting to put in semi-fixed structures (made out of plywood). We still live in tents (with electricity and A/C's and heaters). Our FST is a large tent with a central air duct that runs right down the middle. It is small and cramped in the OR. For OR tables we use the stretchers that the patients arrive on. I end up doing the splits for most cases.
ReplyDeleteWe do not have any CT scanner here at Shank. The nearest one is up at Bagram. The single pieces of technology that we have is a crappy ultrasound for doing FAST exams with and X-ray. We have to get creative with AP & Lateral views to get two dimensional ideas of what is going on with fragments.
One of the most helpful books that we have is a paperback book written by a group of surgeons with the target audience being doctors in Africa. It has good sections on neurosurgery, facial trauma, hand trauma etc. Most of the stuff we do here has a goal of temporary fixation, stabilization and getting a warm, resuscitated patient to the next levels of care where they will either be evacuated back to the US or get their definitive care (afghani's).
Consent issues are interesting topics here. As a rule, we do not do any amputations on US soldiers. We will stabilize their fractures, stop bleeding, repair arteries and veins, resuscitate them and send them on. IMO, it is best to allow the soldier to come to the decision themselves or to be able to come to grips with that decision. We will always lean towards limb salvage. We also do the same with the afghani soldiers and local nationals.
Withdrawing care issues can be sticky. We have a ethics committee protocol that we have developed. First, you have to understand that we have finite and limited resources. I can't detail these out in the open, but it is supple and manpower. If the patient is someone that cannot be transferred out to another facility, we have to weigh what kind of strain it will put on our system and our ability to fulfill our mission. Second, (this applies to local nationals) what is their prognosis? The local systems are so bad, someone with a high C spine fracture with neurologic deficits has no chance of survival, there is little to no rehabilitation, let alone complex rehab like tube feedings, vent weens, long term hospital care all the stuff that makes discharge planning such a pain in the states. As a rule, if a patient presents with a GCS < 5, they are treated expectantly. US soldiers are stabilized and transferred to Bagram where there is a neurosurgeon and sent to the states where they can get all of those thing I described. Afghani's who fall into our Medical ROE, can be sent to Bagram, but it is tough to get them all the support they need.
Dearest Neil, I wept as I read your accounts aloud to Uncle Pat. I want to thank you for sharing these wonderful feelings of yours. You expressed them so well and the spirit is so strong. You have turned out to be such a wonderful strong warior yourself. The song (although I am sure I won't get the title right but. . .) "The Sons of Helaman" comes to mind as I read these things. It is wonderful that you are writing these and they will mean the world to your children as they grow up. Uncle Pat served in Viet Nam. Although it is tougher to be a Dr. during the war. I am so grateful for the gospel in my life and for the knowledge that we have of eternity and the comfort it gives me to know we will once again be united with our loved ones. The fact that you have such a great desire to stay worthy to be able to be an instrument in the hands of the Lord will help throughout your life. That is our ultimate desire as we serve him in our own lives. You are in our prayers. FYI Tanja's husband is serving in Afghanistan as well, as a gunner. Whitney Bernson with all our love Uncle Pat and Aunt Nel
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