This experience is in stark contrast to the post previously entitled "A Hero's Salute". Yesterday we had an EPW (Enemy Prisoner of War) casualty come into the FST. Apparently he and two buddies were hastily planting an IED ahead of a route clearance patrol. Hastily was the operative term and they blew themselves up. They brought all three, my patient (still alive, barely), one of this buddies (in bits and pieces) and a skull of the third to which they could not find any associated body.
Needless to say, this patient was in distress with massive facial trauma. I performed an emergent surgical airway and we were able to stabilize him. In the assessment of a trauma patient's mental status we use what is called a GCS (Glasgow Coma Scale). You award points for various responses and activities performed by the patient. Nothing, more than following commands, opening their eyes and speaking. Normal is 15 and anything below an 8 is considered severe head trauma. This patient had a GCS of 4 (very low with very poor prognosis). X-rays showed intracranial fragments and given his overall burden of trauma his prognosis was abysmal at best, even under ideal circumstances at a level 1 trauma center in America. We called our command to get their input and given his massive trauma burden and injuries to withdraw care.
Side note: This was the guy who planted the IED who killed the soldiers in my previous post.
As my partner and I discussed this plan of action, we confirmed with each other that his status as an enemy played absolutely no role in our decision. We gathered our team together to make sure no one had any other ideas or objections. I emphasized to them that in no way, shape or form was his EPW status having any bearing on the decision. After everyone was able to voice their opinions, we gave the patient pain medication and sedative to keep him comfortable and pain free, removed his endotracheal tube and allowed nature to take it's course.
I experienced many emotions that day. The soldiers sent with the patient lost friends to this man's hands and were very eager and vocal about their wishes for him. Yet, in my heart, I had to make sure that this decision was done from a medical and humane standpoint, not with the least bit of malice towards this man. I was very vocal and adamant about him getting adequate sedation and pain control, something he would not afford those other soldiers. I looked at what was left of his face and body and had to see him as a child of God, a brother that at one point in the pre-existence decided to follow the plan of our Lord and Savior Jesus Christ. I don't know what circumstance or how he ended up on the other side of the world from me, being raised in a culture so polar opposite as mine. Yet beneath the mutilated flesh was another brother. Death is the great equalizer and the ultimate final common pathway of all flesh.
I don't mourn this man's death. There was no hero's salute or grand fair well. I did say a prayer, knowing that the Lord would judge him in righteousness and mercy. Who knows when my time comes, one day, I may meet this man and call him brother.
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ReplyDeleteI am reminded of Moroni's comments, another warrior who'd seen enough bloodshed to last a lifetime and more, as he concluded his record in Moroni 1. He first pointed out that he was on the run, hiding from Lamanites who sought to destroy him. And then, "...I write a few more things,that perhaps they may be of worth unto my brethren the Lamanites, in some future day, according to the will of the Lord" (v. 4).
ReplyDeleteCharity and virtue are the only qualities that can carry a man through war with a peaceful heart, and bring him home to his family with an increased capacity for love.
Proud of you son. You are a credit to your family, your country, and the Lord.
What are the rules for withdrawal of care for U.S. soldiers?
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