KC-10 Driver
Well-known member
- Joined
- Feb 24, 2002
- Posts
- 503
I understand the following isn't aviation related, but I was moved by it enough to post it here. I don't know the person who wrote the letter from which the following was taken -- I received it by email after it was forwarded several times. However, I am sure that the author is representative of our medical personnel who are overseas saving lives -- both American and other.
Here it is:
Dear XXXX,
This is what it was like yesterday.
It started out on Sunday morning, and it just got worse until this morning when it became really really bad. It was like a mass casualty operation on steroids. I operated all day yesterday with routine gunshot wounds and blunt trauma from motor vehicle accidents, and it was manageable because they came in one at a time, and I finished with the last one at around six this morning. Everyone made it, and the rain stopped, and I was looking forward to getting to bed when the car bombs in Bakubah and Balad went off. The choppers started landing just after 0800, and we started working right away. I was triage since I was on call last night, and the radio calls kept coming in, and it was obvious the situation was becoming more desperate. We called in all the hospital personnel, and I was the greeter at the door when the patients came into the Emergency room. The Iraqis were all shapes and sizes: men, women, kids, infants, elderly, short, tall, thin, but they all had one thing in common - all of them were bloody. Some had received some first aid care in the field, but many had just been loaded on the chopper and scooped up off the streets. The PJ's are normally solid guys and girls, but they were all pale, and even the really reliable ones were pale and visibly shaken by what they were seeing.
The Operating rooms were opened immediately, and they started operating two by two in each room, as I got the immediates sorted from the delayed and the expectants. I coordinated which patient went to CT scan, which patient went straight to the theater, and directed catheters, central IV lines and chest tubes, and tourniquets, antibiotics, labs, and X-ray. A few of the patients were too critically injured for the ER Docs and ICU docs to handle, and I started going from patient to patient putting in chest tubes and Central IV lines. The floor in the ER tent was soaked with blood, and we started putting surgical gowns on the floor with sand so it would not be too slippery to walk on. I looked out the front door, and there were two choppers hovering waiting to land at the helipad while four were unloading at the same time. When the OR's were full, we started operating in the ER to stop bleeding and get the patients ready for OR. The patients that needed airways were intubated, but some of them had such facial injuries that we had to cut their necks open with cricothyroidotomies to get tubes and oxygen into the airway. The senior Army and Air Force surgeons were here to talk about coordination of trauma in the AOR, so we had some extra hands that we would not have had tomorrow. About noon, we were all out of surgeons and it was my turn to go to the OR, and I handed off the triage to the senior nurse colonel and took a patient into the room.
The OR is a Conex that has been wired and plumbed. The first thing I noticed when I went into the room was a bag of arms, legs, hands, and feet, and it reminded me of the pictures you see on Civil War surgery.
The guy was fifty three years old according to the interpreter, and he was on his way to heaven in a hurry with a blast wound to his left arm and chest. The left arm was open from the inside of the elbow to the chest, and the blood was coming from the chest tube like a faucet. I had a tourniquet on the arm, but the hole was right where the arm attaches to the chest, and it looked like the artery was destroyed for about six inches, and I could not put the tourniquet any higher on the armpit. Everybody else was gainfully employed, so I snagged the dentist to assist me, and I sawed the patient's chest open right down the midline from his windpipe to his belly. The blood was clotting in his chest, and it was like scooping handfuls of jello out of the chest to see what was going on. The fragment was what looked a piece of a fender, with chrome on it, that had taken out the axillary artery to the arm before cutting the lung and the left ventricle of the heart. You come to war with the hospital that you have, and there were no heart-lung bypass machines in the tent. The dentist and I had to repair the heart with it still beating. I removed the fragment from the heart muscle, and I used a foley catheter balloon to stem the flow of blood while I sewed around it, and I had to lead each stitch like I was duck hunting because the heart was jumping around. As soon as I got the heart sewn up, the patient's blood pressure came back up to normal, and I had about 7 big leaks on the inside of the chest that were not apparent when the patient was hypotensive. When I got those under control, I fired a big staple gun across the left upper lobe of the lung to stop the air leak. And then the axillary artery had sufficient pressure to really start throbbing, and I was glad I had proximal control of the darn thing. It reminded me of when I was a kid I in AZ and we used to hunt the gophers - we would put water in one hole and wait to see where it would come out next. At this point one of the PA's came in, and harvested a piece of the saphenous vein from the leg, and I reversed it to make a graft for the axillary artery. Once that was done, it was time to move down the arm and stop the bleeding there. The vein was shot, but the nerves looked in good shape, and I started sewing the bleeders and cleaning out bony fragments. I washed the arm with a surgical pressure washer, and we put mechanical leeches on it to start sucking out the dead tissue. Then it was back to the chest, and I wired it together, and sewed it up. We got the guy off of the table, but I was too covered in blood to walk out of the room without slipping, and I raised my arms up so the nurses could get me out of my scrubs without contaminating me. I was glad I had on good underwear, today.
As soon as I was dressed, I turned around to the table behind me, and the patient was a 15 year old who spoke perfect English and told me he was dying. He was in fact dying right there. He had a small pinpoint hole just below the clavicle that did not look like much, but then he coughed, and the thing started spraying blood like a garden hose. Same scenario, I opened his chest, and went to work on his heart, but this one was much easier because he did not have the arm injury, and the thoracic surgeon was just finished with a patient, and he scrubbed in to help. The kid made it off of the table, tough kid, and this evening he told me that he wants to come to America one day and see baseball.
I am going to go eat lunch/dinner/breakfast, now. How is your day
going?
Tell XXXX I said hello.
Love XXXX
Here it is:
Dear XXXX,
This is what it was like yesterday.
It started out on Sunday morning, and it just got worse until this morning when it became really really bad. It was like a mass casualty operation on steroids. I operated all day yesterday with routine gunshot wounds and blunt trauma from motor vehicle accidents, and it was manageable because they came in one at a time, and I finished with the last one at around six this morning. Everyone made it, and the rain stopped, and I was looking forward to getting to bed when the car bombs in Bakubah and Balad went off. The choppers started landing just after 0800, and we started working right away. I was triage since I was on call last night, and the radio calls kept coming in, and it was obvious the situation was becoming more desperate. We called in all the hospital personnel, and I was the greeter at the door when the patients came into the Emergency room. The Iraqis were all shapes and sizes: men, women, kids, infants, elderly, short, tall, thin, but they all had one thing in common - all of them were bloody. Some had received some first aid care in the field, but many had just been loaded on the chopper and scooped up off the streets. The PJ's are normally solid guys and girls, but they were all pale, and even the really reliable ones were pale and visibly shaken by what they were seeing.
The Operating rooms were opened immediately, and they started operating two by two in each room, as I got the immediates sorted from the delayed and the expectants. I coordinated which patient went to CT scan, which patient went straight to the theater, and directed catheters, central IV lines and chest tubes, and tourniquets, antibiotics, labs, and X-ray. A few of the patients were too critically injured for the ER Docs and ICU docs to handle, and I started going from patient to patient putting in chest tubes and Central IV lines. The floor in the ER tent was soaked with blood, and we started putting surgical gowns on the floor with sand so it would not be too slippery to walk on. I looked out the front door, and there were two choppers hovering waiting to land at the helipad while four were unloading at the same time. When the OR's were full, we started operating in the ER to stop bleeding and get the patients ready for OR. The patients that needed airways were intubated, but some of them had such facial injuries that we had to cut their necks open with cricothyroidotomies to get tubes and oxygen into the airway. The senior Army and Air Force surgeons were here to talk about coordination of trauma in the AOR, so we had some extra hands that we would not have had tomorrow. About noon, we were all out of surgeons and it was my turn to go to the OR, and I handed off the triage to the senior nurse colonel and took a patient into the room.
The OR is a Conex that has been wired and plumbed. The first thing I noticed when I went into the room was a bag of arms, legs, hands, and feet, and it reminded me of the pictures you see on Civil War surgery.
The guy was fifty three years old according to the interpreter, and he was on his way to heaven in a hurry with a blast wound to his left arm and chest. The left arm was open from the inside of the elbow to the chest, and the blood was coming from the chest tube like a faucet. I had a tourniquet on the arm, but the hole was right where the arm attaches to the chest, and it looked like the artery was destroyed for about six inches, and I could not put the tourniquet any higher on the armpit. Everybody else was gainfully employed, so I snagged the dentist to assist me, and I sawed the patient's chest open right down the midline from his windpipe to his belly. The blood was clotting in his chest, and it was like scooping handfuls of jello out of the chest to see what was going on. The fragment was what looked a piece of a fender, with chrome on it, that had taken out the axillary artery to the arm before cutting the lung and the left ventricle of the heart. You come to war with the hospital that you have, and there were no heart-lung bypass machines in the tent. The dentist and I had to repair the heart with it still beating. I removed the fragment from the heart muscle, and I used a foley catheter balloon to stem the flow of blood while I sewed around it, and I had to lead each stitch like I was duck hunting because the heart was jumping around. As soon as I got the heart sewn up, the patient's blood pressure came back up to normal, and I had about 7 big leaks on the inside of the chest that were not apparent when the patient was hypotensive. When I got those under control, I fired a big staple gun across the left upper lobe of the lung to stop the air leak. And then the axillary artery had sufficient pressure to really start throbbing, and I was glad I had proximal control of the darn thing. It reminded me of when I was a kid I in AZ and we used to hunt the gophers - we would put water in one hole and wait to see where it would come out next. At this point one of the PA's came in, and harvested a piece of the saphenous vein from the leg, and I reversed it to make a graft for the axillary artery. Once that was done, it was time to move down the arm and stop the bleeding there. The vein was shot, but the nerves looked in good shape, and I started sewing the bleeders and cleaning out bony fragments. I washed the arm with a surgical pressure washer, and we put mechanical leeches on it to start sucking out the dead tissue. Then it was back to the chest, and I wired it together, and sewed it up. We got the guy off of the table, but I was too covered in blood to walk out of the room without slipping, and I raised my arms up so the nurses could get me out of my scrubs without contaminating me. I was glad I had on good underwear, today.
As soon as I was dressed, I turned around to the table behind me, and the patient was a 15 year old who spoke perfect English and told me he was dying. He was in fact dying right there. He had a small pinpoint hole just below the clavicle that did not look like much, but then he coughed, and the thing started spraying blood like a garden hose. Same scenario, I opened his chest, and went to work on his heart, but this one was much easier because he did not have the arm injury, and the thoracic surgeon was just finished with a patient, and he scrubbed in to help. The kid made it off of the table, tough kid, and this evening he told me that he wants to come to America one day and see baseball.
I am going to go eat lunch/dinner/breakfast, now. How is your day
going?
Tell XXXX I said hello.
Love XXXX
