Our Beloved Soldier

Since Dave is too modest to post this his proud wife will. A New York Times reporter spent some time with Dave and his crew a few weeks ago. Here is an article that shows some of the hard work and challenges Dave is facing everyday.

When Afghans Seek Medical Aid, Tough choice for U.S.

The 4th and 5th slides are also good pictures of Dave at work. If we're lucky Dave might expound/correct it for us. We love you, Dave!

Stupid Rail Road Companies anyway!

All the experiences with time zones in my existence have been either so-so or bordering on the negative. Such as: trying to facilitate phone calls to family members without waking them up in the mornings. Or vise-versa, them waking me up at night. All in all, not that big of a deal since I like talking to family and we all agree sleep is highly over rated. Most recently we experienced one of the negative aspects of time zones.

Dave and I had a little jaunt up to Louisville, Kentucky a few weeks ago. (Yes, we saw the big bat outside the Louisville Slugger Museum while driving around. It's hard to miss since it accents the skyline.) Even though Louisville is only a 3 1/2 hour drive away, we had planned on staying a few nights and seeing what the city had to offer. Due to school madness and timing we were limited to one evening. Before returning home from Afghanistan Dave purchased tickets to Wicked in Louisville.

By process of elimination, we choose to go the night of the show and leave our packed overnight bags to gather dust on the living room floor. Arriving 4+ hours before the show we killed time in a local book store and at dinner. I've just got to say that I judge restaurants by the quality of the raspberry lemonade. Hard Rock Cafe is one of the few that still puts real raspberries in theirs. They are now on the good list, even though they're way mainstream, which usually takes people off the list. Melting Pot, on the other hand- I have no words for serving me hard lemonade. My lawyer might though. But that's for another post.

So, back to Louisville. We would have loved to continue killing all our oodles of time down at the river and enjoy more of the city. As fate would have it, the weather was bitter butt-cold, and the wind howling like a banshee, so we opted to go the venue about an hour early and see what they had to offer by way of visual art. Bah, as if we saw any. The show had started 7 min. before we got there. While trying to wrap our minds around this concept it dawned on us that we must be in a different time zone.

DUDE! I mean really! Shouldn't there be like some loud voice that announces when you've entered a new time zone. Or, at the very least, a sign on the freeway. Every city and county we passed through had a sign letting us know we were in their territory. We were in one county for less than 2 miles. And how do I know this? Because there were signs. I even commented to Dave on the matter when he was wonderfully reading Treasure Island. Our city alone has 10+ signs letting everyone know that it's the home of Miss USA 2007, who fell on her face at the Miss Universe pageant. OK, so it doesn't say all that. I can't help but think of it when I see them though. So signs, they're handy, they're informative, they're helpful, they're necessary. Come on people, work with us here!

And another thing: why are there two times zones in one state. They should all take after Alaska and become one time zone. It took like four years for Alaska to get there once they started (it's just that big). But they did it. And if Alaska can do it, you can too.

On a completely different tangent, Wicked was pretty good. The Defying Gravity song, spectacular.

Medevac Stories.

So apparently it's not against the law to murder your children in this country. We picked up a ten-year-old girl with 2nd and 3rd degree burns covering about 90 percent of the body, including her face and mouth. It looked like a huge pot of boiling water was poured over her head. I guess that out in the sticks it's a popular form of punishment- pushing your kid in a fire or throwing hot liquid on them. The call came this morning, and it took the civilian hospital in Kabul about 4 hours to decide wether to admit the patient. We think they were just stalling, banking on her dying if they waiting long enough. And- by the way- she will die. Soon.

The Jalalabad crew picked her up from the base closest to her town, and we took her from J-bad to the hospital in Kabul. When I went to the J-bad aircraft to transfer the patient, mom and dad were sitting in the back seat looking as cute and concerned as could be. For a second I thought about not killing them both. I sure as heck didn't let them on my bird, though. They flew in our escort bird. It's such a crime that parents here can do that to children and not face some kind of legal consequences or something.

The little girl was stable throughout the flight. She was a mess though, sedated and intubated of course, and drugged out. I won't go into detail, but I doubt she will ever wake up. I'm really glad she at least made it to the hospital. I don't know how I would have handled that.

Anyhow- now for a more positive story.
The last 'exciting' mission I got was for two local guys way down south near Salerno. They got caught in a crossfire between some good guys and bad guys and got shot up. They laid in a ditch bleeding all night and all the next morning. I think it was like- about 12 or 13 hours before they were found and brought to a base for treatment. One guy was shot up on his arms and legs and gut, the other was shot in the neck and had a severed carotid artery. And yet they both lived and looked like they would have a full recovery. What the doctor thinks happened was that they got hypothermia from laying outside in a cold ditch. That made their blood pressure drop and their hearts and brains shut down, and also caused them to bloat up- which in turn constricted their injuries and helped stop their bleeding. Amazing, isn't it? Talk about miraculous. Not many people who have those kinds of wounds do so well, if they even survive. That's not even considering laying out with no treatment all night long. That neck shot guy was lucky to live ten minutes.

The things you see happen out here.

This one time in Afghanistan...

It's been a while since I had any cool war stories to share. I had a trying mission the other day that I'll relate, and give my readers some insight into the exicting side of my deployment. These exciting moments don't come along everyday. Or even once a week. And sometimes in a month. But I did have a really cool one come along a few days ago.

I was on the second-up crew and through a series of unexpected events we had to take a mission for three urgent patients without the assistance of a flight doc. It's standard practice to bring one with us in case the patient needs care that exceeds the medics ability, training or if there is just too many things going on at once. We don't always bring one if the patients have some really lame ailment. But this wasn't one of those times. The only info we had was that all three patients required immediate surgery, and they were all already on ventilators. No info about specific injuries, treatment they have already received or anything.

While I was loading up the aircraft with all the extra monitors and breathing machines I thought I might need, someone else was trying to get a doc to us. In the end we decided to go without. I was a little nervous on the way down. When we got to Jalalabad and I saw my patients I was able to relax a bit. They were in a truck that was hit by a bomb, caught fire and crashed. Two were US soldiers and one was a local interpreter. They all had burns to their upper bodies and airways, and some broken bones, but they were all stable and drugged out. Our people in flight operations had called the Jbad aid station while we were in flight and told them we were without a flight doc, and they had a surgeon there for us. He didn't have any medevac experience but it was better than nothing so I brought him along. None of the patients looked like they would be any trouble and I didn't think I would need him anyway.

Normally if we only have one patient the doc doesn't have to do anything. If the patient is really messed up the doc and I will split up the work- ei one of us works on the airway and the other hooks up monitors and get the fluids and drugs pumping. And if we have multiple patients I'll work on the one worst guy and the doc will keep an eye on the less severe ones, and be a ready resource if I run into anything I haven't seen before.

On this flight the doc had no way of knowing what he should be doing, and wasn't up on our internal communication system. So to get his help with anything I used the highly inefficient point and scream method. Like so.

Me: (points to doc and screams) "YOU", (points to my eyes, then points to patient closest to doc and screams) "HIM".
Doc: (blank stare)
Me: (same thing but louder)
Doc: (nods, but doesn't do anything)

I wasn't his fault though. We normally train our docs on what we expect them to do. And doc aren't used to working in an environment that they didn't personally set up.
It all worked out in the end. It was extremely crowded and cramped in the back of our bird but eventually I got everyones O2 adjusted, IV bags hung and flushed, monitors monitoring and wounds looked at. Once that is done the rest of the flight usually goes real smooth but with these three there was always one or two things that needed to be done. A piece of equipment would fault and need to be troubleshot and fixed, a different patient would need suction, the middle guy needs more oxygen. And since the doc didnt know where anything was, I spent the ride crawling over the litters from one patient to the next constantly trying to fix something. The worst was in the last 5 mintutes of the flight.

I was doing something with dude-in-the-middle when I faintly heard the doc screaming something at me and pointing to the monitor on dude-on-the-left. His oxygen saturation display is showing a rapid drop. After checking the equipment to make sure the sensor is working right, I disconnected the ventilator and hooked the O2 to a bag and started breathing for him manually, and asked the pilots to please fly faster because all of the oxygen tanks are about to run out. I happily those O2 sat numbers climbing back into the pink. That's when I looked at dude-on-the-right and saw his pulse had doubled and his hands where clenched and shaking. Apparently while I wasn't watching his drugs were wearing off and he had noticed a big fat tube was shoved down his throat. So the doc took over bagging and I crawled/swung over the patients so I could get to my drug bag and send dude-on-the-right back to lala-land. Once that was done I looked to see how the doc was doing, and it lookded like his guy was tanking again. Thankfully we landed right then. Whatever was wrong with the patient at that very moment could wait the 60 seconds it takes to get to the emergency room.

We got everyone off nicely and wheeled into the ER, I gave my report to the doc there, thanked the guy that flew in the back with me, and went back to my bird. The cargo area looked like a bomb had gone off. Wires and tubes strewn everwhere, wrappers and syringes and trash getting blown around, a couple little puddles of bodily fluids, the hiss of leaking oxygen canisters, and alarms beeping angrily from two or three various machines. Accompanied my all this was a deep feeling of peace and accomplishment. I managed all three patients without panicing or forgetting everthing I ever learned about medicine, and everyone got to the hospital safely. After 9 months in this country I felt like I had been thrown into the fire and finally come back out unsinged. It was a great feeling, and since that mission I haven't had the usual pre-mission butterflies and doubts. I have arrived!

Stink-eye

This morning we gave a lift to local guy. He kept giving me the stink eye during the whole flight. I thought it was a little rich. We patched him up and gave him a ten thousand dollar ride, but he glared suspiciously at me the whole flight. And in return he made the whole aircraft stick like crap. I even gave him morphine. I didnt have to. I could have just let him suck it up. He wasn't stink-eyeing anyone else in the bird, just me. The flight doc had a thought about why that might be. I have a red cross patch on my helmet. Apparently that means I am an evil christian crusader, and want to take over the muslims. So there you go.

Perspective

Sometimes I think that I should focus more on positive things. Peoples accomplishments rather than their failures or pain. Someone reading my blog might get the idea that I am a negative person who delights in embelishing on the suffering of others. I want to say that this is not true. I am a very positive person. I am an optimist. And I do not enjoy watching people suffer. Perspective is what is needed here.

As a flight medic in Afghanistan, I see people at their lowest. The service we provide brings me close to suffering, injured, sometimes dying people on a daily basis. These people are innocent victims of cruelty, or brave volunteers who accepted the mortal risks of being a warfighter. Only a small percentage of our clients deserve to be in their situation. Being a medic can be really difficult sometimes. Pain is never funny.

Or is it?
Being able to compartmentalize makes things easier. I take one part of a situation and put it in the serious drawer, and another part of the same situation goes into the hilariously ironic drawer. Today for instance:

This afternoon my crew got a call to fly to Jalalabad and pick up a young woman with burns to her face, right arm and hand. On the way there, we were guessing how she got burned. We were pretty sure it didn't have to do with fighting because of the place and manner in which we were picking her up. Was it from a hot coffee spill, an accident in the shower, did her clothes catch on fire somehow? I found out when I arrived. Apparently she was trying to burn some pieces of wood, and they weren't burning as fast as she wanted. So she decided to dump gasoline on them and light it with her cigarette lighter. Um... duh. Back to that perspective thing. On the one hand- oh, sad. On the other- Friggen awesome with a side of serves you right. Taking into account that she's fine- no permanent damage, and she gets a free trip the Germany for recuperate for a few weeks. Like free leave! So yeah I think it's funny, and I'm sorry you were hurt because you did something super-retarded.

The story gets better/worse.

While the doc and I were getting her all ready to go, we got another call. There was a second helicopter on it's way to Jbad with a middle aged local guy for us to take to Bagram, with gasoline girl. He had some bad eye and face trauma and a big laceration on one of his arms. So I'm thinking- was in an I.E.D., a mine, some kind of industrial accident, or was he kidnapped and tortured by the taliban? Nope. And I kid you not... Mauled by a bear. I didn't find much funny about this one. But it brought a bunch of questions. We have bears here? How did he manage to find one? How do you get it to attack you!? Flying around the mountains out here I've never seen or heard of anything accept goats and camels. And the biggest question of all- How did I wind up with these two bizzare cases on the same day, even on the same flight?

I have no doubt that this is the weirdest job I will ever ever have. Good thing I'm so positive.

A Sharp Increase in Sphincter Tone.

I hit another benchmark today. Today I had my first cardiac emergency patient!

We got the call to pick up a guy at a little outpost over an hour away. The only information we got was that it was a US Army male and "unconscious and clenched jaws". That was all. Thanks a pantload people. About five minutes out from the pickup we were radioed that the guy wasn't breathing anymore and they were going to do an emergency cricothyrotomy. That means cut a hole into the trachea through his neck and push a tube down into his chest. We were still getting ready for that when we landed. So we loaded him up and took off while we hooked him up to a ventilator (that only worked for 10 seconds- we did it manualy after that) and a cardiac monitor that told us his heart wasn't beating. Instead of coming back to Bagram we flew really really fast to a closer base. After 5 or 6 minutes of CPR, two shots of adrenaline, some atropine and 200 joules his heart started beating on its own again. After the first few minutes I didn't think he was going to make it. I thought he had a head injury because he had some bruising and blood was coming out of his mouth and nose- but that blood was actually from the hole he had cut in his neck being pushed up to his mouth because of the CPR. Cardiac arrest cause by head trauma is a really bad injury. The base we went to was only about 15 minutes from the place we picked him up. I kept bagging him until we got into the hospital and then someone else took over. I also learned there that his condition was caused by a drug overdose of sleep aid and other unknown drugs, not head trauma. He looked like he was doing pretty under the other doctors care by the time we left the clinic.

It was a good thing I was flying with a more experienced flight medic and a very experienced trauma doctor. That dude was a handfull. He would have been screwed if it was just me and the crew chief. I learned a lot from that one patient about cardiac care. And about messing with sleep aids. It's too bad because I know that is a problem that a lot of soldiers struggle with here. That guy was just trying to get to sleep and nearly went to sleep forever. Plus having to wake up with a hole through his neck, subcutaneous emphesema, multiple broken ribs and an assortment of other aches and pains to be sure. Maybe he will get legal action against him by the Army as well; for drug abuse and destruction of government property. I'm glad that I'm not that guy.

So to sum it up. Yay for me for getting to learn some cool stuff about patient care and gain some awesome hands-on medical experience. Yay for the other medic and doc for saving the guy and teaching me to do awesome life-saving stuff. And yay for the patient for only being dead for a few minutes.