PATIENT #1

I was eager to get started and fall into a rhythm of treating the injured servicemen.  Each deployment, the ethos is slightly different. I spoke with Jeff XXX. He deployed 4 times, including a stint in Balad.  He’s a trauma surgeon who has practiced many years at a civilian institution before joining the Air Force. He’s well respected for his clinical and personal adeptness.  We discussed how the war is different here than Iraq. While we are learning in Afghanistan, we’re learning less new lessons.  He also commented that the tempo and culture is different here than in Iraq, and particularly in Balad.  In Iraq, mass casualties were frequent and surprise patients with 3-4 tourniquets were routine.  Here, the patient volume is high, but steady.  The terrain and weather limits flight and more patients are sent to a smaller hospital or air station before arriving to Bagram.  We talked for a while and reminisced about Iraq, the food, the tents, and made comparisons to this war.  I was still tired and hopefully working would shake the jetlag.  My first day at work began as expected. The 1^st hour was quiet as we waited for the call.  “Dustoff to Task Force Med Ops…break…we have liter urgent..break… “ They brought in a young marine involved in an improvised explosive device [IED] attack. He was infantry [and proud of it].  He was on patrol when hit unexpectedly by an IED.  The explosion left one marine dead.  Two others received leg amputations and genital injuries, a signature of the dismounted attacks in the rugged Afghanistan mountains where vehicles cannot travel.  He was awake, 1 day post injury and stoic, as most of the young marines are.  His initial injuries were treated at an aid station, a small tent with few resources and one doctor or physician assistant.  He lost one leg and had a fracture of the other.  We assessed his injuries, stabilized him, and then he maundered through the details of the attack.  At times he seemed distant, almost viewing the attack from above, and at others the details were ghastly as he described the screams of some the marines and the quiet, white, blank, dead faces of others.  After the trauma resuscitation quieted and many had left the bay, I resumed a habit I learned from a patriotic physician assistant I deployed to Iraq with in 2005.  I rested my hand on his shoulder, recognized him for his brave work, and thanked him for his service.  He thanked me and silently cried.  The remaining two nurses and doctor approached the bed and the room was quiet. Later that night, the Marine was awarded the Purple Heart in the hospital ward, pinned to his chest by his commander who was bedecked with ample decorations of his own.  The marine was evacuated three hours later to Germany and then to the US where he will likely be retired from the Marine Corps, never to return to war.