Tuesday, September 28

This is Just Horrible

A friend of a medic working in Iraq forwarded this email for publication. On the off chance that any of you that visit this fine establishment and don't check out Gilliards place on a regular basis, I will post some of it here and suggest you read the rest. Pass it along. This needs coverage far and wide.
The daily news reports are somewhat antiseptic and it's easy to lose track of the meaning of the words. Those in our positions should not.

This is a note I received this morning from a colleague working in Iraq. This is what it's like. Today. Last week. I've taken the ID off of it, but it's a trustworthy source from my immediate sphere of friends and I know him well.

GSW is gunshot wound. EPW is Enemy Prisoner of War. IED is Improvised Explosive Device (a roadside bomb). KIA is Killed in Action.

Subject: Casualty report


How is everyone at [Deleted]? I suspect things are all still going well and the clinic continues to run smoothly. Apart from a sighting of the bat in the bat cave, things in general are about the same out here. The bat was a trip, as it flew around in circles in the hooch like, well, a bat out of hell I guess. The casualties picked up some this week which was too bad, and we had one day in particular which was a bad one. Otherwise life out here has developed a routine, and it seems as though the time is starting to go by faster. The team itself is getting better and more efficient with each resuscitation, and we all seem to work well with each other for the most part. Our surgeon, although for the most part a really good guy, can get a little uppity sometimes if things don't go exactly how he says they should (he seems to think the only person in the room with any clinical judgement is him), but even that isn't really a big deal. It's just a bit of an adjustment stepping out of the role of being in charge and being the boy again. I'm good at being the boy and can do what I'm told as well as anybody else, but it has been a bit of an adjustment. Anyway, I thought I'd drop you a line to let you know we've seen over the last couple of weeks or so.

I'm not sure if I told you about the family who came in I think a little over a week ago (time out here is a weird thing and hard to keep straight). The story is a little muddled, but apparently they ran a check point. It's unclear whether they confused stop with go or if they were really running the check point, but regardless of the specifics they ran a check point and were taken under fire by a combination of M-16's and at least 1 50cal machine gun. The car was apparently a wreck and we had 5 casualties come into us. There were apparently 2 or 3 KIA at the scene, including a young child who I think was 8 (they don't bring the civilian KIA in to us thank goodness). The guy I took care of had his right foot nearly taken off by a 50cal round. It was hanging by tissue and sinew, and ultimately got amputated. Apart from now being a legless old man, he otherwise did fine. The other casualties included an old woman with a GSW to the L chest who had a large L sided hemothorax with 800cc of bloody drainage. She eventually developed respiratory distress and got intubated, but otherwise didn't have any injuries. She was transferred to Al Asad, but I have no idea what happened to her after. Another woman had a GSW to her L flank, and despite maybe having a hemotoma around her L kidney on FAST exam was otherwise hemodynamically stable and did fine while she was here. Another guy had a GSW to his L shoulder and developed a tension PTX (picked up on follow up exam as subQ air). He had a chest tube placed and his shoulder dressed and did fine while he was here. He was also sent to Al Asad. The 5th guy had a some superficial wounds but did fine. We had a couple other Iraqi civilian/EPW casualties related to check point violations around the same time (I'm not sure if this was because the Marines have been jumpy recently, or there was some kind of insurgent offensive going on).

One guy was driving a water truck and had both feet nearly completely taken off by a 50cal round. Impressive injuries which shattered the bone and left his L foot dangling, but he was amazingly neuromuscularly intact. He kept both legs, and after having on external fixater placed on his L leg he was sent to Baghdad for definitive repair. Another guy had several GSW to his chest but had amazingly had no significant injuries and didn't require any procedures. Bullets are funny things and seem to have a mind of their own sometimes.

And the last Iraqi civilian was a poor old woman who came in last night at around 0400. The Marines were apparently conducting a house to house search, and this woman didn't answer her door right away. Can't blame her really because at 0400 we didn't answer our door right away either when they came to tell us about her. She apparently did answer, but not in time, for as she was reaching to open the door the Marines blew the lock with a shotgun. It appears as though she took most of the shotgun blast to her L arm, for when she came in the L distal L humerous and proximal radius were shattered with no complete loss of structural integrity to her L arm. Although the arm was vascularly intact, she had no sensation and ended up losing the arm. I got to intubate her in the OR, but otherwise all of these stories are pretty tragic and sad, and events like these unfortunately will not go far in the campaign to win the hearts and minds of the people. It's difficult to really explain the emotions they conjure (other than sadness I'm not sure I had to many), but one question comes up over and over again when I see these types of accidents- "What the fuck are we going out here?" I guess that's not really for me to ask right now though. I don't place any blame on the Marines for this stuff. They are doing their job, and if I went out everyday with the prospect of getting killed by an IED or some other unseen enemy, I would most assuredly shoot first and ask questions later in the wake of any suspicious activity. It's a dangerous place, and one can only hope that it gets better over the next few years.
He unfortunately had also sustained a head shot from a sniper (who knows if it was the same one or not), and he died before he got here. When we saw him, the back of his head was shattered and you could feel the bones floating around. While moving him into the body bag, his bandage slipped off his head, and I found myself looking into the young man's eyes. He had big green eyes, and appeared to be looking right through me. What he was asking me I don't know, and will probably never know. Although I had his blood all over my boots and pants and was a bit shaken as I was washing it off, he has not haunted me the way some of the others have, so I don't think he was angry with me in any way. It was a bit disturbing and capped off a shitty day.

The last 2 Marines we had come in the other day. Their tank was hit by some kind of missile, and I think these were the guys up in the turrets. One guy came in KIA with the left side of his face blown away, and his left arm missing. I didn't go see this guy (I don't know but maybe I needed a break). The other guy came is with an open fracture of his L humerous with exposed muscle and the like all up the back of his arm, and open fractures of several of his R metacarpals with avulsion of most of the skin off his R hand. He had a small L neck hematoma and some superficial facial lacks, but he had a GCS of 15, was talking to us, had bilateral breath sounds and was hemodynamically stable.
Can someone explain why we should keep the guys that made this mess, in charge.