Combat Doctor

by Marc Dauphin

  Well, that trauma team liked to crank up their MP3 player in the bay, and they boogied to this outrageous the-singer-is-about-to-vomit type of heavy rock. Because of their size, this was the only team that Dave and I let spill over into the corridor between the bays. Until the casualties started to arrive, that is.

  The girls’ team, The Five-Foot-Two Crew, all managed to look bored. But it was fake bored, although they did a good job of it. Isabelle, their leader, would stand, feet apart, hands hanging at her sides. But even though her muscles were relaxed, her whole body was ready, sort of like some black-belt fighter in her Zen zone. And her eyes unblinkingly bored into you above a Mona Lisa–like half smile. Kristi liked to stand on one leg, her elbow lazily resting on the note-taking table, and one foot negligently crossed over the other, just as if she was taking a smoke break outside her office building and watching people go by. Except she didn’t smoke; and when you’re relaxed, the muscles of your jaw don’t alternately clench and relax. And Tynah kept her head bent over her notes, even though there was nothing written there except that day’s date. And Olga, who became an American citizen on the day she arrived at the unit, could be found joking with other youngsters with that carefree, clear, adolescent, almost little-girl laugh. My God! What are we doing? They’re all still children! … Sorry, that one got away from me.

  In the corridor, well back from the door, Captain B was standing in his T-shirt in front of Trauma Bay 2, feet planted well apart, and his arms crossed. The surgeons and anaesthetists were waiting by the OR doors with their crews, waiting to be told who goes to which OR, and what kind of surgery to prepare for. The imaging crew assembled in front of the radiology monitor and huddled like a football team. “Cheryl, you take Pierre (that was what we called one of the portable X-ray machines — they all had names — the portable ultrasound was R2D2) and take Bays 1 to 3. Abraham, you take Daisy (as in “Driving Miss …”) and cover the outer bays. Muddy, you do the ultrasounds. Major Dauphin and Captain B will direct you to whatever bays they want. It’s an IED blast, so expect a lot of plain films before the CTs. Dave (another Dave, not the CSM), is the CT up and running?”

  And so on.

  Rhonda, one of the lab techs, was already having the teams sign for uncrossed and unmatched blood units, usually four O+ PRBCs and four AB FFPs to each of the major trauma bays. Once out of the fridge, these units had to be used within twenty minutes or they’d spoil in the balmy (35° to 37°C) ER. And, to Rhonda, spoiling a blood product was the major sin. She got very worked up over this. So she’d make sure that, twenty minutes after they were given out, those units were either accounted for or back in the fridge. She prepared them and placed them in the fridge in plastic boxes identified to each bay. When she heard the chopper landing she would rush to her fridge, take out the boxes, bring them to their bays, and start her timer (among all the other things she had to do very quickly). There were many lab techs over there who did the same job, and attended to the horrific injuries, all of them, under the watchful eye of Sergeant Duperré. Thank you, Sarge.

  Then there were the PAD clerks waiting outside with their airport wands, their walkie-talkies, and their clipboards. They had to clear all casualties for weapons, ammunition, and booby traps before they were allowed inside. Once that was done, the PAD clerks followed the casualties into the bays and made sure they got the identity of the injured right. It wouldn’t do to have Mrs. Green informed that her son has lost a leg, when it is, in reality, Mrs. White’s son. And the PAD clerk had to do this while the resusc was ongoing, being as unobtrusive as possible in a corner of the bay. At that point, the conversation was going something like this, most of it being fired at the poor casualty. (No wonder most of them don’t remember anything that happened in the trauma bays. Maybe it’s just as well.)

  “Okay, you’re safe now, soldier. You’re in the hospital. We’ll take care of you.”

  “Is your name Bloggins?”

  “We’re gonna cut off your uniform now. Tell us if we’re hurting you.”

  “This is an oxygen mask to help you breathe better.”

  “We’ll have to cut that boot off now. We’ll hold your leg as steady as we c—”

  “AAAAAAAHH! … Jesus f--ing *%$ that hurts!” [That was the patient.]

  “What’s your unit, soldier?”

  “Four forty-first, A Company. AAAaaaahh!”

  “You’ll feel a needle prick in your groin. Then it’ll burn like hell, but not for long.”

  “What’s your service number?”

  “This is an ultrasound to see if you’re bleeding in your belly. Sort of like when you’re pregnant. We’ll tell you if it’s a boy.”

  And so on. All the voices controlled. No shouting. No nervousness, please.

  But by that time the PAD clerks were doing their “Taco, this is Salsa. The helo is wheels down at this time. Over” thing.

  Three DI techs goof off for the camera. The “hair dryers” are our portable X-ray machines. The aprons are lead, weigh a ton, and are designed to protect them from the radiation. Ms. Bridget Sangster, a Canadian civilian volunteer; USN Hospital Corpsman Second Class Cheryl Sanchez; and NZ Defence Force Lieutenant Sheree Mudford.

  USN Lieutenant Commander Gao, an intensivist, lends a hand in the Five-Foot-Two Crew’s trauma bay, by inserting a femoral line into a conscious casualty.

  Like I said, this was still at the beginning of the roto, before the establishment of dedicated trauma teams, and we were still scared. Real scared. Which was good, because it kept us on our toes. I always said I would stop doing ER stuff the day I stopped being scared.

  But there’s scared, and then there’s scared. So, just then, when the front gate called to ask us if we would take a boy with “a cut on his leg,” I was annoyed and told them to send the boy to town at the civilian hospital. Then I put him out of my mind.

  Another lesson learned: those guys at the gate, they were Slovaks, and they didn’t really speak English, even if they did sound like Peter Statsny. Oh, they knew most of the words, but they just didn’t nuance them the way they should. And it’s a good thing they didn’t listen to me. That kid had just stepped on a mine and gotten both of his legs blown off. Technically, he did have a cut on his leg, but he would never have made it to town alive.

  When you’ve worked in the ER long enough, your eyes take in the essential stuff at one glance. So when that Afghan Army soldier carried that boy in, I thought he was dead. What with his head hanging back, just swaying at each of the soldier’s steps, with his legs blown off, no tourniquet on, and leaving no blood trail, I knew it was baaaad. His face was ashen grey, and his rolled-back eyes were only half closed, the visible part caked dry in the hot sun. His mouth was open, exposing his teeth, which were covered with dust. As far as I was concerned, he was dead. D, Y, A, D, dyad. But when he spoke, it was a hint that all life hadn’t been extinguished. That’s what we try to teach our interns: if your patient is talking to you, it doesn’t matter what the monitor says, you don’t zap him with a gazillion volts of Hydro-Québec.

  “Water,” the boy asked. “I’m terribly thirsty.”

  This was one of those Oh shit moments. Still, everything just fell into place. The team that had handled the head trauma was still there. Captain B just happened to walk by. “Put two tourniquets on,” he ordered. For a fraction of a second, that struck me as weird, since he wasn’t bleeding at all, which goes to show you that even the most experienced of us can do the deer-caught-in-the headlights thing for a second or two if we’re surprised.

  Anyway, one leg was pretty much mush from the knee down. It was just dirty, gnarled, dusty, flopping meat with sand and pieces of bone mixed in, until where the ankle should have been. Then there was nothing. The other leg was a mess; foot gone and, above where it should have been, a bare tibia with nothing left on it. What struck me later, when he started to wake up, was that he would bang that bare amputated tibia on the table like a peg leg as he thrashed about. That must have hurt like a
ll hell.

  Okay, so let’s go. We knew we’d hesitated, but to the onlookers, even those with trained eyes, it just appeared smooth and well-rehearsed. I guess we were getting better.

  It was just a case of getting some fluid and some blood in. But with the profound shock that he had suffered, veins were going to be hard to find. So I decided to step in. Later in the roto, the teams could have handled that with their eyes closed; but this was still early — a central line on a shocky kid was something new to them. So, as they were cutting away the shreds of his Transformers T-shirt, I asked Glenn Stryker to give me a pediatric central line kit and proceeded to put in a subclavian, which I estimated I put in in record time. But I was surprised when I looked up and saw Phil had put an intra-osseous line in the kid’s left humerus and Captain B had put in a femoral line. We all finished at the same time and announced our triumphs, then looked at one another, surprised as heck that the others had also succeeded. We really were getting better at this. Well, blood started pouring in, and the kid started to wake up, and we sent him on to the OR. Elapsed time: nothing at all.

  Christine tells me that at this point people will want to know what happened to the kid afterward. You should always listen to nurses. Especially those who, like Christine, know how to write. So I’ll digress.

  The boy had been selling juice outside the airfield’s gate. When it gets to fifty-five or sixty degrees in the sun … (That’s a hundred and thirty to a hundred and forty for you Americans, and yes, your boys do go out to fight in those conditions. Hey, if we Canadians can do it, so can they. Like Stephen says, and he’s American, “Suck it up, buttacup.” Now I’ve digressed from my digression. Have I mentioned that I don’t think in straight lines?)

  Outside the gate of the airfield, transport trucks lined up by the dozen, waiting to bring in all the stuff that the thousands and thousands of military inside needed. (I’m not allowed to tell you how many thousands, but any number would probably have been out of date the minute I wrote it, what with President Obama’s surge and all.) These trucks were all gaily painted (if I was cynical I’d say the paint holds the rust together) with pictures of forests, and streams, and snow-capped mountains, which is kind of cool when you haven’t seen the colour green in months. More than once I saw soldiers standing out in the sun beside one of those parked trucks, wistfully staring at the crude, child-like paintings.

  Between the pictures are sentences written in Arabic that are supposed to bring holy thoughts to your mind. At least, so they said, but I couldn’t read Arabic and most of those truckers couldn’t read, period. (No wonder you can make some of them believe that they’ll be getting seventy-two virgins in heaven if they blow themselves up along with their truck and kill a bunch of infidels like me. Luckily, such guys are rare. All the Muslims I know don’t believe that kind of crap.)

  A big old semi is a nice place to hide a bomb. Some dissatisfied ex-soldier proved that in Oklahoma City a few years back. And before you say “Don’t give the Taliban ideas about blowing up a truck inside KAF,” trust me, they’ve already figured that one out. These people are illiterate, not stupid. As a matter of fact, they had already tried it a few weeks before. We had felt the boom with our feet almost before we heard it when the guy, seeing that he was about to be found out, pulled his switch in a bus just outside the gate. Not counting the dozen dead bystanders, there had only been a few wounded, which KRMH, the ANA hospital, and we had handled easily. C’est comme ça.

  So it is that, at any hour of the day, there was a long line of trucks waiting to be inspected before entering KAF. One thing those trucks have in common, besides their garish paint jobs, is that they have no air conditioning. The Afghans buy them off the Indians, the Pakistanis, the Tadjiks, the Uzbeks, or the Iranians after they have been declared unsalvageable by their owners. Then they patch them up enough to haul those heavy loads across the mountains. (Come to think of it, maybe they’re not so ignorant either.)

  A smart and enterprising eleven-year-old whose father is too crippled to work can feed the whole family by selling diluted fruit juice to those thirsty truckers. He just buys some cans of juice that come over the border from Pakistan and dilutes the stuff one to three or one to four with the purest water he can find. (Did I tell you those people are immune to almost all germs? Heck, I almost died after eating Afghan food that sure looked clean to me — yeah, probably washed with water from a river downstream from ... well, you get it: you’re always downstream from somebody.)

  Well, that boy was making a killing, maybe even as much as $2 a day. The front gate was his territory, and he knew every inch of it. At least, he thought he did. He knew where every one of those old Russian mines had been laid thirty years before. Every one except the one that got him. When it blew up, it threw him quite a few feet, but he stayed conscious. So when the soldiers rushed to his aid, he stopped them from running blindly in and guided them through the mine field while he was lying there, losing his blood. Like I said, some smart kid.

  He didn’t stay long in the OR. Sonya, the U.S. Navy orthopaedist who took care of him, said there wasn’t anything salvageable in his legs. Even his knees were done with, which is sad, because it’s a lot easier to relearn how to walk when you keep your knees. In our roto, most soldiers who stepped on a mine and survived ended up keeping their knees. But then, most soldiers are taller than an eleven-year-old, especially an Afghan eleven-year-old.

  The kid — I never did learn his name; I guess it hurts less that way — eventually woke up and started smiling right away. Not one of those sad or hurt or brave smiles you would expect a child to have after losing his legs. None of that for him. After all, he was born in a country that has no place for the weak. Or maybe he knew that without his legs he was going to have to rely on his wits to feed his family. So, right away, it was one of those show-all-your-teeth-and-smile-with-your-heart hundred-million-dollar grins. The nursing staff was all over him. The girls hugged him and showered him with gifts. The guys, with Jimmy in the lead, traded insults with him: Jimmy in Québécois, and the kid in Pashtun. Occasionally, I would translate:

  “Hey Jimmy, he says the Montreal Canadiens suck.”

  “Oh yeah? Tell him the Kandahar Nordiques are a bunch of wimps.”

  “There are no Nordiques in Kandahar, Jimmy. They are in Denver.”

  “Denver, Kandahar, what difference does it make? The Nordiques fled to the mountains because they were tired of being whipped by the Canadiens.”

  “The kid says to go f--k yourself, Jimmy.”

  But that was a weak argument, and Jimmy knew it as he high-fived the boy. Delicately, because the little fellow was hurting all over, as the girls found out when they first hugged him. Besides, only his left hand was serviceable. He hadn’t lost his right hand; I remember checking it out before he went to the OR. Sonya said that all the pieces were in the right place and it could be saved, but he would have quite a few weeks of suffering before it was serviceable again. Now, that can be a problem, because some of these Afghan kids, when a body part started to hurt, they wouldn’t move it, and the whole thing would seize up. Before long, you’d have retracted scars that you would have to operate on before you could try to move that limb. But this kid had a winner’s attitude, so he would be exercising the hand like Sonya told him, to keep it from stiffening. Anyway, that was in the future. For now, he was just grinning all the time. Glad to be alive, I guess.

  He did open up once to Brigitte. It was after his father started showing up to see him. Starting on day three, the gnarled old man would arrive at eight precisely. He was a humble, quiet old guy, with a grey beard and kind eyes in his crinkled face. He was always dressed the same way, in long robes with one of those thick scarves wrapped around the top of his head. His clothes were always impeccably clean. I guess you can buy a lot of soap in that country with two bucks a day. The old guy (he looked about seventy, which means he was probably forty-two) clipped along at a good half-mile an hour. Every step looked so painfully dif
ficult that I figured he must get up at two every morning just to get there by eight. In Afghanistan, if you wanted to go somewhere, you walked. The public transport system wasn’t so good. As a matter of fact, I think the southern Afghans weren’t quite there even yet.

  Every morning, the father would bring with him a smaller carbon copy of his injured son. A replica right down to the grin. If it hadn’t been for the legs, it would have been easy to mistake one for the other. So when the kid opened up to Brigitte, she had a ready-made answer.

  “How am I going to feed my family, now that I have no legs?”

  “You can teach your brother your job!”

  Brigitte is like that, a no-nonsense, practical, today-is-today and tomorrow-is-tomorrow kind of girl. The kid didn’t answer back, but his eyes got that faraway look people get when they’re trying to see the future across the hell of today.

  He did well in the hospital. Extremely well. No infection. No blast lung. No concussion. As a matter of fact, he remembered everything that had happened to him that day, including the delay in the guard house while they phoned me. Sorry, kid. That one’s on me. And on the Slovaks’ English teacher.

  A few days later, Sonya washed his stumps and closed them. She fixed up his right hand pretty good, too. Then it was St-Jean-Baptiste Day, the holy day for French Canadians, and the girls decked him out with fleur-de-lys balloons that they twisted into a ridiculous oversized hat, which the kid wore to our party with his million-dollar grin.

  The staff would come in on their days off — yeah, Dan, the six-foot-four head of nursing, made sure that his crew got days off so that we wouldn’t burn them out. He later told me that was his goal for the roto: not to burn out his people. He knew we were going to get hammered and he wanted to protect his nurses and med techs from exhaustion. My goal was even simpler: not to eff up. As in the ER physician’s prayer: Please, God, don’t let me eff up. Funny, how both of us had such negative goals and low expectations, yet came out of it with the biggest success the Canadian Forces’ Health Services System has had since the Korean War, or maybe even since the Second World War. I should get a promotion to general. Anyway, throughout the roto, Dan and I would argue over the amount of rest the staff needed. He always won. I know the army’s not a democracy and I could have ordered them to do whatever I needed them to do, but believe me, having a nurses’ revolt is the last thing the OC of a hospital wants.