View Full Version : Trauma, shrapnel and the fight for life

11-28-07, 07:28 AM
Trauma, shrapnel and the fight for life
An unforgettable day at U.S. Air Force hospital in Iraq
Posted: November 28, 2007
1:00 a.m. Eastern

Editor's note: Reporter Matt Sanchez, currently embedding with military units throughout both Iraq and Afghanistan, has been providing WND readers with a glimpse into the Iraq war most Americans have never seen.

By Matt Sanchez

One of the rules for a media embed is that you're not allowed to show the faces of injured people without their consent. I had to keep that in mind while spending time recently at the Air Force hospital in Balad, a level three facility, which makes it the best hospital in the entire Middle East for trauma.

"Any doctor who has spent four months here is probably ready to handle anything," Lt. Col. Christopher Coppola told me. What set the newly completed facility apart from emergency rooms back home was the typical patient and "the severity and multiplicity of wounds," Coppola explained.

A 17-year veteran and graduate from Brown University, Coppola was a trained pediatrician, which came in handy. The medical facilities saw local Iraqis when their injuries were too severe for the Iraqi medical system. In a bed, there was a young Iraqi boy who suffered from third-degree burns. He apparently fell into a bundle of flaming leaves his parents were using as fuel in the kitchen.

The hospital saw every sort of injury, from blast and gunshot wounds to burns and falls. Most of the patients were Iraqis, but that was about to change.

The alarm sent every available person to the receiving hall. Just outside was a helicopter landing zone, where hospital workers awaited all arrivals with a wheelchair and enough manpower to handle whatever came off the birds.

This time it was Americans.

Two of the five men were in the operating room when Coppola asked if we wanted to observe the procedure.

He led me to a locker room where the staff changed. Just a year ago, this facility was operating out of a tent, but now the building looked pretty much like any other hospital, except the staff wore combat boots and occasionally carried firearms.

We changed into scrubs, I washed my hands, put on a surgical mask and entered the operating room. We stood to the side to get out of the way of the dozen or so men and women who were working to keep two severely wounded soldiers alive.

The room temperature was just below 90 degrees, because that was more comforting to the trauma patients.

During my travel throughout Iraq I have seen many injuries, bullet wounds, blast wounds, broken bones. Usually, I've witnessed these things on the ground, where there was plenty of dust, noise and the threat of another attack. But this Air Force facility was a level three hospital in Iraq, a newly built modern facility. Patients sat in the waiting room, nurses had clipboards and the surroundings were antiseptic, clean. There was an air of civilization built on a sense of security. Civilization meant wounds like the ones the young man on the table had were not supposed to happen.

"We have to be very careful, some soldiers have been injured in ways that aren't always apparent when they come in. It's more than a typical car accident, there are the added issues of shrapnel and whatever else can be packed into those things," Coppola said. He had a wry way of explaining procedures, injuries and situations. This was not his first tour in country, but he did want it to be his last.

A "completion amputation" was necessary for a limb that had been partially severed and was beyond repair, in contrast with a "traumatic amputation" which happened during the actual event. Between the two soldiers on the operating tables, there were examples of both.

The violence in Iraq has dipped dramatically, but there is still violence. These soldiers were caught in an improvised explosive device or IED attack, as the effectiveness of the enemy has been reduced to planting homemade explosives and crossing their fingers. Explosions often detonate without harming anyone, but sometimes they are extremely lethal.

The soldier's intestines had been removed and neatly placed on his stomach, and the surgeons where checking his thorax for any internal bleeding. The operating room was well-equipped and immaculate, but blood had spilled all over the floor around the table. I saw a surgeon take a mop and clean up the mess. There was no ego in this type of environment.

A nurse placed bandages on the stump that was his right arm. Every few seconds or so she took the bandage off, wrung the blood and fluids into a bowl and put on a new bandage. It was tempting to just see a heap of flesh on the operating table, but the patient had a face. He was a man, a soldier, a son, maybe a husband and father – an American. Watching the men and women labor to keep him alive and seeing his enormous injuries made any observer feel useless.

The patient's heart stopped and, just like on TV, the doctors used the defibrillator to run a jolt of electricity through the body. Muscles contracted and his limbs involuntarily jerked upward. The heart was beating again.

The soldier had gone into a "v-tac" – ventricular tachycardia – a rapidly increased heart rhythm in one of the ventricles.

The medical staff was focused and professional, the assistants responded to the commands as the surgeons tersely discussed how to continue. There was a feeling of dread, this one was "very sick."

In the operating room across the hall, his buddy was quickly losing blood. A voice came over loudspeaker asking for donors.

Everyone felt it, the dread that time was running out, but the staff kept working. These people were willing not only to tend to the wounded, but to do so with engrossing commitment. They darted in and out of the room, ran big IVs, monitored vital signs.

We all have jobs or ways of making a living. But those men and women in that operating room were doing more than working, more than even saving lives. They were actually guarding hope, fighting to make every possible attempt, sparing no effort, for someone they had never even met.

The heart stopped beating, and the flurry of healers cleared the table as the lead surgeon, once again, resuscitated the patient.

This time, things had changed.

Hemorrhagic shock, low blood pressure, multiple amputation, blood loss, fluid loss – the heart had lost the ability to contract, asystolic arrest.

"Does anyone have any other ideas?" asked a surgeon in a calm, meditative tone.

"OK, I'm going to call it." He looked at a clock on the wall, repeated the time, others confirmed it on their wristwatches. It was over.

A female cried and a co-worker comforted her. Some of the staff left the room immediately, while others stayed a bit longer, maybe not sure what to do.

There's something about the passing of a human life that is so spiritual, so undeniable, so final.

Maj. Cliff Boyd, the chaplain, had been associated with the military for over 25 years. He originally left the service as an enlisted man, but came back after completing a degree in religious studies. He felt called to lead others spiritually, and was ordained as a Baptist minister before coming back to the military and deploying to Iraq.

Maj. Boyd read, as the hospital staff gathered around.

"The Lord is my shepherd; I shall not want.
He maketh me to lie down in green pastures:
he leadeth me beside the still waters.
He restoreth my soul."

The chaplain told me he liked to read Psalm 23 because it said the most with the fewest words.

"Attention," a female lieutenant colonel commanded. Everyone drew upright.

Men and women in their scrubs who looked very much like normal nurses and doctors revealed themselves to be something much more.

All were silent as two soldiers approached the body. They unfurled the American flag. One tucked part of the flag underneath the soldier, while the other folded the other end over.

"Present arms."

The two soldiers took out their comrade-in-arms and the men and women snapped to a salute. We stayed there for a few seconds after the door had closed. He was gone.

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