Outside the Wire 22-23April

I posted on facebook awile ago that I would write about my experience outside the wire. I have been motivated, but not inspired to write. My muse is still slightly elusive, but I'm going to try for the sake of productivity on my night off.

Our Ambulance mission got a call that said a gunshot wound patient was at the gate. N got geared up and rolled out. It appears that an Iraq SF soldier was shot in the head, he'd been taken to the Iraqi hosptial, and when his buddies were told they could not do anything for him, they took him out of the hosptial and drove him to us to seek further help. Our Trauma Team was in the EMT when the patient arrived. K and I were in the unit preparing our ICU bed. N came in covered in blood and full of adrenaline. He told us that the patient was breathing on his own, bleeding all over, and had solid signs of life. Our surgeouns were prepared to take this patient to the OR for a craniotomy. When the Neurosurgeon in Balad saw the CT scan, he said "no". What makes this man a man is gone, the bullet had destroyed his higher brain function, his brain was swelling, and all we could do was make him comfortable.

He came to me and K sedated, intubated, and ventilated. His head was wrapped in a pressure dressing. He had a femoral triple lumen, a cordis, and an arterial line. He had a foley that was POURING urine. He'd been given 8 units of blood and FFP's through a rapid infuser in the EMT. His heart rate was in the 80's and his BP was in the 130's/90's. Now were were mearly going to watch him die....comfortably?

A translator was with him, he asked if we could turn the patient's bed around so that he could face Mecca. We unplugged everything, turned the bed around, and extended all the cords to set up him. The translator then sat at the head of the bed with the Holy Qur'an and read him his last rights in Arabic.

The patients initial assessment revealed rhonchorus lungs, fixed and dilated pupils bilaterally. Warm extremities, and Normal sinus rhythm. He was unresponsive to pain. He had no gag no cough reflex.

As the night went on, his face swelled from a shattered orbital rim. His right eye no longer opened. The skin became increasingly bruised and shiny. His ventialated breaths never gave way to any spontaneous breaths. His body was putting out liters of fluid an hour. by the end of the night, he'd put out 13 liters of urine. His brain swelling was putting pressure on the gland of the brain that controls telling your body to hold to water, so instead, his body was flushing all fluids out his system. The blood and FFP's created a lot of volume to go through and make urine out of, but the rapid accumulation of the vast quantities of urine is the result of the brain swelling affecting circulating hormones.

If he lived throughout the night, we were going to take him back to TTH at 0830 so that when he did die, they could prepare for his burrial in the proper way. We were told that he had 24 hours to be properly bathed, wrapped, given to his family, and placed in the ground. Any amount of time in our care past his death took away their time to say good-bye. We hoped he'd last the night.

As sad as the futility of it was, it was amazing to watch the body die. Hour by hour was watched his vitals signs fight to compensate his body's failure. His bowel sounds disappeared, his urine by then end was decreasing as his kidneys shut down, his heart rate increased nearly 10 beats every hour as his systolic BP dropped nearly 10 mmHg every hour. What had started as normal vitals became those of a body burning out. When shift change came, his BP was 70's/50's and his heart rate was in the 160's. But he was still alive.

K and I stayed past shift change to transfer him to the care of the Iraqi's. We changed into our ACU's, pulled on our 35 lb vests and helmets, and transfered him on a portable ventilator to the Field Litter Ambulance waiting outside. We both didn't need to go, but neither one of us wasn't going to miss the chance. We had a medic as well as a respiratory tech. The doors of the FLA closed and we began to roll out to Area 51. It was a long, hot, bumpy ride.

We couldn't see anything from the inside of the FLA. It's a big dark military box on wheels that holds 4 litters. But, we could still tell when we got to the gate. Things somehow change. When we turned off the road into the dusty lot that was to be our meeting point our hearts pounded a little harder. Area 51 isn't outside the wire like it would be for combat soldiers, but none of us had been this far from the CSH, except for our Ambulance medics. The doors opened flooding the inside with light before our eyes adjusted to see 30 Iraqi men standing in a huddle waiting for their soldier to be returned to them. There was a mixture of traditional Iraqi dress, suits, and sandals. The ambulance crew were the only ones in jeans and jackets. We removed all the monitors from the patient and breathed for him while we unloaded him from our vehicle and onto theirs. Our doctor felt that he probably would not make it to TTH alive. I don't how how far away TTH is from our meeting point. There is an odd feeling in squeezing an ambu bag for the last time and watching a patient leave your hands. For all we know, that was his last breath.

In the moment between being patient-less and getting back in the vehicle, I felt very vulnerable. The area around was a trash dump, for lack of a better word. The buildings were square, crumbling, and graffitied. Trash was scattered everywhere. There were battered vehicles surrounding us and men standing up in the beds of trucks. I had my weapon slung over the front of my vest, and my hand never left it. Once the patient was gone, I was ready to get back to the CSH as fast as I could.