Fighting for Life

Yesterday was a rough day at Craig Joint Theater Hospital in Bagram. Just after lunch, we were barraged with 6 trauma patients, 2 of which were critically injured and went to the operating room immediately. (Their injuries ranged from a severe pelvic fracture with broken bones in both feet to a simple head laceration; I orchestrated the resuscitation on a mid-level patient, one with a spinal fracture.) Before we could even get all the patients out of the ER and onto the ward, there was a 2-soldier trauma and another 4-soldier trauma. All but 1 of the 12 trauma patients were Americans. Thankfully, all of the soldiers survived the night, and all of them that require transport will be in Germany by tomorrow.

The pace at the hospital has been picking up, which is to be expected during the summer months here in Afghanistan. Last year, there were around 240 surgeries in the month of April, 280 in May, and 300 in June. (That's a whopping 10 surgeries per day!) I would anticipate that with the new troop surge, we might even surpass these numbers in the summer of 2009.

In thinking of yesterday's trauma patients, I remembered a documentary which was screened for USUHS students and faculty in the spring of 2007. It's title is "Fighting for Life", and James and I went to the screening and the reception that followed. We both agreed that the film was superb, and I will even admit to shedding a tear or two. It tells the stories of doctors, nurses, and patients at the combat support hospital in Balad, Iraq, and in the case of the patients, follows their stories to Germany and to the United States as they are treated for their wounds.

When I initially saw the film, I never imagined that I would be one of the physicians caring for these wounded troops. I'm not sure why - I was a 2nd year resident at the time, and it should have been obvious that I would be deployed in the next few years. But I guess I was so emotionally caught up in the film that I didn't see myself in that role.

I would recommend the film to anyone interested in the life of a physician in a war zone, anyone interested in military medicine or medicine in general, or anyone supporting a soldier, sailor, airman, or marine in the current world conflicts in Iraq and Afghanistan. It is truly enlightening.

The documentary has been available in limited release in movie theaters around the country, but next weekend, for the first time it will be broadcast on national television. For most, it will be on PBS between May 23 and May 26th. (In southern California, it will be on channel 28 [PBS] on Saturday, 5/23, at 10PM; in Phoenix, it will run on Sunday, 5/24, at 10:30PM.) It will also be available after the TV broadcast for purchase on VHS and DVD.

Find out more about the movie and find your local listings here.

These are some snapshots from the film:

The power of family

I have always known that family was important. But I didn't know that here in Afghanistan, family is not just important, but it is crucial for the survival of children in the hospital. Not that our nurses and doctors are incapable of taking care of children; it's just that kids heal so much better when their families are present.

The 5 year old little girl with the penetrating head trauma has been in the hospital for several weeks now, and she has been getting feedings through a tube inserted into her nose. We have been trying endlessly to get her to take feeds by mouth, offering everything from applesauce to yogurt to milkshakes. Not only would she take nothing, but she would spit out the semi-solid food in disgust. She would not sip from a straw, and the only way we could get her to take any liquid was by squirting it into her mouth using a syringe. In her case, there are three reasons why she might not be eating:

(1) she's not hungry - this seems possible given that she's getting tube feeds and therefore her stomach is rarely empty

(2) she cannot eat - this doesn't seem likely given the location of her injury and the fact that she is able to swallow her own secretions

(3) she doesn't like the food - always a concern with these Afghan children; their diet is very different from the "typical" American diet we offer them in the hospital

We tried to "fix" problems #1 and #3 as best we could by offering her a wide variety of foods and slowing down her tube feeds to attempt to artifically create some hunger. But all of our efforts were to no avail; she still would only take a few ounces of liquid per day, nowhere near as much as she would need to in order to maintain her hydration and nutrition. A few days ago, it seemed that we had met an impasse.

Meanwhile, a few days ago, her uncle (who had been her guardian since a few days after the injury) needed to return home to take care of some personal matters. She was far less happy during his absence, and did not want to interact as much with the nurses. She no longer spoke or played. However, everything turned around once her uncle returned last night.

When he walked onto the ward and saw her sitting up in a chair (almost) by herself, he literally started crying. She had made a ton of progress in her rehabilitation since he last saw her. She was returned to her bed with her uncle at her side, and a few hours later the nurse went to check on her. Would you believe that there was an empty box of juice on her tray? When questioned, the uncle stated that she took the entire box - and she drank it by the straw! She was provided with a nutritional shake and a half banana, and with some help from her uncle, she took those too! Amazing.

This morning when I saw her, she was eating yogurt from a spoon. It was quite a happy sight, with her opening her mouth for more food and her uncle shoveling the yogurt in. (The trauma surgeon said that it reminded him of a little bird opening its mouth for food.) She will be transferred to a Red Cross rehab hospital today, and will follow up as an outpatient next week in order to track her weight, blood protein level, neurologic status, etc.

Thank goodness for happy endings!