Life and ... in the ER

Hello everyone!

 

This week I’ve had some busy shifts in the ER so I’m a bit late on my weekly update.  As my social life is not changing much I’ll tell everyone about my work.  I work 10pm-7am as the only doctor in the ER.  I’ve got one nurse and several technicians that work with me.  We see quite a variety of patients here, both medical and trauma.  I’ve seen patients with heart attack (60 year old American citizen in Afghanistan to visit family), kidney stones, drug overdose, vomitting and diarrhea  (a lot of these), newly diagnosed pregnancy (yep, even here) and a few other medical type problems.  I’ve seen minor traumas such as lacerations from the razor wire fences here, ankle sprains from walking on the rocks that are everywhere, and sports injuries.

 

We get a variety of serious trauma patients such as IED (improvised explosive device) blasts, rocket propelled grenade injuries, land mine injuries, rolled Humvee injuries, gunshot wounds, and what I call red-neck injuries which are usually military members that squirt flammable fuel on an already lit barbecue or bonfire and the flame flashes back on them.  Often when the serious traumas come in there are several injured guys that are flown in together from a FOB (forward operating base) somewhere in Afghanistan.  We overhead a call and page a “trauma” and I usually have several surgeons that come, orthopedic surgeons, ICU doctor, nurses and technicians.  So we usually have plenty of help unless there are more than 3-4 very sick patients at a time…then it’s a bit crazy.  I usually take the sickest patient and run the show with him and the other docs will manage the other patients.  Often times the patient has already had some kind of surgery done at the FOB and are already on ventilators.  If the trauma happens closer to the base then they come in “fresh” and we start from scratch.  We stabilize them, make sure no injuries are missed and decide what further testing (X rays and CT scans) are needed and where to send them from the ER (Ct scanner, Operating room or ICU.)

 

For the wounded American soldiers, they are usually only kept her about 24 hrs then are flown to Landstuhl, Germany where they are further stabilized and assessed; then they are sent Andrews AFB, Maryland(what a coincidence…) where they are either transferred to Walter Reed or Bethesda hospital or sent back to a military hospital by their hometown.  We also treat soldiers from the other coalitions forces (Polish, French, etc.) and they eventually go back to their own countries.  We also treat Afghani National Army soldiers, Afghani police officers, Afghani civilians (both adult and child) and “Enemies of Peace”—previously called Insurgents or Enemy Combatants.  We can also see both Afghani and American civilian contractors that work on base and Afghani prisoners from the jail that is on base.

 

I’ve had a couple of guys come in with their legs blown off, fingers missing, one guy with his genitals gone (from a rocket), multiple  guys with severe chest, head and abdominal injuries, bad burns; all of these injuries I had expected and as awful as they are, they aren’t as upsetting as some of the unexpected things I’ve encountered.  We’ve had 2 suicides, 1 intentional drug overdose where the guy died, 1 suspicious drug overdose where the guy died, a dead premature baby found on base that I had to pronounce dead (and I later had the “pleasure” of treating the mother that dumped the baby), sexual assault cases.  Two nights ago I had a 20 year old guy that had a cardiac arrest in his room (drug/alcohol related), I was able to resuscitate him only to have him declared brain dead yesterday.  Most of the soldiers that die of combatant injuries are dead before they get to us…we had 5 last week, 3 the week before.  Every time someone dies they have a “fallen comrade ceremony” where they bring the flag-draped casket down the main street of base on the way to an airplane that them “home.”  The street is lined with hundreds of military in uniform saluting as the casket passes.  It’s very touching…and depressing.  On a lighter, note if you make it to us alive you 95-99% chance (depends on the stats that month) of surviving to make it back to the states!  I’m working with a good bunch of docs and medics here…it’s amazing how the consultants don’t mind coming in to help out when then their commute is only 3 minutes from their room and they have nothing else to do (no family outings, no golf, no cruising on the boat).  So that’s pretty much my work, day after day…at least it’s not boring, that’s for sure.  I look forward to the fairly slow nights (like last night) where I can email and buy something for my kids online.

 

As always, thanks for everyone’s well wishes.  I’ll keep the emails coming until you tell me to stop!

 

 

Mother's Milk

Fri 7/10/09 9:55 PM

Hey Everyone, 
Looks like your prayer and cold well-wishes helped!  After 3 1/2 days the milk arrived home mostly in good shape.  I was quite anxious as it got stuck in the UK for 1 1/2 days and my calls to DHL did not give me any answers.  I didn't know if the cooler was kept in a cool place or not.  The milk traveled from Bagram to Bahrain, then London, then East Midlands, UK then to Ohio, then Maryland then D.C.  It was taken by courier from D.C.  to the house. 
  
I sent 50 6 ounce bags, about 1/2 arrived at least half frozen and were put in the freezer; the other half was mostly thawed but still very cold and was put in the fridge.  Only 1 bag leaked.  The plan is to get L. to drink as much of the fridge milk as possible over the next few days.  Hopefully, she'll be able to use about 80-90% of what I sent.  Next time I think I'll arrange the bags a bit differently in the cooler and I've ordered some reusable "like dry ice" heavy duty ice packs to add as well.  This should help with the next shipment.  I'm also sure that if it hadn't sat for a day and a half in the UK many more bags would have arrived frozen.  But for a first attempt, not bad.  This shipment should get her 2-3 weeks closer to that 1 year goal.  Another 2 good shipments and we should make it.  I'm very relieved as I had feared that it would all arive thawed and unusable.  Breastfeeding your baby from a combat zone over 6000 miles away...who would've thought it possible?  Miracles do happen! 
  
So preparing for, worrying about, and tracking this shipment has pretty much been my week.  I'm almost at 8 weeks now.  I've attached my "Wheel of Despair" which I use to track my time here.  I hope you're all doing well, and thanks again for all of your well wishes. 
  

Hey all you Ladies and Moms, 
I need a bunch of prayers coming my way to help me with the final stretch of something I've been trying to do since I left.  I was so upset about leaving both of the girls but especially L...knowing that I would miss so many milestones.  I was also very upset that I would have to stop breastfeeding much earlier than I wanted to and 4 months earlier than the recomended "at least a year" that the American Academy of Pediatrics recommends to help boost immunity and to decrease the chances of many childhood and adult diseases like obesity, diabetes, allergies/asthma, and various cancers.  So in my grieving of all that I would be missing out on with L I sort of grabbed ahold of the breastfeeding and thought that if I could somehow continue to get her breastmilk until at least a year I could put myself back in control and remove one thing from the growing list of "what L and I would be missing".  So I became determined (maybe obsessed is a better way to word it) to see if there was any way for L to keep breastfeeding until a year (don't worry, I'm not looking for wet nurses!)  I was able to pump and freeze enough extra milk throughout her early infancy to last the first two months that I was gone, and I've continued pumping and freezing since I left.  It's been very hard, logistically, as I had to "pump and dump" for the 5 days until I got here, and I've had to figure out where to stash the frozen milk, wash the pump parts, etc.  My supply has dwindled quite a bit, but over the past 7 weeks I pumped and froze 60 6ounce bags which will get us 1 month closer to that 1 year goal if I can just get it to the states.  There is a DHL here on base that said they'll "try" to keep it in a cool part of the plane and it should make it to Maryland in 2-3 days.  So, yesterday the cooler that I ordered finally arrived and I modified it a bit with some added styrofoam to the lid and bubble wrap around the inside.  I packed up my milk this morning and jogged (carrying a 30 pound cooler) 1/2 a mile to the DHL and got a shoulder shrug when I asked if they thought it would arrive frozen.  We have no dry ice or anything here so I'm just praying that all of the frozen bags packed together will keep each other mostly frozen.  I just need all of you to send ice cold thoughts my way in hopes that this milk will get to L still frozen.  It's probably a silly thing to cling to but despite the hassle that pumping/washing/freezing brings it has made me continue to feel like a mom and if this crazy plan works out I can at least let go of some of the guilt that I am carrying about being away from such a young baby.  And if it doesn't work out, I'll at least know that I did absolutely everything that I could to make it work, it's out of my hands now.  It's funny because I didn't realize how huge of a deal it was to me as I got into the routine of pumping/washing, etc. until I actually handed the cooler over to the guy that looked at me like I was crazy...."you're sending what?!"  I am now all wound up worrying about this liquid gold that I've spent 7 weeks laboring over.  So please keep my shipment in your thoughts/prayers and in a few days you'll get an update.  I tell you what, being a mother is much harder than any other job that I've ever, or ever will have! 
  
Thanks for listening girls, 

Hey Everyone!

I passed the 1/3 of the way done mark, two months down!  Sometimes it feels like it's good progress, other times I don't know how I'll make it another 4 months...my whole time here twice more.  One day seems to merge into the next.  Still the same old stuff, day after day.  Work has been okay, really busy one night then not bad at all the next.  It's nice to be busy sometimes as the time passes so quickly; however, it's nice to be slow because I can catch up on emails and most importantly slow means no one's getting hurt! 

 

We've had a lot of pediatric patients the last few weeks.  Most of them are doing well, I take them little toys and coloring books which they seem to like.  We have a 3 year old little girl in the ICU that is just a bit smaller than my daughter...that's kind of hard.  We had a 12 year old girl die of her injuries a few days ago and they wanted a female physician to help prepare her body to give back to the family.  I spent over an hour getting her into a better shape and cleaning her up so that her father could take her home to bury.  That was pretty awful...it reminded me that my job is not always done when the patients heart stops.  I was just greatful that she was not the same age as one of my girls, otherwise I don't know that I could've handled it.  Last week I had a 12 year old boy that came in severly injured by shrapnel and he looked just terrified.  I had the translator tell him that he would go to the operating room and that we would take care of him and he'd be just fine, I then talked to him softly and stroked his head while we gave him medication to put him to sleep, then I intubated him.  As we rushed him to the OR I held my hands over his abdomen as he was pouring out blood, when we got into the OR and the surgeons opened him up they saw the extent of his injuries and one said, "this may not be a survivable injury".  He was in a really rough shape for a few days and I was worried that the last words that he heard (that he'd be fine) may not come true.  But thank God, he did well, is no longer on life support and I saw him up and walking in the hall yesterday.  On the other hand, we had a 25 year old healthy troop die from pneumonia last week.  It's really strange here...people die from things that they shouldn't and others survive injuries that seem unsurvivable.  It all goes to show you that when it is your time, it's your time.  When it isn't, it just isn't.  It sounds so obvious but I see it played out over and over.

 

Everyone back home is doing okay.  The girls are doing fine and M. is talking to me on the computer longer and longer each time.  Sometimes her and I talk for 30 minutes straight which is a really long time to hold a 3 year old's attention.  She really seems to miss me and I think it helps that we talk almost every night.  She went to work with A. on Friday and they had lunch together, she really loved the individual attention.  L. still screams and gets excited when she hears my voice or sees me on skype.  Her and M. are playing together more, they chase each other around the house and she wants to copy everything that M. does.  She even wants to drink most of her milk from a regular plastic cup as that's what she sees M. doing.  She only takes a bottle at night!  Who knows, maybe M. can potty train her in a year!  A. is doing well and my Mom is continuing to do just fine.  So we all are continuing on cruise control for now. 

 

I hope you are all well, Miss you!