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!