I received this via the API List. I did a bit of checking (being rather suspicious of e-mails purporting to come from the combat zone), and it looks like the author and names he mentions are the real deal. Very moving, and worth thinking about (and giving thanks for) this Christmas.
Subject: From Scott D. Barnes, Medical Corps
Letter From A Battlefield Hospital, Scott D. Barnes, LTC, MC, USA
Date: Tuesday, 13 December, 2005 17:42
To All, 08 DEC 2005
Well, as promised, with this letter I have kept my commitment to do better
in keeping you informed of what I was doing over here in Iraq. Since I had
only sent one letter previously, with this update I have doubled my
correspondence. Again, if there is anyone else you think would want to get
a copy of this letter, please feel free to pass it along.
I had every intention of trying to get this out just around Thanksgiving
but very soon after that holiday, things seemed to pick up at work and I
have just been trying to keep pace with the influx.
November has been an interesting month. Certainly not as busy as October
but patients would come more in waves than a steady stream. During the
month of October, the 86th Combat Support Hospital (CSH) was the 3rd
busiest trauma center in the world! You read that correctly, only the
trauma centers in Miami and Los Angeles did more work that we did. Just
think of all the trauma hospitals in New York, Chicago, Baltimore, Dallas,
Philadelphia, Washington DC, and those in Europe, Asia, and Central/South
America, most of which have 5-10 times the number of staff which we have
here. It's amazing what you can get done when you eliminate the burdensome
task of JCAHO (hospital regulating organization) and the exponentially
expanding administrative tasks that have grown like Kudzu (weed that has
overtaken much of the highways in the southeaster US) as they choke off
efficient patient care. That and the fact that if you work 24 hours a day
and live in the hospital while being locked down to about two square
blocks seem to help us see more patients.
This is medical and surgical care practiced the way that many doctors
dream. You see problems, diagnose the condition, quickly plan the
operation, and you just do it. Patients don't wait, doctors don't wait, OR
staff doesn't wait.it is amazing! We all love it and if it weren't for
missing our families or dealing with the occasional rocket and mortar
attack, most of us would not want to leave.
I have had the privilege of being adopted by the neuro team. We have world
class care here. COL Ecklund is the chief of the neurosurgery program at
Walter Reed, COL Ling is the only neuro-intensivist in the entire
department of defense (he actually works at Johns Hopkins neurosurgical
ICU teaching most of the military's critical care and neurology residents
as they rotate through), and COL Mork is the anesthesiologist dedicated to
the neurosurgical cases. As a number of head injuries involve eye
injuries, it is a somewhat natural pairing. This has afforded me an
incredible opportunity to be involved in quite a number of neurosurgical
cases. COL Ecklund has shown me how to drill some burr holes in the skull
and screw on plates to hold the bones after the case as well as closing up
the scalp incisions over the craniotomy at the conclusion of the case. I
can operate on the eyeball and use suture much finer than human hair,
but to be a surgical assist to such a master as COL Ecklund has been
inspiring. These soldiers, civilians, and even prisoners have no idea how
fortunate they are to have such skilled hands at work in their case.
The integration of the whole team approach is one of the greatest factors
in setting this experience apart. Within minutes of a patient hitting the
doors of the emergency room you have a general surgeon, neurosurgeon,
oral-maxillo-facial surgeon, urologist, orthopedic surgeon, and an eye
surgeon all examining and conferring on the way to best care for a
patient. The nursing staff, the OR staff, the radiology
techs--everything. It all just appears. Sort of like magic. A couple of
doctors get called, word starts to get out and the machine starts working.
The medics start drawing blood, the radiology techs arrive and start
shooting pictures, the administrative personnel (yes we do have some!)
start preparing the necessary paperwork, the anesthesia providers coming
around like all of the other doctors, blood products from the blood bank
starts to appear, and often the chaplain arrives. It really is beautiful
to watch if you have a chance to sit back and really see what is going on.
Too often we don't see it because we are knees deep into the moment. We
need to be reminded by those outside. Last month, the commander of one of
the MP brigades asked to have a service for the OR/ER personnel that have
meant so much to this unit over the duration of their deployment. This
unit had been hit so hard week after week. Almost 40% of their members
have been impacted by injuries. They had been such frequent fliers that we
have become brothers in this struggle; the unit commander and sergeant
major often join us in the operating room as we work on their men. This
closeness and unity of purpose is not commonly seen between the medical
corps (docs and the like) and the line units (real soldiers), but in this
setting we are brothers. These line units no longer see us as detached,
primadonnas who sit in a luxury white hospital while they train in the mud
and dirt. They see us in our environment and see the same faces when they
come in on Monday morning as when they come in at midnight on Tuesday and
again on Thursday night. They ask if we ever get any sleep and how we can
keep going. My answer is always the same, "Sergeant, when you are on combat
operations, when was the last time you slept and how do you keep going?"
When the unit Sergeant Major told me that they do it because they don't
want to let down their buddy next to them because he is depending on that
help and they do it because they know that if they get hurt, they feel
sure that the medical machine will not let them down. I told him our
answer was similar for how we can operate the way we do. I don't want to
let down my neurosurgeon or my general surgeon who depend on me for
helping with the eyes (a lot of the neurologic function in an unconscious
patient comes from the eye exam and in a severely traumatized eye that can
be difficult to asses even for an eye surgeon) and I don't want to let
down that soldier who puts his life on the line in part because he put his
faith in our ability to put him together if he gets broken.
We work two sides of the same street but when we meet it is under the most
difficult circumstances. When those young MPs roll in after having been
torn up by IEDs (improvised explosive devices) and their lives are in the
balance the family pulls together. The unit leaders come into the OR and
the jobs are less defined.you just look for something that needs to be
done and you do it. One young sergeant was badly broken and rushed to the
OR. The IED had done its intended job and shredded this courageous
American everywhere that wasn't covered by body armor. He was dying, but
we weren't going to let him go without a fight. He had no immediate eye
injury, so I just went to work getting the blood and hanging it on the
infusers since those that usually do this were otherwise occupied. We kept
pouring unit after unit into him but he was loosing it as quickly as we
were able to get it in. The trauma surgeon and the vascular surgeon
cracked his chest and started going after his injuries to try to stop the
hemorrhaging. His heart stopped a number of times. The trauma surgeon held
his heart and kept squeezing to aid in circulation while the
anesthesiologists were infusing the medications needed to restart the
heart. The two unit commanders were right there voicing their support and
praying as they were watching the team. Two major injuries were found in
the carotid and subclavian artery but too much damage had been done too
much blood had been lost, and too much time had passed before his injuries
could be repaired. We went through 45 units of blood. His heart stopped 7
times and we were able to restart it 6 times. When it became clear that we
would not win this battle and that this young sergeant had gone into that
good night, we turned off the machines and monitors, the chaplain stepped
forward, and the unit commanders, nurses and doctors closed into a circle
and we asked for the Lord's mercy on his soul and for God's peace with the
family that will soon find out what we already know. This hero paid the
ultimate price while doing his country's bidding.
I walked out onto the hospital roof which has been my refuge after such
cases. I usually stay closer to some cover because I don't want to give
snipers any target practice but this time I went over to hang over the
rail looking down into the parking lot/patient receiving area. This is
where the men usually gather to wait for news on what happened to their
buddies (we don't have a waiting room). I will never forget what I saw
there for the strength of the emotion but also because I have seen it now
too many times. About 30 soldiers hanging out in various groups, some
talking, some joking, some smoking, some tossing a football, some catching
a few winks, but just doing what waiting soldiers do. LTC T (their
commander) walked out to the group who immediately jumped up and gathered
around the boss. I couldn't hear what was said from the roof, but I knew
that commander had a difficult message to deliver. I didn't have to hear
the words, these warriors' actions said it all. Some just there motionless,
some grabbed their buddies and just let the tears run down their
dirt-stained faces, others unable to contain their anger, went to find a
wall and began hitting it. The commander and sergeant major moved through
their guys, reaching out to each one with a hug or supportive arm.
Sometimes I can put all the damage and suffering behind me; my years in
medicine have introduced me to death and in some ways I can detach myself.
But to see this effect on his brothers in arms, transformed my previously
detached self and turned on my humanity. In the ER and the OR, I can be
the professional doctor--but on the roof, I become a human again. Under the
cover of darkness I feel the pain of what I've seen.
Once the sergeant's body was prepared, his fellow soldiers came through
and paid their last respects. This will always be the hardest part of my
time here--to see these rough men break down at the sight of their fallen
comrade. These leaders and subordinates file past their brother, touching
him and paying their respects, shedding their tears, hugging their
surviving brothers, then in a most amazing display of professionalism, they
wipe their tears, put on their gear, and walk out of the hospital back to
their unit and start their patrols all over again.
So the Sergeant Major asks how can we go without sleep and how can we
operate for hours at a time. After seeing the heart of his soldiers,
how can we not?
Under His Omnipotence,
Scott
Scott D. Barnes
LTC, MC, USA
Theater Ophthalmology Consultant
10th Combat Support Hospital, Baghdad
Freedom Is Not Free
