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About the Author
Col. Brett Wyrick is commander of the 154th Medical Group, Hawaii Air National Guard, and is serving as a surgeon in Balad with the 332nd Expeditionary Medical Group. This column is part of a series of email reports from Iraq that Wyrick has been sending to his father, a Vietnam-era fighter pilot, who in turn distributes them to a circle of friends and acquaintances.
May 30, 2005
By Col. Brett Wyrick, USAF
BALAD, Iraq - The first rule of war is that young men and women die. The second rule of war is that surgeons cannot change the first rule.
We had already done around a dozen surgical cases in the morning and the early afternoon. The entire medical staff had a professional meeting to discuss the business of the hospital and the care and treatment of burns.
It is not boastful or arrogant when I tell you that some of the best surgeons in the world were present -- I have been to many institutions, and I have been all around the world, and at this point in time, with this level of experience, the best in the world are assembled here at Balad.
LTC Dave S., the Trauma Czar and a real American hero is present. He has saved more people out here than anyone can imagine. The cast of characters includes two Air Force Academy graduates, Col (s) Joe W. and Maj. Max L. When you watch ER on television, the guys on the show are trying to be like Max -- cool, methodical and professional. Max never misses anything on a trauma case because he sees everything on a patient and notes it the same way the great NFL running backs see the entire playing field when they are carrying the ball.
Joe is an ENT surgeon who is tenacious, bright, and technically correct every single time -- I mean every single time. The guy has a lower tolerance for variance than NASA. LTC (s) Chris C. was the Surgeon of the Day (SOD), and I was the back-up SOD. Everyone else was there and available -- as I said the best in the world.
As the meeting was breaking up, the call came in. An American soldier had been injured in an IED blast north of here, and he was in a bad way with head trauma. The specifics were fuzzy, but after three months here, what would need to be done was perfectly clear -- the 332nd Expeditionary Medical Group readied for battle. All the surgeons started to gravitate toward the PLX which is the surgeons' ready room and centrally located midway to the ER, OR and radiology.
The lab personnel checked precious units of blood, and the pharmacy made ready all the medications and drugs we would need for the upcoming fight. An operating room was cleared, and surgical instruments were laid out, the anesthesia circuits were switched over, and the gasses were checked and rechecked. An anesthesiologist and two nurse anesthetists went over the plan of action as the OR supervisor made the personnel assignments.
In the ER, bags of IV fluids were carefully hung, battery packs were checked, and the ER nursing supervisor looked over the equipment to make sure all was in working order and the back-ups were ready just in case the primaries failed. The radiology techs moved forward in their lead gowns bringing their portable machines like artillery men of old wheeling their cannon into place. Respiratory therapy set the mechanical ventilator, and double-checked the oxygen. Gowns, gloves, boots, and masks were donned by those who would be directly in the battle.
All of the resources -- medical, mechanical and technological that America can bring to the war - were in place and ready along with the best skill and talent from techs to surgeons. The two neurosurgeons gathered by themselves to plan.
LTC A. is a neurosurgeon who still wears his pilot wings proudly. He used to be a T-38 instructor pilot, and some of the guys he trained to fly are now flying F-16s right here at Balad. He is good with his hands and calm under pressure. The other neurosurgeon is Maj. W., a gem of a surgeon who could play the guitar professionally if he was not dedicated to saving lives. A long time ago, at a place on the other side of the world called Oklahoma, I operated on his little brother after a car accident and helped to save his life.
The two neurosurgeons, Chris, and I joined for the briefing. Although I was the ranking officer of the group, Chris was the SOD and would be the flight lead. If this was a fighter sweep, all three of those guys would be Weapons School Patch wearers.
The plan was for me and the ER folks to assess, treat and stabilize the patient as rapidly as possible to get the guy into the hands of the neurosurgeons. The intel was that this was an IED blast, and those rarely come with a single, isolated injury. It makes no sense to save the guy's brain if you have not saved the heart pump that brings the oxygenated blood to the brain. With this kind of trauma, you must be deliberate and methodical, and you must be deliberate and methodical in a pretty damn big hurry.
All was ready, and we did not have to wait very long. The approaching rotors of a Blackhawk were heard, and Chris and I moved forward to the ER followed by several sets of surgeons' eyes as we went. We have also learned not to clog up the ER with surgeons giving orders. One guy runs the code, and the rest follow his instructions or stay out the way until they are needed.
They wheeled the soldier into the ER on a NATO gurney shortly after the chopper touched down. One look at the PJs' faces told me that the situation was grim. Their young faces were drawn and tight, and they moved with a sense of directed urgency. They did not even need to speak because the look in their eyes was pleading with us -- hurry. And hurry we did.
In a flurry of activity that would seem like chaos to the uninitiated, many things happened simultaneously. Max and I received the patient as Chris watched over the shoulder to pick out anything that might be missed. An initial survey indicated a young soldier with a wound to the head, and several other obvious lacerations on the extremities.
Max called out the injuries as they were found, and one of the techs wrote them down. The C-collar was checked, the chest was auscultated as the ET tube was switched to the ventilator. Chris took the history from the PJs because the patient was not conscious. All the wounds were examined and the dressings were removed except for the one on the head.
The patient was rolled on to his side while his neck was stabilized by my hands, and Max examined the backside from the toes to the head. When we rolled the patient back over, it was onto an X-ray plate that would allow us to take the chest X-Ray immediately. The first set of vitals revealed a low blood pressure; fluid would need to be given, and it appeared as though the peripheral vascular system was on the verge of collapse.
I called the move as experienced hands rolled him again for the final survey of the back and flanks and the X-Ray plate was removed and sent for development. As we positioned him for the next part of the trauma examination, I noted that the hands that were laid on this young man were Black, White, Hispanic, Asian, American Indian, Australian, Army, Air Force, Marine, Man, Woman, Young and Older: a true cross-section of our effort here in Iraq, but there was not much time to reflect.