166 Days: My Journey Through The Darkness (14 page)

31 July 2008

Causalities of war had become our norm; I learned to expect it on a daily basis. A stab wound, a gunshot wound, or perhaps another victim of an RPG. It was just another part of my day in Afghanistan. How funny, considering back in the safety of the United States these types of scenarios were so far from the “norm.” My reality had become the opposite of everything I was used to treating on a day-to-day basis. Medical conditions had taken a backseat to traumas.

Today reminded me that illnesses were still a part of the new world I was living in. Ivan had not been feeling well all day. He was complaining of generalized abdominal pain and nausea throughout the day that appeared to intensify as time progressed. I had given him an antiemetic (medicine for nausea) but it didn’t seem to touch his symptoms and by the evening, his symptoms became significantly worse. He was out in the common area dry heaving with a slight fever and nothing I was trying was helping. I instructed him to lie on his bed so that I could perform an exam.

I took his vital signs and saw that his fever was continuing to increase and his abdomen was very tender. I pushed on the right lower abdomen and he about came off his bed as he winced in pain. I performed a heel tap, which is an exam that consists of tapping on the heel and seeing if there is a reaction of pain due to the motion that it caused in the abdomen. When patients reacted to such an exam it was a tell-tale sign they had what we in the medical community call an “acute abdomen,” meaning he likely had a severe infection or pathology going on.

When I hit Ivan’s heel, he complained of excruciating pain, and I felt confident in my diagnosis. My concern was he had developed appendicitis, and he needed surgical attention as soon as possible.

“Hal, I’m very concerned Ivan has appendicitis. We need to call a medevac to get him to TK as soon as possible,” I said.

“I’m on it Jenn,” he answered and ran to the OpCen while I finished with Ivan. I met up with Hal at the OpCen and we made the call to the FST. I spoke with the surgeon and expressed my concerns. After the arrangements were made, I sat with Hal and explained why I’d come to the conclusion I did and explained to him the importance of a detailed note to send with our patient as he was transferred to the crew on the flight and the surgeons at TK.

Despite poor Ivan and his agonizing pain, it was an opportunity for me to mentor Hal on what to write in a medical note and acute abdominal pain. He was so receptive and appreciative to all that goes in to making a medical decision, such as the one I had just made. That moment with him made me appreciate how our worlds had come together and how we were able to learn from each other. I’d spent so much time and energy in school learning all about medicine, it had become my passion. Hal, on the other hand, had studied so much on how to treat trauma in his training with the team. As we packaged up Ivan, I couldn’t help but smile as Hal continued to ask me questions on appendicitis.

Ivan was such a trooper through the whole thing. While he waited for the medevac I could see his pain was worsening by the minute. When I offered him pain medication, he refused, “I want to make sure my symptoms aren’t masked by medications. I want the surgeons to have no doubt on what they need to fix…this is miserable.”

“I understand, but this wasn’t a hard diagnosis to make Ivan, plus I’m sending a detailed account of how everything happened,” I asserted.

“No…I’m good, I can take it,” he insisted. As we loaded him on to the bird, I folded up the note I had written with Hal, which contained the details of his vital signs, the medications and doses given, his physical exam findings, and my assessment and plan and put it on his chest.

“Good luck, you are in great hands with these surgeons…I know them well,” I said as I squeezed his hand knowing he might not return to the firebase before I would be leaving.

Several hours later I called back to the FST to find out what the final diagnosis was. Sure enough, it was an acute appendicitis and Ivan went into surgery shortly after his arrival at TK. He did very well during the procedure and throughout his recovery. He later told me he would never forget the experience and was thankful we were able to get him out of there. He said his fondest memory of the whole ordeal was his recovery. He said the FST loaned him a pair of scrubs, and when he was able to get up and walk around, he made it his mission to go around TK and raid the connexes for fresh fruit and bread to send back to us; knowing our living conditions were subpar compared to where he was.

5 August 2008

With just under two months left on the firebase I found myself extremely homesick and missing Greg more than ever. I knew today he was on a solo bike trip on the Harley to Washington D.C. to visit a friend and see the sights. I longed so much to be with him, seeing such important landmarks in our country’s history. I knew I would leave this deployment and this experience with a profound appreciation for what we as Americans have in the United States.

Even the clinic was wearing on my spirits. I wanted so much to reach out to these people, but frequently found myself so frustrated day after day by the limitations I faced in the care I could provide. On an almost daily basis, I would face someone that would absolutely be a hospital admission or a surgical case in the United States. I remember seeing one man who traveled for five days by camel to see me after his arm was blown up in an explosion. He had it wrapped in a dirty cloth and as I took the bandage off I couldn’t believe what I saw. The muscle and skin of his entire elbow was destroyed. It appeared to be covered with a yellow salve that had been applied to help keep it clean. I could see the exposed fractured bones and felt such sympathy for this man, knowing he needed attention I could not provide. Hal and I cleaned the infected wound as well as we could, gave him IV and oral antibiotics and pain medication. I called TK and my friend, the orthopedic Surgeon, and told them about the man. They agreed to treat him so I sent him and his camel on their way in hopes he could get the surgery he needed. He was so grateful for what little we were able to do and he promised to take the medications as I had prescribed and would start on his dangerous journey to the surgeon.

Amazingly, the man did arrive to the clinic five days later. My friend informed me he would never regain function of his arm, but at least they were able to save it. I couldn’t begin to count how many children I saw with acute asthma exacerbations or pneumonia and severe dehydration that needed hospitalization. The majority of their parents, if I was fortunate enough to see the parents, were so terrified of the Taliban they refused the trek to TK for more definitive care. The sad reality of the people around me often became overwhelming.

I treated a two-year-old girl who had “fallen” three days before, and her father stated she hadn’t walked since. “Why didn’t you bring her to me as soon as this happened?” I demanded.

“He say he wasn’t there when she fell,” IG translated. As I looked at the girl, I discovered her leg was swollen, red, and tender to the touch. She screamed in pain with the lightest touch to the area. I sedated her so I could perform an exam and treat her injury.

Based on my initial impression, I was concerned she could have “compartment syndrome,” which is a medical emergency where the muscle compartment has too much pressure that causes compression of the nerves and blood vessels and can cause tissue death. I was reassured this was not the case once I got my hands on her. Luckily she was neurovascularly intact, meaning her blood vessels and nerves were functioning as they should.

I tried to get an x-ray of her femur, but of course the portable x-ray machine was not working; yet another setback to face. As I touched her thigh, I felt her femur literally crunch and move under my hand, mid-shaft and down toward her knee. In the United States, this would require an urgent orthopedic consult. She would likely need surgery, or bed-rest with a special cast as a minimum. I had nothing but fiberglass and an ace wrap.

I tried to tell the father this, and he insisted he could not make the trip to TK for proper treatment. They would have to make do with what I could come up with.

“Sir, I don’t have the proper equipment here to treat her appropriately,” I tried. “If you don’t take her to the surgeon she will likely lose some functioning of her leg.”

“He say he understand and is grateful for any help we can give,” IG translated. I managed to splint her with a make-shift cast in the form of a stirrup and a posterior long-leg splint.

“It is very important you keep her leg as immobile as possible and in the ‘cast’ for at least eight weeks,” I explained.

“He does not understand what you mean, he does not understand the calendar in the way you say,” IG said. I had to find a different way to give him instructions so I found a piece of paper and drew fifty-six hash marks.

“Sir, every day I need you to mark off one of these, and when you get to the last one you need to bring her back to me,” I instructed. The man nodded that he understood. I gave him a bag of pain medicine and antibiotics and directed them to the door. As I watched the father walk away, carrying his daughter, my heart ached. I wished so much I could do for them what I would be able to offer in the United States. Thankfully, eight weeks later, the father retuned with his daughter. He informed me he kept his promise and did not remove the splint. As I began to unwrap it, I was overwhelmed with the scent of urine and fecal waste. It was completely covered in filth. Once I got it removed and she relaxed enough for me to touch her, she realized she no longer had pain and was able to move the leg and she was even able to bear weight on it. I tried to explain basic rehab techniques to the father; I am sure he did the best he could.

Dealing with stories such as these on a daily basis was literally draining. I found my sanctuary in running. There was a track the team had made by shoveling rocks out of the way to form a path around the HLZ. It was very close to the size of a 400 meter track back home and I found myself frequenting it on an almost nightly basis. I was running distances I never attempted to run back home, which was certainly something I was proud of. I had to be careful not to roll my ankle on the large rocks, but it was my only escape. Often times my friend “Rod” (his first name was Greg), who was an Army dog handler, would come out to the track as well with his dog Jacko to train. I think it was his escape too. It became almost a routine to run by them and wave with each lap. The day-to-day was taking its toll on all of us, and we were all coping with it in our own ways.

After clinic was over that day, and after my run, I went back to my room and watched a documentary that Greg told me about on YouTube, done by the National Geographic Channel on the Green Berets in Afghanistan. I watched in awe at the accuracy of the documentary’s depiction of our conditions. Everything that happened to the team they were filming had happened to me on this deployment, whether directly or indirectly with our team; from traveling in a convoy at night, to the MedCap, to dealing with the radios, IEDs, or the reality of losing a friend to combat. I couldn’t believe I was actually in the middle of it all; unbelievable. I had no choice but to push through and do my job.

I looked at the clock and shut off the documentary, realizing it was time to man the radios while the guys left for another mission to find another IED and head into hostile territory in hopes of finding some bad guys. I prayed their night would be unproductive and that they would all come home safe…it was the best I could do.

11 August 2008

Without a dining facility our food options were limited. We could eat what the local nationals prepared which most commonly consisted of rice and beans over naan, MREs, or what we stockpiled from care packages sent to us by our loved ones. Due to the inconsistency of ring flights to the firebase, we rationed our food from the care packages to ensure we would have enough to last until the next delivery, but we often ran out. Tuna and peanut butter became staples for me, and I was always thankful to Greg for sending as much as he could.

Becky and I would often trade food with the guys, depending on what they had, and we quickly developed relationships based on our “bartering.” Our friend Rod always had the good stuff like candy, chips and crackers, and sometimes some dry roasted almonds. He was always so generous with his treats and we quickly developed a bond over our goodies. He would frequently come to our room with his dog Jacko and hang out with us while we would tell stories of home and savor our snacks. After clinic today Becky and I were sitting in our room talking when we heard a knock on the door. It was Rod with a huge smile on his face.

“Hey guys! Guess what? I just heard we’re getting a food drop today!” he said.

“That’s awesome!” We were so excited. I hoped we would get some fruit, but that was often wishful thinking; regardless, it was a welcome piece of good news.

“I’m going to help pick it up at the Drop Zone, do you wanna help stock the storage sheds?” he asked.

“Heck yeah! That means we get first dibs on the good stuff!” Becky said. We hurried to the OpCen and waited for the first load to arrive. After about an hour the guys returned and Rod called over the radio for us to meet him and help unload the ATV. We hurried to the shed to start sifting through what we got. We were excited, but when we opened the first box, Becky and I never imagined how happy we would be to see fresh vegetables. There were heads of lettuce, some onions, and green peppers.

“Becks!” I screamed, “We can make a salad!” I couldn’t even remember the last time I had eaten a salad; one of my favorite meals back home; a rare treat here.

“Oh wow! Quick Jenn! Grab enough for us to make one and let’s stash it in our room before someone else gets it,” she said.

“You got it!” I squealed as we scrambled to gather our ingredients.

Rod couldn’t help but laugh at the two giddy school girls standing in front of him. “I just so happen to have some dry roasted almonds and ranch dressing in my room if I can get in on that salad,” he said.

“You had us at almonds,” I laughed. “We can throw in some tuna and…. look! Here’s some provolone!”

We hurried through our duties stocking the shed over the next couple of hours. As soon as we could, the three of us broke away. Rod went to his room, grabbed his almonds and dressing and we snuck into our room and had our feast. All three of us giggled and talked as we ate. Poor Rod suffered through hearing about clothes and decorating ideas that Becky and I had for our houses when we returned. He was a great sport and chimed in with his own tips.

“Well ladies, I prefer to shop for all of my décor at
Bass Pro Shops
, but that’s just me!” he joked. We talked about ideas for gifts to give our husbands and what he could buy his wife. A simple, carefree conversation over a salad with friends was such a rare treat. It made me forget the realities of the situation we were in. Sometimes such little things in life make a huge difference.