Angel of the Night (5 page)

Wendy’s regular length shift turned into a 13-hour marathon as wounded soldiers from a battle in the Tangi Valley were airlifted into Kabul Air Base. This valley, a mere 80 kilometers from Kabul, was the most horrifying combination of desolate and dangerous. Surrounded by jagged mountains with a lush valley at its base, terror groups and Afghan insurgents control the high ground with ample space to hide among the rocky outcroppings. There they perch, raining destruction on American, British and Canadian forces fighting to hold their ground. Long a Taliban stronghold and favored by some lesser known networks tied to Al Qaeda, the Tangi Valley is where a newbie to the Afghan war does not want to land.

It was to this hell on earth that Sgt. Peter Blanks was sent. Just 88 hours into his deployment on the ground in the Tangi Valley, Sgt. Blanks was struck by the whirling blades of a downed chopper as it struck his barracks. Sgt. Blanks, a Little All American running back from Augustana College in Rock Island, Illinois had his legs sliced off in a jagged amputation. His left leg was taken four inches above the knee. The right leg came off six inches above the knee.

Sgt. Blanks had lost a great deal of blood in spite of heroic efforts in the field by battle tested medic squads. He was all but dead when he arrived on the operating table. Captain McGuire would be his surgeon, with Lt. McKay assisting alongside. Wendy Shafer and Sophia Nolan-Hart were in support positions at the table. While Sgt. Blanks was lucky to have the best surgical team in Afghanistan performing his surgery, he would need all of that luck, plus grace from a Providential God, to survive.

The goal of an amputation is to remove all necrotic and severely compromised tissue while retaining as much of the patient's remaining limb as possible. These amputations are usually left open after surgery for two reasons. First, wounds that are sustained in battle are often heavily contaminated with dirt and battlefield debris. Surgical closure could put Sgt. Blanks at a very high risk for an infection, which could lead to a secondary amputation at a higher level. Perhaps even the removal of his legs to his hip level would be necessary in such an extreme case.

Second, tissue that appeared to be okay during the initial treatment in the field may have been damaged by the blast. In all likelihood that kind of damage would not show up until time has passed or a secondary, and more thorough, examination has taken place.

Before Captain McGuire could even begin to perform the transtibial amputation Sgt. Blanks would have to go through multiple debridement procedures on the table, a process that meant that he would be under at least a mild anesthetic for a very long time. A debridement is the removal of unhealthy, nonliving tissue. To leave that tissue as a contaminant would put the patient at risk for an infection.

Captain McGuire began the surgical debridement by flushing the area with a mild saline solution, similar to the solution used to store contact lenses and keep them moist. Then he applied a topical analgesic to the area to reduce the amount of pain that his patient would have to undergo during the procedure. Even an anesthetized patient, if his body is under a heavy pain load, can develop complications if the pain is of long enough duration.

“Forceps,” Captain McGuire said to Lt. McKay. She slapped the surgical tool firmly into his hand, and the procedure began in earnest. Captain McGuire pulled the majority of the dead tissue away over a six inch square portion of Sgt. Blanks’ left leg. A little of the damaged tissue had to be left in place as a precaution against compromising healthy tissue to which the damage was connected. Captain McGuire knew that later operations would be required to debride the leg further. At that time, the dead tissue that was being left in place today would be removed.

Lt. McKay used the time that it took to debride Sgt. Blanks’ wound to offer a teaching moment for her young nurses. “If we were stateside the doctor would be employing a technique known as autolytic debridement. That takes a lot longer, but it uses the body’s own immune system as a method of debriding the damaged tissue. It is a very tissue selective method. We can’t do that in the field, though.”

Sophia Nolan-Hart spoke up. “Why aren’t we doing that here? The patient is obviously not going to be going back into the field. Wouldn’t it be better if this was done the best way and not just the fastest way?”

Wendy wondered how Lt. McKay would accept this question from Sophia. It was a valid question, but it could also be seen as a form of rebuke to her superior officers. Such a thing was often not tolerated during a procedure. Wendy never found out how the heads nurse felt about the question because Captain McGuire spoke up.

“Actually, that’s a very good question. And there are two pretty good answers. Military medicine has a bad reputation for being carried out in a slipshod manner,” he said while snipping away at some necrotic tissue on the inside of the patient’s left leg. “The truth of the matter is military medicine has come up with some of the great medical breakthroughs in the last hundred years. What the military does, however, is put a premium on speed, sometimes at the expense of accuracy.”

Captain McGuire looked at Wendy, and Lt. McGuire noticed again what kind eyes he had. He could be as hard as anyone on staff members whom he considered as lazy or incompetent. But he had a real love for the people who strove beside him under difficult circumstances.

“This patient has the beginnings of an infection right here,” Captain McGuire said, inviting the young nurses to peek into his work area. The infection was barely visible to the naked eye, but when the doctor pointed it out Wendy and Sophia were able to see what he was talking about. “And right here,” Captain McGuire said, pointing to an area of the leg that he hadn’t debrided yet. “Autolytic debridement is contraindicated when there is already infection resent.

“So you see, Sophia. In this case, it isn’t just an Army doc slapping something together so we can get back to the Tank like on M*A*S*H. There is actual medical science behind why we’re doing it this way.”

Captain McGuire looked down and returned to the intricate work that lay before him
. “What a guy. I’m lucky to be serving with Captain McGuire,”
Alice McKay thought to herself
. “His wife must be missing him something awful.”

Captain McGuire completed the debridement procedure without damaging any of the underlying tendons or blood vessels, and set out to complete the amputation job that had been started by the spinning blades of a crippled Huey. Sgt. Blanks ‘condition under anesthesia was rated as excellent. His luck had held thus far.

Due to the rapid onset of infection in Sgt. Blanks’ wound, Captain McGuire performed what is called an open amputation, as everyone present had assumed from the beginning. An open amputation leaves the end of the skin flap open in case a later procedure is necessary because of uncontrolled infection. This flap would be sewn together at a time when the danger of infection isn’t present.

Captain McGuire, usually silent except for audible requests for surgical equipment, was more talkative today. “I want you folks to notice something about this particular wound. We were talking about infection earlier, and I want you to see why it happened. Normally, in a desert setting like we have in this country, infection doesn’t occur this quickly. But the metal shards of the helo blades were carrying bacterium Clostridium tetani, or the tetanus bacteria. We have to treat that, in addition to caring for the injury that the patient suffered.”

“Gigli saw,” Captain McGuire said. The bone cutter saw for the main portion of the amputation procedure was given to him, and he set to work on Sgt. Blanks’ left leg. He would leave as much of a flap on the amputation as possible. That would help Sgt. Blanks to more easily be fitted for a prosthetic leg at a later time.

By the time the surgery was completed, the surgical team had been at work for just over 11 hours. Sgt. Blanks was sent to recovery to wake up naturally. Aftercare medical specialists would visit him before the day was over, and psychological assistance would be afforded the young man as well. His family in Des Plaines, Illinois had been informed of his condition at the beginning of the procedure, and would be contacted as soon as he woke up. Their support was going to be a vital part of the young man’s recovery.

Wendy went back to her CHU, intending to catch a much-needed rest, but something else was on her mind. Wendy wanted to find out the condition of Pvt. Michael Kitcavage.

After a half hour of tossing and turning Wendy gave up on the idea of a nap and got up
. “I’ll sleep later. I want to know how that young man is doing. Damn fool kid, anyway. And his friend, what was his name? Washer? Washoe? I’ll bet he learned his lesson.”

Wendy dressed in her summer BDU over the top of her Under Armor Tactical Heatgear undergarments. As she walked to the Glynnis Unit, she was glad that she had invested in a good pair of hiking boots even though she was rarely off base. The extreme summer heat would have eaten her standard military issue footwear in just a few short months.

Wendy was greeted upon entering the Glynnis Unit by an armed security officer and an X-Ray machine similar to the one used at major airports worldwide. The security detail on Kabul Air Base had been doubled since Brigadier General McKillop’s death. The word was that the increased security measures would continue at least until a motive was established for the brutal murder.

All of the soldiers deployed at KAB had submitted to retinal identification and a thorough background check within a week of the discovery of McKillop’s body. This check was in addition to the background check, to which they had been subjected upon enlistment, and again before deployment to a foreign land. The Army was taking the killing, and the apparent complete lack of motive, very seriously.

Wendy felt a momentary chill go up her spine when she saw the security measures in place, and would breathe a quick sigh of relief when she was passed through without incident. The young lady at the reception desk asked to whom Wendy was visiting the Glynnis Unit to see. “Private First Class Michael Kitcavage, ma’am. He was brought in a couple of days ago.”

The receptionist nodded efficiently. “Pfc. Kitcavage is in Room 3C. That’s the second door on the left when you come out of the elevator. That’s our burn wing.” Wendy thanked the receptionist; whose name she noted was “Annie”. The lack of rank on the name tag told Wendy that the receptionist was a part of the civilian and military family Corps that the United States Army used for non-essential support positions when possible. It was a morale boost to the deployed soldiers if a family member could come overseas and work at the base.

Rarely, but occasionally, a family member (usually in a family with no offspring) was able to drop what they were doing stateside and come to work in Kabul. Such was the case with Annie Nutre’. Her husband, Lt. Barry Nutre’ was currently leading a fighting force tasked with rooting out a terror cell in the Bagram Mountains.

Wendy rode the elevator to the third floor and stepped into the antiseptic smell of the hallway. She noted something different about the west wing of 3C. The temperature, even in the middle of the summer, was at least 10 degrees cooler than in the rest of the hospital. That was no accident. Burn patients often have damage in their lungs from being too near fire. The cooler atmosphere helped the lungs to heal even while the medical personnel were dealing with external burns. Pfc. Kitcavage was sitting up in bed.

Except for a few Medline Tenderwet Patches that had been placed on some of the severe burns he would have appeared to be the victim of nothing more than minor sunburn. That is, if Wendy hadn’t known better. Up until just a few hours before Wendy’s visit he had still been on intravenous cooling fluid but the doctor had ordered that him taken off of those early in the afternoon. He was reading a month-old copy of ESPN the Magazine and sipping on some water when Wendy knocked on the open door. “Can I come in?”

Kitcavage looked over at the young lady at the door and answered “Sure.”

It appeared to Wendy as if Pfc. Kitcavage had jumped a bit when he looked her way. But she knew that involuntary spasms were not uncommon in burn cases.

Wendy walked over to the bed and placed her hand on the metal railing. She was loathe to touch the patient without a better idea of whether or not he was in any significant pain. “How are you, Private Kitcavage?”

“I think I’m doing okay. How do I seem to you?”

Wendy was taken aback. She had just arrived and without some prior knowledge of how Kitcavage looked under usual circumstances didn’t know how to answer such a direct question. By comparison to the half-dead guy that she had seen on the playfield two days earlier he looked great! But that kind of comparison was setting the bar pretty low. Wendy decided to go with a noncommittal answer to Kitcavage’s question. “Well, you look as if you’ll live. That’s something, I guess.”

Kitcavage laughed. “I guess it is at that. I was more curious, though, about the lung test that you gave me this morning.”

Wendy realized that Kitcavage had mistaken her for a lab tech that had done a lung test to establish the need for an escharatomy procedure. Apparently Kitcavage’s burn had been sufficiently deep that there was some concern about his lung capabilities. An escharatomy would have been necessary if his lung capacity had been diminished by more than 20%. Any number under that threshold would mean that he could be expected to recover naturally. She was going to correct Kitcavage’s case of mistaken identity but was a bit startled that there had been discussion of an escharatomy. That was a procedure normally reserved for flash and electrical wounds.

“He just had a bad sunburn, Wendy thought to herself. “Sure it was a really awful one, and it could have been worse. But why would they want to do an invasive procedure like an escharatomy on a sunburn patient, no matter how severe the burn?”

Wendy shook her head to clear it of the confusion, and decided to start over with Kitcavage. “Pfc. Kitcavage, you have mistaken me with a doctor or nurse that you saw this morning. I’m Lt. Wendy Shafer.”

Kitcavage’s face turned redder than it already was from his burn. “I’m so sorry, Lieutenant Shafer. Up until just a little bit ago I have been in a little bit of a fog. You looked like the nurse that was in here a little while ago. I forgot her name, but when you came in….” Kitcavage’s voice trailed away. “Anyway, Lieutenant Shafer, what can I do for you? I’m glad to have company, especially….”

He stopped again. At home, he was at ease around girls, but this girl had indicated that she outranked him. He decided that a reference to her being welcome because she was “cute” might be misinterpreted as being out of line. So he changed his tack a bit. “Especially…now.”

“Well I didn’t just drop by randomly, Private Kitcavage. I was curious. I was the person that your friend ran and found when you collapsed on the playfield. I provided the initial care while the medics came to transport you to the E.R.”

Kitcavage’s eyes widened. “Oh my God! Was that you? I remember you. I thought you were…I mean I didn’t know…I mean everything was a blur, and you seemed as if you were coming in and out of focus….” Wendy smiled. Kitcavage had obviously hallucinated while lying on the ground in desperate straits. She decided to help him out but was interrupted as the wheezing that Kitcavage was doing turned into a full-fledged coughing fit. The Pfc. in the bed coughed and coughed until he was barely able to catch his breath. He leaned forward and hacked until Wendy was sure that he was going to pass a lung. “I wonder if this is why they are considering an escharatomy?” she thought.

Finally, Kitcavage’s spasms subsided. He had taken several deep breaths before he was able to continue his conversation with Wendy. For her part, Wendy didn’t want him to exert himself. “It’s okay. I understand the mistake. You thought that I was a lab tech or a nurse.”

Kitcavage reached up to the metal bar and placed his hand over hers. “No, it isn’t just that. It’s just that the other day when you were helping me. Do you remember?”

“Of course I remember. It was just a couple of days ago.”

“Well I thought I was dead…and you were an angel.”

“An angel,”
Wendy thought
. I’ve been a number of things, but no one has ever called me an angel.”

Kitcavage continued. “They let me call and talk to my wife and kids right after I was well enough to be able to. I told her that I had been visited by an angel with brown hair. She laughed.”

Wendy smiled at Kitcavage. “I’m glad that you were able to phone home. I’ll bet your wife and little ones were glad to hear from you.”

Kitcavage was about to continue his tale of the conversation home when a voice boomed from just outside the door.

“GET UP YOU LAZY GOOD FOR NOTHING GOLDBRICK. THE SCORE IS TIED AND WE NEED TO….”

Henry Washoe stopped talking when he saw Wendy. He took his hat off and said, “I’m sorry, ma’am. I didn’t know that Mike had a visitor.”

Wendy donned her best expression of mock outrage. “No, Private Washoe. Please, carry on. Tell this
patient
how he needs to get up and do the very thing that he did to get himself laid up in the first place.”

Henry Washoe had been conditioned on the day of the incident that the diminutive nurse before him was not someone with whom he should trifle. “Aw, ma’am. It isn’t like that. I was just giving him some sh…stuff. I didn’t mean anything by it.” Wendy smiled at the enormous, and embarrassed, visitor to the room. “And I’m just giving you sh…stuff as well, Henry. How are you?”

“I’m fine, ma’am. Thank you for asking. I had some time before going on shift, and I wanted to see how Mike was doing.” He looked at Kitcavage and saw that he was both upright and off of his I.V. tubing. “You look great!”

“Well, I feel better. I was just telling Lieutenant Shafer that I thought that she was a celestial visitor the other day when I passed out. I thought she was an angel.”

Henry Washoe looked back at Wendy. “Well, I can see how that might be, Mike. She sure is pretty.”

It was Wendy’s turn to blush. She had been raised as the only girl in a house with three brothers. The horseplay and conversation in the house tended to the rough and ready. She wasn’t used to someone looking at her with quite the frank admiration that Private Washoe was delivering at that moment. Suddenly she found herself at a loss for words.

Luckily for Wendy, the give and take in the room was interrupted by the swish-swish sound of nursing shoes as they marched into the room. Kitcavage’s nurse had brought a couple of orderlies into the room to help the patient out of bed and into a wheelchair. For his part, the patient was excited.

“Is this it? Do I get to go back to my CHU and back to work?”

The nurse shook her head. “No such luck, young man. The doctor wants to run a couple more tests on your lungs. He doesn’t like your airway situation yet. You’ll probably be with us for one more night. I think they will be able to release you at that point.”

Kitcavage was none too pleased, but Wendy and Henry stepped in as cheerleaders. “That’s great, Mike,” Henry said. “Tomorrow you get out of here and then you’ll have the weekend to rest up and get back to work on Monday. You’re too tough to let a little sun keep you down.”

Wendy saw that the patient wasn’t responding to his friend’s good cheer. She put her hand on Kitcavage’s shoulder as the orderlies lifted the wheelchair’s footrests into place.

“They’re just taking the best care of you that they can, Michael. Let them do a little more testing and all of this will be in the past.”

“Ah, I’ll be fine,” Kitcavage said, throwing a smile toward his visitors. “After all, what would I do without one more night with a plastic cup of lime Jell-O?”

Wendy and Henry walked with the orderlies and Kitcavage as far as they were allowed, before wishing him the best of luck and promising that they would see him soon.

“I’m off until 1500 hours, and then I only have a five hour shift, so I’ll be here in the morning,” Wendy said.

“I’m finished tomorrow at 1400 hours, Mike. I’ll come see you after work and Lieutenant Shafer can come in before she goes in. We won’t let you just lay here by yourself.”

“Thanks guys. See you….” He might have had more to say, but was overcome with a bout of coughing as the door closed behind his chair.

Wendy and Henry walked together toward the elevator but saw Michael’s nurse walk by on her way to another room. Wendy stopped.

“Specialist Hatcher, could I have just a minute?” Wendy said, reading the nurse’s name tag. “Michael Kitcavage is going to have another chest X-Ray, and I know that an escharatomy has been on the table for discussion. Did he suffer anything from his bout with the sun besides what is typical from sun stroke? We’re not family or anything,” she said, indicating both herself and Henry, “And I know that there are privacy issues in play, but can you at least tell us what the doctor is trying to rule out?”

Lisa Hatcher paused to answer. “Well, there isn’t much that I can tell you, legally, but the doctor is just double checking the patient’s thoracic region.”

Wendy nodded, “Thank you. I know that you’re constrained by HIPPA regulations. We run into that in the surgical practice all the time.”

Henry waited until the attending nurse was out of earshot before quizzing Wendy. “Did you learn anything? Why would they need to double check his thor…thur…whatever region she just said?”

“It’s hard to say,” Wendy said, “We didn’t really learn much from what she said. Privacy rules are much tighter now than what they used to be. Before, nurses shared information about patients, even if they weren’t practicing in the same discipline. All that has changed since the Health Insurance Privacy and Portability Act (or HIPPA) came along. There are good things about HIPPA, but it has made our job of interacting with a patient’s circle of acquaintance more difficult. There is, of course, lots of paperwork, too.”