Skip to comments.Postings from Afghanistan -- A Kandahar Journal -- Civilian surgeons
Posted on 07/17/2007 4:33:53 PM PDT by Clive
Started my day without much direction.
I had arranged to go and draw helicopters on the runway at 9 a.m. Any photography of flight lines or hangars is strictly prohibited so I had to set up a specific time to visit. I chose first thing in the morning because I figured if I was sitting on the runway, I didn't want to be doing it when the day really heated up.
The helicopters used by Canadian forces belong to the United States or the Dutch. This includes the helicopters used for casualties and it was these I was most interested in drawing. I thought if I were in the right place at the right time I could maybe snag a ride-along. It was not to be.
The whole thing was a bit of a bust. The U.S. sergeant said he would have to be with me at all times. Also, they were about to launch an operation, so most of the birds would be leaving shortly. I shot lots of photographs then thanked him for his time.
Back at the hooch feeling a little disconsolate, I decided to take a walk to the hospital. Usually they are all sweetness and light, but today they were not at all keen to let me in. I managed to catch the eye of one of the nurses I had promised to sketch, and she agreed to keep an eye on me so I didn't steal anything.
We walked past Aziz on the way in. He looked even better than last time I saw him. And one of the interpreters had bought him a bicycle.
I sat inside the triage area and drew Captain Nori Jan Bicknell. As we chatted, another nurse, Lieutenant Patrick Breckenridge, came by to look at the sketch, and I talked him into having his done too.
CAPTAIN NORI JAN BRICKNELL
Patrick was a smoker so we sat outside. I had gotten going fairly well on his sketch when someone came and told him that there was an Afghan National Army (ANA) casualty arriving in the next half-hour. He stepped away to make preparations and then came back to sit for me again. I took a few pictures in case he had to go again and continued drawing.
Often what arrives in the ambulance is not what was advertised. Just yesterday, they were expecting an ANA soldier and got a child with a knife sticking out of his forehead instead. He survived.
I asked Patrick whether it would be OK if I stuck around through the arrival of the patient. It seemed like a great opportunity to see the nurses I had sketched doing their job under pressure. It felt like my usual luck was in.
Patrick, as he should, checked whether it would be OK for me to stick around. The answer was a firm "No." Could I perhaps stay, and just watch, and not take any photographs or sketch? "No." This was a very different hospital staff than the one I had dealt with a few days earlier when I drew Aziz -- the six-year-old who had been shot.
I tried to make an end run around the overly officious members of the staff by talking to the two civilian surgeons I had met previously, and who would be handling whatever came through the door in a few minutes' time. They tried, but the answer was the same. They said that unless I could get the critically injured patient to sign a waiver, it would never happen. I tried to imagine running alongside the ambulance with my pen and waiver in hand. I felt my sarcasm gland about to go turbo, but held off.
I got things in perspective and realized I was going to hurt my chances later on if I continued to push, so I thanked them and exited stage left. Captain Bicknell and Vivian McAlister, a civilian doctor, caught up with me in the hallway and said they would try to sort something out later.
Back in the hooch and feeling a little cranky, I finished the portrait of Patrick, then did another full-figure portrait of him sitting outside, smoking. He looks moody in the illustration, much the way I was feeling when I drew it.
LIEUTENANT PATRICK BRECKENRIDGE
After lunch, I called up the Tactical Uninhabited Airial vehicle (TUAV) guys. They at least are consistent in their love for me. They came by and picked me up and I spent three hours at their compound. I sat against a truck with my back to the wheel and drew the TUAV launcher that I had been unable to do in the dark a couple of nights ago during Operation Pluto. After that, I had intended to do portraits and interviews with some of the guys I had met during the op. When I entered the hangar, it was pretty obvious that they were too busy. So, rather than take up too much of their time, I quickly interviewed Corporal Leudy and Corporal Gagnon -- the two I was most interested in -- then took photos to work on later.
Later turned out to be as soon as I got back to my tent. I finished all of the portraits and worked on one of Corporal Leudy with his arms folded covered in oil smudges. You will have to take my word when I say there is no artistic exaggeration in those forearms.
CORPORAL MICHAEL JEFFERY LEUDY
I was just thinking about how many chicken wings I was going to eat for dinner when Doctor McAlister busted into the media hooch. He said they were about to operate on an ANA soldier hurt by an IED and asked if I would like to sit in. "What about the waiver?" I asked. The good doctor had had him sign it already. What a guy!
I grabbed my gear and headed over.
The good doctor showed me where to get changed into scrubs and then gave me a tour of the operating room (O.R.). It is a complete unit built inside a Sea-can. The Sea-can’s sides fold down and a tented awning folds out, making walls and roof. It can be quickly deployed anywhere. And it is very small.
I decide to leave the sketch pads outside the O.R. and just use the camera.
On duty were four surgeons, three nurses, and anesthesiologist and an X-ray technician. Throw in an artist and we hit double figures. It was going to be a wee bitty cramped. I determined to keep the hell out of their way.
Three of the surgeons were Canadian, the other Dutch; two of the nurses were Dutch, the other Canadian; the anesthesiologist was Dutch, and the X-ray technician was Canadian. And me; I am both Canadian and Scottish and proud of both.
Doctor McAlister took me aside to give me a look through the soldier’s CT scans to show me what some of the issues were going to be for the surgeons.
CT scanners seem to have come a long way. With a roll of the mouse, we could look at cross-sections of the wounded man from head to toe to head, animating smoothly back and forth. The slice on each scan is 5mm from the previous slice.
The ANA soldier was one of six soldiers hit by the IED. Four died immediately; one made it as far as here before dying. This was the blast’s only survivor.
The doctor pointed out body parts as he scrolled back and forth on the CT scan. Heart. Lungs. Kidneys. Intestines. On many of the slices were bright white points. These, he told me, were foreign objects. Some were perfectly round. "Ball bearings," he said. Others were oddly shaped, likely part of the bomb or parts of whatever was between him and the bomb when it exploded. Looking at the number of pieces of shrapnel he had inside him I could see why a CT scanner is so essential for this kind of work.
We were called to the O.R. by one of the other Canadian doctors pretending to be a hospital tanoi. "Chhhht, paging Doctor McAlister, chhhht, please report to the O.R., ccchhhht beep." Obviously, it is something he has heard before.
Back in the O.R., the patient was on the table, getting prepped. I pressed my back to the only available wall space and watched as they worked. The wounded soldier was unconscious and had a catheter, and breathing and intravenous lines in, as well as echocardiogram patches on his chest. When asked whether he had any questions before he was put under, he said through his interpreter, "Please don't take my leg." His body looked better than I had expected. One of the doctors explained that even the tiniest wound, of which there were hundreds visible, might mark the entry point of a piece of shrapnel.
The preparatory work included shaving and washing the areas they will work on, then bathing the skin with iodine. After that, the patient’s body is masked off from the areas they have made sterile. The surgeons scrubbed up, and put on gowns and two sets of gloves.
The work was split into two areas, with one surgeon being assisted by another in each area. Two doctors tackle the head and neck; the other two tackle the leg.
I had been in a surgery in a Mobile Surgical Unit in Iraq, and it didn't cross my mind that I might not be able to deal with this until they started cutting. I had a quick check of myself for signs of faintness or nausea – nope -- nothing. I got the camera out.
As long as I moved slowly and deliberately around the room and clearly telegraphed where I was going I didn't seem to upset anyone. I struggled for a while with my usual ability to find scenes and angles that capture the whole picture or individual moments. There was so much equipment and so many people wearing such odd clothing that it was difficult to see the art. So I just kept taking pictures. I mosaic-ed anything that I thought might have potential because I couldn't back far enough away to get it all in one frame.
I spent quite a bit of time with the two Canadian surgeons pulling shrapnel out of the man’s head. They dug and dug but eventually realized the piece was into the bone. They had to leave it be. They stitched in a small rubber drain from the hole and moved on to the next wound site. There were many.
By moving an instrument around the inside of the hole, the surgeons could find the path the shrapnel took, and hopefully they could find the shrapnel at the end of the path. Unfortunately shrapnel rarely travels in straight lines, and in some of the deeper pieces it was easier on the patient to leave it in place than to dig and dig.
Down at the leg end, they had had a little more success. A ball-bearing was in the kidney tray, and the two surgeons were considering the damage done by its passage. Each of the surgeons had a finger deep inside the leg. The main nerve was almost completely severed, but the artery was intact. He would not lose the leg but it might not be much use below the knee. Over the next hour, the Dutch surgeon cut his way carefully toward the nerve, cauterizing small blood vessels as he went. He repaired the barely intact nerve as best he could. He said it might grow back along his repair but he wasn’t too hopeful.
At the other end, they had started to work on the arm and the upper torso. There was a piece of shrapnel against the man’s spine in his abdomen, plainly visible on the CT scan. But there seemed to be no obvious track to get it there. It was decided to leave it alone, as it may be from an previous wounding.
Back down at the other end, the Dutch surgeon was hunting for a fragment of something inside the kneecap. With the help of one of the Canadian surgeons, they levered open a space big enough to look inside. They could see enough to know that it was not visible and therefore likely to be in the bone. They left that and moved on.
I continued my constant monitoring, looking for the best angle to represent this chaotic, bloody scene. The doctors diligently worked their way from wound to wound. Sometimes successful, sometimes not. It was hard grueling work, and I understand from one of the surgeons that this one wasn't even that complicated.
During the cleanup, all the sheets and masking were peeled away and a man appeared from under them. A rough blanket was thrown over him. With the stretcher standing by, he was gradually roused by one of the Dutch nurses. He started to shiver and I could see him working to pull the blanket up with fingers that wouldn’t do what they were told. The nurse helped him get it to his chin. I stayed through the whole process until the patient was back on the ward and in bed.
I could only imagine the pain he would be in tomorrow.
And I wondered whether anyone had told him yet about his five friends.
Wow!! Amazing! Thank you for the ping, SandRat!!