A Day in the Life

Kandahar, Afghanistan

It occurs to me that among those living outside of Kandahar there is probably a very distorted view of what our lives our like here.  The news is very skewed towards headline-grabbing events (rocket attacks and helicopter crashes), which doesn't accurately portray an average day.

I had a busy day yesterday, perhaps busier than most.  But it represents.

Out of bed by 5:15, it's broad daylight but relatively cool.  I go for a 30 minute run outside, marvelling at the blue sky and sharp, craggy line of the mountain range in Taliban country out there.  The wind is blowing from a different direction and the dust seems to be gone here at 5:45 am - it's crystal out there.  It's only 70 degrees or so at this point, about 45 degrees less than it would be at noon.

I stop at Tim Horton's Canadian donut shack to pick up a dozen for the ICU staff.  I'm on call today and these folks work hard.  Some of them have occasionally unpleasant jobs, cleaning sh*t or other bodily fluids off of patients backsides, rolling heavy torsos and legs for better positioning, and watching patients die before their eyes sometimes.  It's a satisfying job too - many "saves," feeling honored to serve those who have served and have given limbs or eyesight in service to their country.  But it is hard no matter how you slice it, and the least that they deserve is a Timmy Ho's donut to start the day.  Maple is the best.

After morning report we sat down for a talk by one of our surgeons on burn care.  He is a burn specialist on loan here in Kandahar as part of his fellowship.  It's an excellent talk despite the fact that I can barely stomach burn care, but we are interrupted ten minutes into the talk by multitudes of pagers announcing that we have 4 Alphas inbound and multiple Bravos.  All GSWs - gun shot wounds.  A firefight?  We ambulate with purpose toward the trauma bay.

Before noon we have managed over 9 Alpha's and untold number of Bravos.  Apparently a coalition unit arrived in a Taliban-held town and all hell broke loose.  Those that were shot were all locals, seemingly innocents including one child, who all seemed to have been struck by Taliban bullets (that's what they looked like when they were removed).  We rarely get the real story initially as it needs to get pieced together later.

Busy day in the trauma bays

It was a busy morning in the trauma bay, with bays being quickly mopped up of their blood and medical detritus, only to have another trauma come through the bay doors to fill it up again.  It was like a rolling mass casualty without the histrionics that generally comes with that.  I put in a few central lines and moved from one bay to the next, line kits propped under my elbow, sterile gloves in pocket.

Despite the madness, and probably because of our familiarity at this point with groups of casualties, I managed to break away for lunch with some colleagues.  We typically go to the "European" dining facility (DFAC) Luxembourg - the closest to the hospital, but this day we went to the North American one, Niagra.  The highlights to the NBA finals, which had come on at 5:30am, were playing.  Had to see that, a small slice of what was happening at home, 8000 miles away.


Waiting outside the DFAC known as "Southpark"

I went back to the ICU as I my call was beginning - we go noon to noon, 24 hour coverage.  The ICU was getting business coming out of the OR from the morning's events.  I stayed busy fairly continuously through about 7pm, grabbed a quick bite from the food brought in from one of the DFAC's which by this time was cold and fairly gross.

Around 8pm we get a surprise patient who ended up in the trauma bay without warning.  He was a local national, hopelessly mangled in his lower extremities and torso.  By the time I made it from the ICU to the trauma bay, his chest had already been "cracked," in order to clamp the descending aorta and put epinephrine directly into the heart.  It was futile and when all parties agreed, the resuscitation was "called."  

Back to the ICU where I soon found out that an enroute care (ERC) mission was being spun up.  I was on call to cover that mission.  By 8:30 I was getting into my flak jacket and helmet, and having medications drawn up.  In the trauma bay the patient whose chest I had stared directly into before he officially died was now laying in a body bag on a gurney, awaiting mortuary affairs.  I headed out to the flightline alone.

While waiting for the helicopter to pick me up I was able to see two UK jets light up the night sky with their afterburners as they took off.  Several Unmanned Aerial Vehicles (UAVs) flew by, heading to missions unknown.  A half dozen other fixed wing planes took off without navigation lighting, climbing like dark ghosts into the crescent-mooned sky.  Shortly before 9p two helo's touched down on the flightline in front of me.  I climbed into the lead helo and we lifted off into the dark sky.  I was able to listen in on the comms of the pilots, as I had a set of headphones on this mission.  They seemed like two friends navigating their way through the NJ Turnpike.   I could see the Milky Way on the horizon, it was so clear and dark outside.  I was trying to be oblivious to the potential badness below me.

It's in the open press now that one of the local squadrons had a helo shot down recently by the bad guys. I certainly hadn't forgotten this.  As we descended toward the forward operating base (FOB) that was caring for our transport patient I realized I was saying to myself, between Hail Marys,  I hope these guys know what the f*k they are doing.  The holy and profane in one breath.  I amused myself, but was not really amused.

We picked up our patient, myself and the Army medic, who thankfully was very calm and knowledgeable.  Our patient was a local national who had been shot at the jaw.  The bullet went through his oral cavity and out the other side.  He had a lot of dried blood on his face and a breathing tube in his mouth.  He was sedated and paralyzed, lying on a stretcher.  After doing the requisite turnover and patient inspection, we loaded the patient onto an ambulance and then onto the awaiting helo.  Forty five minutes later I was back in the trauma bay, safe.  It was 11p by this time.   I relieved my colleague, Jon, who had to mind the ICU while I was gone.

The ICU Team on rounds

I managed to tuck the jaw-gunshot patient into the ICU by 1am.  I had promised to myself to do some training to the night shift nursing staff - they are often neglected from the teaching angle, so I gave  prepared lecture via laptop to them on an ICU topic that might come in handy in the care of their patients.  By about 2am I was at least supine on my makeshift bed, uniform still on, in case we got another ERC call.  I pinned my pager to my front pocket.  The first time I got an ERC call I only had 5 minutes to get ready.  I clearly couldn't sleep through this and had to be up and ready in minutes if need be.

I manage to get a couple of hours of interrupted sleep: the nurses inevitably have "issues" with their patients, or labs that don't make sense.  It's part of my job to answer these questions, of course.  I stroll through the ICU usually a few times overnight.  The nurses try to save a few of the less critical questions for these stroll-throughs.  I wake up to the same watch alarm that I awoke to 24 hours prior, when I was then thinking about running.  This morning I am thinking about going home, after noon, to try to catch a nap. Instead, I sit here, writing this post.