Body Parts

05 Aug 2010

Kandahar, Afghanistan

The other day I was observing a splenectomy (removal of the spleen) in the OR.  The patient was a young child who had developed thrombocytopenia - low platelets - and by removing her spleen her platelet levels should begin to rise.  It was satisfying to see an elective procedure that had nothing to do with trauma for a change.  One of the OR techs standing next to me informed me that she had made the necessary arrangements for the soon-to-be-removed spleen.  What do you mean by that?, I inquired.  She explained that it was customary for Afghani Muslims to be buried with all of their parts, so we had to call Mortuary Affairs to come to the hospital to collect any body parts that are removed, whether it be a traumatically amputated limb, or a spleen.  My head began to spin when I tried to envision how this little girl's family would deal with a spleen in an urn or bag when they got back to their mud hut in whatever village they were from.

The girl has done well post-operatively.  No idea where her spleen is at this point.

This morning I was called to do a task that I would be happy to never do again.  The suicide bombers of yesterday were apparently sitting in body bags at Mortuary Affairs.  Someone had to fill out their death certificates.  A British medic drove me over to the refrigerated conex boxes sitting adjacent to the flightline, making small talk about the weather.  He was the one who had to pick up the body parts after their failed attack.  He was clearly disgusted and perhaps a bit traumatized, if I read him correctly.

With the help of another gent, I unzipped the six black bags one by one, biting my lip.  I really didn't want to see what was inside.  There certainly were recognizable human parts, admixed with brown scrub brush and dirt.  There is something obscene about seeing hair, skin, and flesh gathered together in no recognizable pattern.

I had problems filling out the death certificate.  What would I call the cause of death?  Occasionally we who work in the ICU have to be creative when filling out these forms: many of our patients expire with multiple organ systems in failure at the time of death.  But what about when someone blows himself to bits, what then?  I chose sudden cardiac death, which at least on some level seemed to fit.  I learned later that the correct phrase is total body disruption.  Grisly, in a semi-sterile sounding way.

As I walked out of Mortuary Affairs I wondered about their families.  Were they proud of their sons, their brothers?  Was it worth it?  Where do these bodies go from here?, I asked. The International Red Cross mediates the exchange of bodies apparently.  Or what's left of them.