Bombshelter Blues/Bloodbath

04 August 2010

Kandahar, Afghanistan

Heard in the bombshelter yesterday morning: "This makes 51 rocket attacks and two ground attacks!"  There was a tone of excitement in his voice.  He didn't give a time range over which this occurred, but it seems like I've lived through more than 51 of these things.  I am weary of them.  I returned to my book, awaiting instructions from the Great Oz.

I had gotten to the bomb shelter early, having been out on the flightline again, a few yards away.   I had had a few spare hours on my hands before I taking over the ICU for another 24 hour shift.  I was daydreaming about Alexander's initial seige on the Persians a couple millenia ago when the sirens went off.  The cousins of the Persians now attacking us, I thought to myself as I lay on the ground, dust filling my nostrils.  I heard two Shoomp-Shoomps of rockets landing somewhere nearby, and then scurried my ass over to the shelter.

The day had started inauspiciously.  Earlier that morning I had noted that we hadn't had a rocket attack in at least 10 days.  The rumor is that the security forces are finally trying to smoke out the area from which the rockets are launched - brilliant tactic.  Maybe they were finally making a difference, I thought to myself as I headed towards the Kandahar International Airport.  As I finished the last 100 yards of my 30 minute run the sirens had gone off.  I sprinted much faster than I thought I could to the nearest bomb shelter.

The ne'er do wells were out in force yesterday.  Their ground attack was as brazen as it was ludicrous.  From the details that are emerging it seems that at the time of the flightline rocket attack, two of them simultaneously detonated explosives (and themselves) at one of the perimeter gates, paving the way for a tractor which attempted to breech the fence.  Ten other insurgents bum-rushed the gate and were promptly gunned down by a .50 caliber machine gun.  It was a short attack but created the usual mayhem on post.  We were confined to a hardened shelter - the hospital for me.   Great Oz kept barking out non-information updates, most incomprehensible, but we did finally figure that we now could go about our business on base only if dressed in flak and helmets.

I was happy to be on call yesterday.  Going anywhere in flak is so onerous I would rather just stay put.  We had a steady stream of patients throughout the day - only a few injured from the rocket attack, fortunately.  After an eventful night in the ICU which included the small 50% burned child "coding," and being subsequently resuscitated at about 4am.  He had stopped breathing after being overmedicated with narcotics for his burns.   Shortly after wrapping up the code and feeling assured the child was safe, I was paged with word that a patient with traumatic amputations was inbound.

He arrived at 6:15, crazed and yelling that he couldn't breath.  This is odd because if you can yell that you can't breath, you probably don't have an intrinsic lung problem.  It didn't matter, he would soon be sedated and have a breathing tube inserted into his trachea.

He was thrashing around and it was difficult to gain iv access.  I could feel his blood dripping off his macerated right arm onto my shoes.  I looked down, blood was everywhere.  His arm clumsily fell off the gurney by accident, the damaged bones evident by the limp and awkward way it dangled.  I lifted the arm gently back onto the gurney.  More blood.  He was cold, having been in the field a long time and his cold blood was acidic, resulting in problems with coagulation.   Another doc and I attempted to place large bore central lines below his clavicle.  Neither of us were successful.  I finally managed to get one of these lines into his femoral vein, in his groin.  We had been in the trauma bay all of 5 minutes and it looked like a slaughterhouse, blood everywhere.

I spent the next six hours with him, resuscitating him, putting in more lines through which blood, plasma, and platelets could be poured with our Level One, our life-saving blood pump.  We frenetically gave calcium, bicarbonate, vasopressors to increase his blood pressure, warmed saline, and other life-supporting fluids and medications.  We were going backwards, blood dripping onto the diaper-like "chucks" under the patient, and ultimately spilling on the floor.  I eventually made the decision to activate the "walking blood bank" - legions of volunteers of various blood types that could be summoned to donate "whole blood" of the appropriate type which would be pumped into the patient ("whole blood" as opposed to component therapy - packed red blood cells, plasma, and platelets, which occurs 99.9% of the time).  After over 120 units of blood component therapy and over 12 units of fresh whole blood we finally turned the tide, and the parameters of coagulation began to right themselves.  We had transfused many human being's worth of blood to save his life - a veritable bath of blood.