End-Of-The-Year Craziness

Well, the Holidays are over and I must say that I'm glad. It was tough being away from my family during this time of year. However, it has been an interesting couple of days and I've seen a wide variety of cases. From a trauma standpoint, I've seen a "scalping" injury, another GSW to the abdomen, 2 penile injuries, and what we thought was a landmine injury. I was able to washout and debride the scalp wound, repair the galea, and close it. Actually turned out okay; the surg techs were happy because I let them close the scalp. The patient with the GSW was another lucky individual; you can see the 2 wounds in the photos. I explored him and somehow the bullet missed everything; he only had a small serosal tear in the right colon which we repaired. I'm not sure what the deal is with the penile injuries, but the stories surrounding both of them were "fishy" and I suspect foul play. One patient had a fracture, which I was not comfortable fixing, so I sent him to the local hospital in Kabul. The other patient had a circumferential degloving type of injury that did not involve the corpora. The weather was too bad to send him elsewhere, so I went ahead and repaired it here. It actually turned out pretty well (I'll spare you the pictures for now).

The patient with the supposed landmine injury was an ANP (Afghan National Police) officer who was involved in a TIC (troops in combat) along with some of our Polish colleagues. The medics got a tourniquet on each thigh and both arms, and the medevac here was quite rapid. He arrested shortly before arrival so I performed a thoracotomy but was unable to salvage him. His heart was completely empty when I opened his chest. We learned later, however, that he was actually a Taliban operative disguised in an ANP uniform who blew himself up while trying to set an IED. I'm sure you all have been watching the news and are aware of the recent killings on various FOB's throughout Afghanistan by Taliban disguised as ANA/ANP. We have guys like him all over our FOB, and it does make us nervous at times. It's just so hard to tell who the bad guys are. Fortunately, security here is a bit tighter now in light of recent events.

I was also asked to see a little 8 year old girl with an 18 month history of an enlarging neck mass. This thing is impressive; I've never seen anything quite like it. She has difficulty breathing due to compression of her airway. She also has an enlarged liver and spleen as well as large lymph nodes in her left axilla. I sent her to our military hospital in Bagram but the docs said there was nothing they could offer her. They did do a CT scan and it appears to be a lymphoma, but I still do not have a tissue diagnosis. Her father is desperate for help but doesn't have insurance or enough money to get her to Pakistan or India, and there is no one in Afghanistan qualified to care for her. I'm working with some of my colleagues back home to see if we can get her to Children's Hospital of Pittsburgh as a charitable case; I hope we can swing it. I just feel helpless; all I can offer her right now is a bunch of Jolly Rancher's and some lollipops (she loves them).

On a lighter note, we had a New Year's party with our Polish friends out at the new hospital. It's not yet ready to function as a hospital, but it sure is a nice place to party! We all had a good time. At midnight, they fired off a bunch of flares which really lit up the night sky. I have some pretty cool video of it which I'll share when I get back home. I went to bed around 2 but was still able to wake up in time to skype with my wife and children & catch the arrival of the New Year in the states; pretty cool stuff. I can't believe my 4 oldest kids all made it to midnight! Besides that, we have drifted away from "movie night" and have become addicted to karaoke (SGT Fernandez got a karaoke machine for Christmas). It's a big hit with the FST and the Dustoff (medevac) guys. I've done it a few times, but I'm pretty bad. Guess I'll stick with surgery!